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TLC for your arteries

October 9th, 2013


TLC for your arteries

Ischemic heart disease and coronary heart disease can sometimes be confusing matters, as they share similarities. Ischemic heart disease means some areas of the heart do not get enough blood flow, and it does not necessary mean the blockage is due to narrowed artery. Likewise, a narrowed artery does not always result in not enough blood supply to the heart, ischemic heart disease. However, most of the time, these two buddies come to visit together.

Think of your heart as a water pump that sends blood to every part of your body, and each part’s demand is different depending on what you are doing. If you have just eaten, the blood flows more to the digestive system. When you are stressed out, the brain needs more blood. When you are exercising, the blood flow to your muscles increases. When you are sleeping, the heart gets to rest a little (not entirely, because it still has to beat). It is estimated that in a day, your heart beats around 100,000 times.

Come to think of it, the heart is a very generous organ. It is always working for others and catering to other organs’ needs. If the need for blood increases, the heart has to work harder. Now are you feeling a little more sympathetic for it? Working 24 hours a day for needy bosses isn’t easy!

The heart has three main arteries, called coronary arteries, each about 3 mm in diameter that carry blood to its muscle. Despite the small size, the blood supply to the heart, per minute, is more than any other organ. Such heavy blood flow passing through such small tubes can result in wear and tear of the artery walls.

Many of my patients, upon hearing such a sad story about what the heart has to go through, tell me that they should not exercise in order not to add burden to the hard-working heart. That’s just an excuse for lazy people. It is true that exercise makes the heart work harder, but it also helps strengthen the heart. While you are running or swimming, the rhythmic movements of big muscles allow the heart muscles to work better (more but easier!!!) as well. Regular exercise can train your heart to utilize blood flow efficiently, sort of like a car with low fuel consumption.

But of course, there are many more excuses that I have to try to fight off from my patients when they don’t want to exercise. It’s exhausting! I have no time! It’s raining! The traffic is very bad! It’s hot! And the hardest one to argue with is “I’m lazy!” Read on and maybe I can change your mind.

Let’s get to know the three arteries of the heart better. The first one, the longest, is at the front of the heart, next to another one which is a little to the left towards the back. These two share the same origin, while the third one is on the right, wrapping around the right side of the heart and feeding the right and lower parts of the heart.

Most of us were born with healthy arteries, but as we grow older, around the time we enter our twenties, fat deposits start to build up on the wall. Next, dead cells and plague join the party and eventually the artery can be hardened with calcium.

These build-ups, if left untreated, will continue to worsen like rust on a pipe. Usually, our heart can tolerate mild narrowing, but if the artery is more than 70% narrowed (in diameter), the heart will start to complain when given hard work (but not when its workload is moderate or you are at rest).

Little by little, the build-ups start to clog the artery, and once the artery is more than 70% narrowed, symptoms will start to show. The symptoms include exhaustion, shortness of breath, tightness in the chest and pain in the chest when engaged in heavy activities. The problems usually go away after getting some rest.  We call this tightness feeling in the chest, angina pectoris.

Sometimes the build-ups on the artery start to crack, so the blood flowing through it can be exposed to substances under the build-up, causing blood clot. Our body can naturally solve blood clot on its own, but not every time, especially not if it is a big clot. If the clot cannot be naturally disposed of, it might clog the artery, entirely blocking all blood from getting to the heart. This is what we call a heart attack or acute myocardial infarction (MI).

Heart attack can be prevented by keeping the cholesterol level in check to prevent fat deposit. You can also lower the chance of the build-up cracking by exercising, watching your diet and limiting your sugar intake and stop smoking. Consult your doctor if you need anti-platelet medicine, like aspirin and Clopidogrel.

Speaking of using aspirin to prevent heart attack, my patient, in his sixties, told me he felt pain in his jaws after every meal, especially when walking after the meal (which I did not recommend). After examination, it was found that he had narrowed artery and he was treated with balloon angioplasty and stent placement. He went back to playing tennis and exercising as usual. However, I told him that he needed to take aspirin to prevent blood clot and acute blockage.

He came back to see me about half a year later, and I asked to see his medicine. Strangely, aspirin wasn’t one of them. He confessed that he had taken aspirin for a few months and it hurt his stomach, so he switched to paracetamol, assuming I had prescribed aspirin to reduce the pain in his jaws. It was my turn to feel the pain in my jaws, as they had dropped to the ground after hearing what he said.

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.



Life really is a bowl of cherries
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The old and the new

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