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Listen to Your Pulse

September 3rd, 2014

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The heart and the head are two entirely different organs yet they are closely related. If the heart is art, the head is science, and we certainly cannot have one without the other. Medical studies have shown that a human brain has two sides. The right side controls artistic and intuitive thinking, while the left side presides over the scientifically rational and logical processes. The heart supplies the entire body, and one of the most demanding organs is the brain inside the human head. Without the heart, the head cannot function at all. In turn, the brain controls the heart through its nervous system.

The nervous system generates two types of impulse and sends them through the heart, one causing it to beat fast, the other to beat slowly. These two must be in sync or else they might cause irregular heartbeat problems.

To raise an example, about ten years ago, there was a thirty-something female patient who walked into the examining room, her eyes locked on the floor. She sat down and just remained silent. I introduced myself and asked how I might be able to help her. Her eyes not leaving the floor, she told me she was possibly neurotic and that her heart shook. The symptom had been going on for six or seven years already, she said. I could not help wondering why she just came to see a doctor about it then.

As soon as I asked her that, she met my eyes and said she had seen other doctors before she came to see me. Five other doctors told her that the feeling of shakiness was not because of her heart, but it was because of her head. It was her own imagination, they all said. After those doctors had done several check-ups, her heart seemed fine. She started to feel afraid of people and lost sleep as well.

I thought confidently that she had emotional problems, but however, I told her I would need a physical check-up to make sure. While she was lying on the bed (I have a confession to make – I am a big Chinese movie fan and I have always wanted to be one of those ancient doctors who could tell everything from pulse palpation!), I felt her pulse and felt that her pulse was irregular. I asked my assistant to measure her heart activity. Everything seemed just fine, except for her pulse which beat 150 a minute even when she was lying perfectly still.

I could not be sure because the heart activity measurement results and the pulse seemed to contradict with each other. Just to be on the safe side, I asked my assistant to perform the EKG test (a diagnostic test that analyzes the electrical activity of the heart). The EKG results were shocking – it appeared as if her heart was being electrocuted.

I told her that her mind did not have any problem – it was her heart that had a problem. Her eyes, which had been locked on the floor most of the time, looked up at me and she asked me to help. There was confidence and hope in her voice. I referred her to a heart’s electrical system expert.

I learned that sometimes it is not enough to listen to the heart – we should listen to what the pulse has to say too. There is no medical evidence that emotions directly affect physical health, but ideally, the two should be kept in balance. Keep your head happy and your heart healthy – that is the best way to take care of your body.

Reality Check

Heart diseases are among the most common as well as most discussed diseases of all. Cardiologists always say that when it comes to heart diseases, prevention is better than cure, and early detection can curb the risks. Well, sometimes a threat works better than a kind word, so they might also have to point out that some heart disease may come with no visible warning signs. Like any other diseases, heart diseases are often curable when detected early, so it is highly encouraged for people, healthy or not, to have a regular heart check up to see if they are at risk for having heart diseases or not. Some deadly diseases – like kidney disease and cancer – are completely silent, but once the symptoms start to show, it might be too late already.

Doctors always say that early detection makes the disease easier to cure, but in fact, some diseases are not at all curable, so sometimes the advice sounds more like an excuse for not being to treat them.

Annual health check-up is a new service designed to detect the earliest signs of these fatal diseases. Both private and public health institutes try to convince the general public (as in potential customers), both healthy and almost healthy people alike, to have a health check up annually. Most government and private organizations offer this benefit as a gift of health to the employees.

I always tell everyone to check their health on a regular basis, so I am often asked whether the cost of the annual health check up is worth it. This is a tough question because one person’s definition of “worth it” might be different from others’. For example, when a man is trying to win a woman’s heart, no bouquet can ever be too expensive if it means the girl of his dream would accept it and give him a chance. Quite contrastingly, most guys (myself excluded) who have been married for years would consider the act of offering their wife a glass of water “not worth it” because not only might she not say “thank you,” but she might also say that she hadn’t asked for it in the first place. Well, that’s certainly not worth it!

Medically speaking, there are four factors to consider:

  1. How big are the risks for you?
  2. How much does the check up cost?
  3. Are the procedures reliable and precise?
  4. Are there proper treatments should it be found that something is wrong?

First of all, speaking of the risks, it varies from one person to one person. For instance, a person would be at greater risk for having heart disease if he or she smokes, has high blood pressure, diabetes, high cholesterol or has heart disease in the family. A yearly check up could help detect early signs of the disease and treatments are easier at that stage. If the cost is not obscenely high (those who end up finding nothing wrong at all might see it as a waste of money) and if the procedures are not too invasive (like a procedure that is a matter of life and death), I don’t see why you should say no to it.

To give an example, an 18-year-old girl with no visible signs of heart disease who doesn’t smoke, has no heart disease in the family, doesn’t have diabetes, high blood pressure of high cholesterol does not have to undergo ECG testing to see if she has Coronary Artery Disease. It is true that the ECG test is not that expensive and non-invasive, but it is not going to be worth it because the chance of her having this disease is virtually zero. Now, another example. A 6-year-old man who smokes regularly and has high blood pressure as well as diabetes should definitely undergo ECG testing because it is likely for him to be at risk.

The same rule applies to other diseases such as breast cancer, cervical cancer, lung cancer and liver cancer. Those who are considering annual health check up should calculate their own risk factors first and find a program that suits them and their health concerns best, not just general health check up. Another thing to keep in mind is whether you are ready to hear the results if something is wrong. The other day, I met a 40-year-old female patient who appeared healthy. She loved food and was a bit overweight. She had her health checked up as her employee perks and it was found that her cholesterol level was high. After a short conversation with her, I told her that she should cut back on fat from animals such as pork, beef, duck skin, chicken skin, yolk, coconut milk, dairy products and all types of fried food (to sum it all up, she must give up delicious food!) and exercise at least 4 times a week, 20-30 minutes each. This is what I always tell people in general to do anyway.

Two months later, because she was concerned about her health, she came back for another blood test. Surprisingly, her cholesterol level was even higher and she had gained 2 kilograms. She admitted that she hadn’t been able to do as I had said. I decided to let her know this magic ideal for patients who want to lower the cholesterol level and lose weight… and that is to stop measuring. That way even if she gained weight or if her cholesterol skyrocketed, she wouldn’t know!!!

I have another story about annual health check up to tell. There is this doctor friend of mine who was living abroad. He took a very good care of himself – jogging every day, steering clear of greasy food and checking his cholesterol level yearly. He sometimes did a heart check on a treadmill as well, and as far as he knew, there was nothing wrong with his heart.

Then one day, only 2 days after his annual check up, he fell sick. What seemed like a usual cold extended longer than usual so he had a blood test. He found out that he had leukemia and passed away from that disease soon after. This goes to show that even annual health check ups can’t detect everything.

If you want to do an annual health check up, you should look for one in which you get to see the doctor and have enough time to ask him or her any questions that are bothering you. That is how you make the most our of an annual health check up and make it “worth it”.

Fast, But Not Furious 

While doctors are no fortunetellers, sometimes the boundaries are crossed. More than often, doctors have to answer the all-important question: “Am I going to die, Doc?” Medically speaking, based on the doctor’s years of clinical experience, the truthful and honest answer would be “Of course!” but then again, upon hearing the answer, the patient’s death might come too soon (as in right there, right then, due to the major shock). Or if that truthful answer doesn’t shock the daylights out of the patient, it is very unlikely that he or she will ever show up at the doctor’s next appointment… or ever again.

Years of dealing with critical patients would definitely teach doctors to adopt soothsayer’s skills. The milder version of the answer could be, “Everyone is going to die some day. It is only a matter of when and how.” Now that sounds like a monk talking, but believe it or not, this actually helps prolong the patient’s hope as well as life. Doesn’t everyone want consolation? Sure enough, and that’s what keeps the patient coming back to the doctor just so he or she can hear those comforting words again. Now, the patient might ask, “So, when and how will I die?” That’s a tricky question indeed. It is now turn for the doctor-meet-soothsayer to cite statistics and possibilities before saying something like, “There is xx percent of chance that patients suffering from this disease might pass away in a year or five years, depending on the complications of the case.”

Medical statistics are derived from doctors’ observations on tens of thousands of patients over the years. Information on what happens to the patients and how long they can live is collected from patients who suffer the same type of disease. In a way, it sounds like astrology and the five elements theory, doesn’t it?

Recently, there was this man who was brought (well, carried) to the hospital. He was in his early fifties and it was reported that as he was stuck on the road in horrendous traffic, he suddenly felt tightness in his chest for 10-15 minutes, out of outrageous anger, when a motorcycle hit his car’s right side mirror. Before he could get a grip, the motorcycle had already fled the scene.

Being a short-tempered person, he opened the door and started racing after the motorcycle, but as soon as he started, he felt a sharp stab of pain in his chest. He had to come sit in his car for a while, but the pain didn’t seem to go away. He and his wife decided it would be best to seek medical help so they went to the hospital on that very same road. As soon as he arrived in the emergency room, he became unconscious. The hospital’s medical team tried to help him by giving him chest compressions. The ECG indicated that the electrical activity of his heart was not normal. Electrical shock and chest compressions were performed for half an hour until normal heartbeat and circulation were restored. He was, however, still unconscious and survived on assist ventilation, so I was summoned urgently.

The moment I saw this patient, my brain which had absorbed medical expertise (and soothsaying skills) automatically told me that this patient suffered from Acute Myocardial Infarction that was a result from clogged arteries. The reason behind my presumption was the fact that he was obese – I would say he weighed some 110 kilograms. Plus, there was a pack of fine, imported cigarettes stuck in his pocket, and his left-hand fingers had yellow nicotine stains on them.

As I was mentally analyzing him, the ER nurse informed me that his blood pressure was 50/40 mmHg, and his pulse 60. His heartbeat stopped from time to time and two electrical shocks had been performed. I immediately told the medical team to send the patient to the Cardiac Catheterization Laboratory to unblock the clogged arteries. Ten minutes later, he was in there, all in place and ready on the bed.

An arteriogram was performed on the patient, and it was later found that the arteries in the front of the heart were clogged with blood clot so we had to keep his artery open. During that time, his heart stopped beating several times, so constant chest compressions were called for. We worked rigorously for two whole hours and finally his blood pressure improved little by little, and his artery unclogged. Once his blood could flow freely like a river, I transferred him back to the CCU. At the time he was leaving the Cardiac Catheterization Laboratory, his blood pressure was 110/80 mmHg and his pulse was at the healthy 90 beats/minute rate. He still needed the assist ventilation and was still unconscious.

As soon as I finished giving orders to the nurse, I went home for a long rest I think I deserved. The next day, I went to check up on the patient again. The nurse told me that everything was fine, his blood pressure in the morning was 130/80 mmHg and his pulse a steady 70beats/minute. His eyes were open, and he was conscious. He could sometimes breathe on his own but he still needed the assist ventilation. I asked the nurse to remove the assist ventilation and keep a close eye on him to see if he would be all right without it. After that, I left to see other patients. (I still had not met his relatives for it was too early at that time.)

In the evening, I came back to see him again. The moment the CCU door swung open, I was pleasantly surprised to see that the patient was sitting right up there as his beautiful wife fed him and his adorable children playing near the bed next to two aged lady and gentleman who were presumably his parents. I felt a surge of pride that my profession (that was so brain-crushing it almost squeezed the life out of me) could indeed save lives.

What I saw the night before was a patient whose blood pressure and pulse were critical, his heart rate unreassuring, his brain unconscious and his breath maintained only by assist ventilation. Miraculously, he was back to life overnight. We doctors can bring a husband back to his wife, a father back to his children, and a child back to his parents. At the same time, on the next bed, a patient of the same age suffered from the same symptom (tightened chest) but this other patient was sent to the hospital 10 hours after he’d felt the pain. He was found lying unconscious on the floor by his relative. It is true that the medical team could save his life, but his heart only functioned at about 30% capacity only. Nobody knew how long the blood supply to his brain had disturbed. He was lying on the bed next to the first patient, but unlike the first patient, he couldn’t open his eyes to see his wife and kids who were waiting for him patiently.

The first patient recovered very quickly so he was discharged home after only 5-6 days. Before he left, he asked, “Will this happen again?” so I answered both as a doctor and as a soothsayer that there was as much chance for this to happen to him as there was to me provided that we were about the same age. If he was careful and tried to avoid risk factors, it would help. I gave him advice such as to exercise, try to lose weight, cut back on greasy (which means yummy) food and drink lots of water. I told him that the reason he was standing right there with his family was because he had made the decision to come to the hospital soon enough. The most important thing about treating heart diseases is to be as fast as possible, and as ready as possible, too.

I also suggested he think about the prevention and cure should this same situation arise again whether at home or at work. He should be aware which hospital is the nearest to where he was, and if possible, he should also check those places out to see if they were equipped enough to give him immediate and effective medical assistance. This means a team of specialized heart experts. Let me repeat this one more time, the most important thing is to be fast and ready.

Even if you have a family doctor, do not waste time by trying to track him down in case of emergency or if anything dangerous happens. Go to the nearest hospital that you have already studied, and that should significantly increase the chance of your own survival… just like this lucky man.

Women’s Heart Is Complicated

Women. It’s impossible to understand them. To satisfy their heart is extremely difficult, but to treat their heart is even more so!

According to the statistics in the United States, one out of two women dies from heart disease. That makes heart disease the number one cause of mortality in women, killing more women than breast cancer and cervical cancer. Heart disease is not, as many would believe, men’s disease. Formerly, it was perceived that coronary heart disease was not associated with women because of the misconception that the feminine hormones could help prevent heart diseases.

The truth is women stand somewhat less chance than men of having coronary artery disease, but that’s only during the first 50 years of their lives. After that, the chance increases, and eventually both sexes will stand almost as much chance as each other of experiencing it. What’s more, medical researches have shown that women’s heart is more complicated than men’s and this leads to confusion and complexity. Diagnosing and treating coronary artery disease in women show less clear results compared to those in men.

Why oh why do women have to be so hard to understand? And I’m not just saying that medically.

For example, chest tightness is a vital sign of coronary artery disease (well, in fact, only 50% of coronary artery disease patients experience chest tightness, but still) and in men, the tightness is felt in the middle left chest area when the muscles are worked such as during exercise or a quick walk uphill. From this sign, doctors can usually tell that coronary artery disease and myocardial infarction are the suspect since this is one of the classic symptoms.

How I just wish it would be as obvious in women! Chest tightness that is a symptom of coronary artery disease in women is not felt only in the middle of the chest. Other symptoms also show up, including sharp pain, neck ache, shoulder ache, nausea, vomiting and fatigue. These symptoms are not necessarily associated with coronary artery disease so doctors are often mistake by the symptoms.

See? Women’s heart is really difficult to understand!

When women with heart disease come to see the doctor, it is often found that the risk factors are greater than those in men. And the worse part is they only decide to seek medical advice when their heart is already in critical condition, or in other words, when it’s too late.

Worse still, the results of special heart tests such as treadmill testing are not as accurate in women as they are in men.

Women with heart disease have higher tendency to lose their lives than men. This could be because of the complexity in diagnosis, the different level of effectiveness in the treatment, and other factors.

Women and men respond differently to medical treatments – that is to say treatments show better results in men than in women. Ladies, I think it’s now time you started taking care of your own heart!

There is this research from a Western country that studied how women prioritize their daily routines. The first priority for women is their children. House chores comes second, career comes third and, believe it or not, pets comes fourth! Quite discouragingly, husband comes fifth, even after those pets. And the last thing they care about is exactly why I am telling you about this study – women care about themselves last.

This research supports the fact that women increasingly experience heart disease because they choose to care about other things before themselves. (I’m still not over the fact that husband is less important than pets… My sympathy goes to my fellow men with lots of pets at home!) However, it does not say what men prioritize, but I would assume things are prioritized differently.

Ladies, you should indeed pay more attention to your health, both physical and mental, because health contributes largely to doing well in other aspects like career growth. Basically, start with estimating your risks of heart disease. If you are over 55  years old, have heart disease in the family, have diabetes, high blood pressure, high cholesterol level, are overweight and do not exercise regularly, you are at risk, and should seek medical advice as soon as possible to prevent serious illness that might endanger your fragile heart. Oh, and don’t forget to care of the heart of your loved ones… I mean your pets’.

Coronary artery disease is preventable and curable if found at an early stage. It is never too soon to take care of your heart. With a healthy heart, you can stay with your loved ones (you know what I mean) for as long as you shall live.

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

 

Reference : http://www.rbsc.org

 

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