Ischemic heart disease and coronary heart disease are sometimes confused because the two conditions share similarities. The first term is used to describe a situation whereby there is insufficient blood flow to some areas of the heart; it does not necessarily mean there is a blockage.
Likewise, the narrowing of arteries _ a characteristic of coronary heart disease_does not always result in a reduction of blood supply to the heart. However, most of the time, these two "buddies" come visiting together.
Think of your heart as a water pump that sends blood to every part of your body. The needs of each part of your body varies depending on what you are doing at a specific time. If you have just eaten, more blood flows to your digestive system. When you are stressed out, the brain needs more blood. When you are exercising, there is an increase of blood flow to the muscles you are using most.
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 single 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, always catering to the needs of other organs. If the demand 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 a needy boss is far from easy!
The heart has three main arteries _ called coronary arteries, each about 3mm in diameter _ that carry blood to the muscles of the heart. Despite their small size, the amount of blood they carry, per minute, is more than that supplied to any other organ in the body. Such heavy blood flow passing through such small tubes can result in wear and tear of the artery walls. Many of my patients, after hearing this "sad" story about the trials that the heart has to go through on a daily basis, suggest to me that they should probably give up exercising so as not to increase the burden on their hard-working heart. But that, of course, is simply justification for being lazy!
Exercise makes the heart work harder, that's true, but it also helps to strengthen the heart. While you're running or swimming, the rhythmic movements of big muscles allow the heart muscles to work better (more but easier!) as well.
Regular exercise can also train your heart to utilise blood more efficiently, sort of like a car with low fuel consumption.
Other excuses that I have to regularly fend off _ all from patients of mine when they don't want to exercise _ include: It's exhausting! I have no time! It's raining! The traffic is very bad! It's hot!
But 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-hand 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 20s, fat deposits start to build up on the internal walls of our arteries. Next, dead cells and plaque join the party and eventually the artery can become 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 one engages in heavy activities. The problems usually go away after one gets some rest. Angina pectoris is what we doctors call this feeling of tightness in the chest.
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 clots. Our body can usually deal with blood clots on its own, but not every time, and especially not if it's 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 attacks can be prevented by keeping one's cholesterol level in check in order to prevent fat deposits. You can also lower the chances of the build-up cracking by exercising, watching your diet, limiting your sugar intake and giving up smoking. Consult your doctor if you need anti-platelet medicine, like aspirin and Clopidogrel.
Speaking of using aspirin to prevent heart attack: a patient of mine, who's in his 60s, told me he felt pain in his jaws after every meal, especially while out for a walk after eating (something I did not recommend).
After examination, it was found that he had a 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 clots and acute blockages.
He came back to see me about six months later and I asked to see what medication he was taking. Strangely, aspirin wasn't one of them. He confessed that he had taken aspirin for the first few months, but that it had caused stomach pain, so he switched to paracetamol, assuming I had prescribed aspirin to reduce the pain in his jaws. Then it was my turn to feel pain in my jaws, when they dropped to the ground after hearing what he had said!
Dr Nithi Mahanonda is a consultant cardiologist and interventionist at Perfect Heart Institute, Piyavate Hospital. Visit www.drnithi.com.