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08 - 14 Sept, 2012
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INTERVIEW
Heart Talk
Shireen Anwer – The Kitchen Queenby WAJIHA JAWAID

Dr. Sadia Arshad is a Consultant Cardiologist and a senior instructor at the Aga Khan University Hospital. After completing her MBBS from Baqai Medical College, Karachi in 1999, she joined Aga Khan University (AKU) as an intern. In 2002, she joined the residency program in internal medicine at AKU and later did her residency in adult cardiology. During her residency in medicine, she got enrolled in the Masters in Clinical Research Program and graduated from that in 2011. In an interview with MAG she talked about the treatment of common cardiac problems prevailing in our country. Excerpts:

In our society, gynaecology is the first preference for most female doctors. What led you to pursue a career in cardiology?
I believe one should always pick a profession in which he/she is more interested. One should never choose a profession just to join the rat race. Right from the beginning, I knew that cardiology would be a career choice for me.

What are the common heart diseases found in our country?
The most common heart diseases are cardiovascular that are usually caused by hypertension and atherosclerosis. Other commonly found heart disease includes valvular diseases which are characterised by damage or a defect in one of the four heart valves. Congenital heart defects such as hole in heart is also a serious problem in our country.

What causes cardiovascular disease?
The major risk factors include high blood pressure (hypertension), atherosclerosis or high cholesterol, obesity, physical inactivity, unhealthy diets and diabetes. Sometimes people have a family history of heart disease but they don't give it much importance and later on develop many complications because of it. Cardiovascular diseases are preventable if all the risk factors are evaluated at an early stage.

What does high blood pressure and high cholesterol have to do with heart disease?
High blood pressure puts stress on the heart forcing it to work harder leading to a serious heart problem. Due to high BP one may also suffer from other health complications such as kidney diseases and stroke.
Atherosclerosis or high cholesterol is a condition in which the excess cholesterol settles on the inner walls of blood vessels. This cholesterol deposition narrows down the blood vessels and promotes blood clots which eventually slows down or even halts the flow of blood passing through the vessels.

Can you talk about the role of sugar and refined carbohydrates in cardiovascular health?
Excessive consumption of sugar and refined carbohydrates can ruin a person's health. Unfortunately, the population in the subcontinent have comparatively smaller coronary arteries which automatically increase their risk of diabetes. Moreover, our diet is also mostly comprised of oily foods and refined carbohydrates so there are more chances to develop diabetes.

What are the symptoms of cardiovascular diseases?
If a person has chest discomfort while walking, climbing stairs or if he faces difficulty in breathing while performing daily chores then it means that he is at the risk of heart diseases. However, in women, the symptoms may not be the same and they may complain of unusual fatigue, sleep disturbance, shortness of breath, indigestion and anxiety. There are chances that her family members may not take her seriously. She is even not aware of the severity of her own condition and cannot even describe her state to a doctor in a typical manner.

Is it true that heart diseases are more common in men than women?
It is a misconception. In fact more women have died of heart diseases than breast cancer. At a young age, women have a protective effect of hormones that save them from heart diseases. Once they reach the menopause stage their chances of acquiring heart diseases increases.

Could you please elaborate how the chances of cardiovascular diseases increase after menopause?
Once a woman reaches menopause the protective effects of hormones becomes less efficient putting her at a risk of heart disease. Unfortunately, in our society exercise is not a part of daily routine for most of the women and they do not consume healthy food. So, to avoid health complications after menopause, it is wise to bring healthy changes in lifestyle.

Does taking birth control pills increase the risk of heart diseases?
The use of birth control pills leads to blood clotting in various systems such as clotting in legs and lungs but generally it doesn't lead to heart problems.

What should women do to reduce this risk?
They have to be physically more active. To remain healthy, it is recommended to walk thousand steps a day. In our society, working out or being a sports person is considered less acceptable for women. Once they cross their mid-twenties it is better for them to exercise daily for atleast 45 minutes to an hour. They can go for a brisk walk, use the treadmill or can go for swimming. Yoga and aerobic exercises are also some good options.

How are cardiovascular diseases treated through medication or hormone replacement therapy?
Cardiovascular diseases may be present in different forms, some patients come to me with chest pains and exertions while there are many who approach me after a serious heart problem such as heart attack so the treatment is different at every level. But generally when people have heart attack, I prescribe medication that prevent blood cells from sticking together, relieve their pain and control their anxiety. Sometimes oxygen is also given to make them breathe better. The blockage in blood vessels can also be treated mechanically through angiography and angioplasty. Sometimes when the disease is very advanced then we proceed to surgical methods. As far as hormone replacement therapy is concerned, in some cases it is found helpful in delaying the onset of disease.

What is the difference between heart attack and heart failure?

The main function of heart is to pump blood, but it also needs some of that blood to nourish its own valves. Heart attack occurs when blood supply to the heart muscles suddenly stops and it doesn't get the blood to perform its normal functions. It happens when one of the heart's own blood vessels get blocked. The severity of the heart attack depends on how big a blood vessel is blocked. Heart failure is a condition in which the heart can no longer pump enough blood to the rest of the body. Heart attack may be one of the causes of heart failure.

What should a person do if he/she sees someone having a heart attack?
For a layman, it would be hard to diagnose and treat heart patients. I think the only thing anyone can do is to make the patient more comfortable and call for an ambulance.

What effects does stress have on the heart?
When a person experiences stress, a lot of hormonal changes happen in his body which help him deal with that response and at the same time causing inflammation throughout the body. Prolonged inflammation causes ruptures of unstable plaques (fat deposits) making stress a risk factor for heart disease.

How can a mother know that her newborn baby has a serious heart problem?
If the baby turns blue, sweats and shows uncomfortable signs while feeding then a mother can get the idea that something is wrong with her baby's health. It is better to take the baby to a paediatrician for a complete medical check-up.

What does it mean to have a hole in the heart?
It is a congenital (hereditary) heart defect. This defect creates problems in the normal flow of blood through the heart. When some tissues grow in that hole, it closes up on its own. But unfortunately in some children that doesn't happen. Take your child to a heart specialist if he unable to run and play, gets breathless quickly or turns blue and tires when trying to do little activity. Normally it is treated through a surgery.

What are the most important lifestyle choices one can make to keep heart healthy?
To keep your heart healthy, try to eat balanced diet. Avoid fatty foods and try to limit the oil intake. There are a lot of healthy cooking techniques available to make the menu delicious as well as healthy, such as baking, grilling and steaming. You can have red meat once in a while. Increase the consumption of vegetables, fruits, pulses and chicken. You can also consume fish as it has good fats. Try to exercise atleast 45 minutes five times a day.

Any message you would like to give related to heart problems?
If you have a chest discomfort always think about getting your heart evaluated by a doctor as a simple chest pain could be the cause of death. Most youngsters have chest discomfort at night which they assume is due to the biryani they ate. They spend whole night treating it by consuming soda drinks or opting for some desi totka. But unfortunately, by the time they come to us a lot of damage has already been done. Always remember that early diagnosis is the key to the prevention of heart problem.


 
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