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This Heart Month, make sure your heart is in tip-top shape.

by Ivan Olegario, M.D.


When it comes to hearts, the first thing that comes to mind is love. But we often overlook their main function—to sustain life. While February is often touted as the month of hearts, the truth is that the spotlight should be on cardiac care every day of every month.

According to Department of Health statistics, heart disease remains the leading cause of deaths among Filipinos. The most common is coronary artery disease (CAD), which can lead to a heart attack. A heart attack occurs when the blood supply to heart muscles gets blocked, most often by blood clots blocking the coronary arteries, or blood vessels that feed the heart muscles. Starved of precious nutrients, the affected heart muscles die.

Attack awareness

Marcellus Francis Ramirez, M.D., a cardiologist at the University of Santo Tomas and Medical City, says chest pain—usually a squeezing sensation or a heavy pressure on the chest—is the most common symptom of a heart attack. The Philippine Heart Association Clinical Practice Guidelines for the Management of Coronary Artery Disease also describes it as “viselike,” “constricting,” “suffocating,” and “crushing.”

Dr. Ramirez cautions about the deceiving nature of the symptom, saying it can manifest as “a simple gnawing sensation or discomfort—and as a result, [patients] ignore the pain until [it] becomes intolerable. By then, it may already be too late.” He adds, “Surprisingly, a significant number of heart attacks will have no symptoms, or show atypical symptoms such as breathlessness, excessive sweating, weakness, lightheadedness, nausea, vomiting or palpitations ... [as] frequently observed in women and older patients.”

A heart attack can be deadly, and if the patient survives, he or she may suffer from different complications, such as heart failure, wherein the damaged heart can no longer pump enough blood to the body. Heart attack victims are also at higher risk of getting a second attack. This is why, as with most catastrophic diseases, heart disease is best prevented—by lowering your risk.

Risk recognition

The Philippine Heart Association’s Clinical Practice Guidelines for the Management of Dyslipidemia enumerates a risk stratification that assigns a person’s risk as either low or high, based on the following risk factors:

• high blood pressure (blood pressure of 140/90, or higher);

• familiar hypercholesterolemia (a genetic disease causing high blood cholesterol levels);

• left ventricular hypertrophy (enlargement of the left lower chamber of the heart);

• smoking;

• family history of premature CAD (CAD among those younger than 40 years of age);

• gender (males generally more at risk; female risk increases after menopause);

• age greater than 55;

• proteinuria (protein in the urine) or albuminuria (albumin in the urine), measured through a urine examination; and

• Body Mass Index (BMI, or weight in kilograms divided by the square of the height in meters) of at least 25.

A person with at least three of these risk factors is considered high risk. In addition, Dr. Ramirez highlights that any person with diabetes should be considered high risk as well.

The European Society of Cardiology developed HeartScore (Heart Systematic Coronary Risk Evaluation), an interactive tool available online for predicting the risk of heart attack in patients. It assigns a score from zero to 47, based on the patient’s gender, age, smoking status and blood cholesterol levels, to reflect the probability of having a heart attack in the next 10 years. In general, men, old age, smokers, and high cholesterol are associated with a higher risk.

Proactive prevention

Knowing your risk enables you to lower it by eliminating factors that you can modify. While you cannot change your gender, age, family history and genetics, you can control your blood pressure, smoking status and weight. Even low risk patients “should avoid cigarette smoking, [they should] exercise, and maintain a healthy blood pressure and BMI,” advises Dr. Ramirez. “A [lifelong] low-salt, low-fat, low-cholesterol diet that is rich in fiber and omega-3 fatty acids … is essential in lowering your heart risk.”

When it comes to the heart, no chances should be taken. For those with high risk, Dr. Ramirez says the first step is to visit your doctor, who can advise you on the right tests to undergo. The most straightforward test is a blood test called a lipid profile, which measures the levels of fat in your blood. (See our related article on triglycerides and the lipid profile, page __.)

Depending on the findings from your history and physical examination, your doctor may also recommend other tests. These may include a 12-lead electrocardiogram, a chest x-ray, an echocardiogram, a treadmill exercise test, or heart imaging tests.

Your doctor may also prescribe medications, if needed, to help you lower your cholesterol, blood pressure and weight. Most of these medications require the supervision of a physician.

To know more about what you can do to lower your heart attack risk, get a copy of the February issue of HealthToday magazine, out now in major newsstands and bookstores.

are you at risk of heart attack

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