News for the management of heart disease.jpg

News for the management of heart disease

Dear Reader,

HEART DISEASE causes the majority of deaths in the developed world. The biggest killer is the heart attack, also called myocardial infarction. The myocardium is the specific muscle of the heart, while infarction means the destruction of tissue due to a lack of oxygen and blood supply.

A heart attack is caused by a blockage of an artery supplying the heart muscle with nutrition. This blockage develops over many years through furring of the arteries, and the last event to cause the attack is often a blood clot mixed with other substances.

Fifty per cent of people who suffer a heart attack report that they had never experienced symptoms like angina or shortness of breath. Therefore, you can imagine that it is difficult for your GP to ascertain whether you have a heart problem during a health check. However, I would like to inform you about exciting new technology for the prevention and treatment of heart problems.

As you can guess from the above, the good old ECG is not at all sufficient when it comes to really establishing the facts about your heart. It is a basic test that must be done and you can only be submitted to further, more stressful tests, if it is normal.

In the olden days, the stress test and the heart ultrasound were about all one could do to check the condition of the heart. Only 20 years ago, angiograms were major undertakings. In the last few years, ultrasound of the heart has become more and more sophisticated and is now available in 3D. The recorded three-dimensional pictures are very impressive and even small details are visible.

Total body scan is now a buzzword and the CT scan’s thin slice technique can measure calcium density in the coronary arteries – the more calcium the greater the chance that the arteries are narrowing. These tests have been done in the US for more than 10 years already, but, in the beginning, it was difficult to tell if the calcium was inside or outside the actual blood vessel.

If still wanting to avoid an angiogram, then a myocardial scintigram is a valid option. A small amount of radioactive fluid is injected in a vein and the uptake of the substance in the heart muscle is recorded by a scanner (gama-camera).

However, the gold standard test is still the angiogram or heart catheter. A tube is inserted through the artery of the leg or arm and is directed to the origin of the coronary arteries. Then, contrast fluid is injected while the heart is X-rayed under a digital image intensifier. The examiner can then see how the heart contracts and if there are scars. The blood flow through the arteries is visible and blockages can be located.

If your cardiologist is an interventional cardiologist, he/she will have been trained to treat narrow coronary arteries with balloons and stents. A stent is like a bridging tube through a narrow passage of the coronary or other arteries. These stents themselves could become quite blocked, so the latest generation is now coated with a substance like Teflon and, therefore, it is much more difficult for blood and cholesterol to block them.

These stents can give the same result as a bypass, providing they are used for the right patient with the right technique. Once the stent is in, the patient needs to keep his/her blood thin with aspirin and Clopidogrel.

You need to enjoy decent earnings to be able to afford one, as the cost for the procedure and material is between 3,000 and 10,000 euros. However, this is still a lot cheaper than paying for a bypass operation.

Taking the costs into account, prevention sounds much sweeter than before. For 10,000 euros, you can work with a personal trainer three times a week for three years. I am sure this training would be as effective as a stent for the health of your heart.

Prevention is better than cure

When you go for a check-up next time, insist that your doctor also tests you for Homocystein and LP(a). These two substances, like cholesterol and smoking, are risk factors for the heart. Folic acid helps to ensure Homocystein is raised. You should also be grateful if your doctor measures your abdominal circumference, even if it feels a bit embarrassing. The typical beer belly physique is far more likely to suffer heart problems than body shapes that have fat spread diffusely.

In the Algarve, there are two units where all this new technology is available. Faro Hospital now has a very well equipped cardiology unit. The first cardiac intervention unit in the Algarve was founded by Professor José Batista, who has been working hard for the local population for three years from the Hospital Particular in Alvor. He is now also giving consultations at the Vale do Lobo Medical Centre on Fridays. Both Faro Hospital and Alvor Hospital Particular carry out stents and balloon dilatations.

Time is crucial for heart problems

The doctors from INEM (Instituto Nacional de Emergência Médica) are now very quick to respond to an emergency call and often arrive at the scene within minutes after the phone call. That is great progress and very reassuring to know. The number to dial in any emergency is 112.

With very best wishes


Dr Thomas Kaiser

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