The silent heart epidemic we’re not ready to handle

Mondays are a busy day for most hospital emergency rooms, with young men seeking care for non-specific complaints, in an effort to squeeze a sick note out of the doctor, so that they can go home and nurse the weekend hangover.

When Kenny walked into the accident and emergency department on Monday morning, he could easily have been lumped into the category of men seeking an excuse not to go to work, but he appeared quite alert and didn’t have any alcohol breathe.

He had experienced chest discomfort that disturbed his sleep at night, but he didn’t think it warranted a check-up. His wife prevailed upon him to pass by the hospital for a quick review on his way to the office. Knowing that she wouldn’t let him rest until he had been examined, he opted to attend the 8am strategy meeting at work before going to hospital.

The doctor who reviewed him found a healthy 38-year-old who was mildly overweight, with borderline high blood pressure, but who otherwise appeared healthy. He made a tentative diagnosis of upper oesophageal reflux disease. However, he took the cautious path and ordered for an electrocardiogram of Kenny’s heart and blood samples to check his cardiac enzymes.

Kenny walked back to the office to get some work done while waiting for his results from the lab.

Forty-five minutes later as the doctor walked to the tea room for a break, the nurse beckoned him to the phone. The lab technologist was breathless. He could not believe the results because Kenny had walked to the lab, yet his enzymes were hitting the roof. Kenny was having a heart attack!

The doctor quickly called Kenny and was relieved to hear him respond to the call in person.

He ordered him not to leave his desk as the hospital dispatched an ambulance to collect him from the office.

Kenny protested while being wheeled to the high dependency unit. He could not comprehend how close he was to death, yet he felt just fine. His wife was overwhelmed.

Kenny was the talk of the doctors’ tea room for days. He was a classic case of a near miss.

OVERT RISK FACTORS

He did not exhibit any overt risk factors for a heart attack yet here he was, hooked onto monitors, wondering what would become of him.

He mostly ate right, drank little, worked out at least three times a week and preferred to walk instead of driving, whenever he could. Yet here he was, sharing a room with people who looked like they needed to be in the HDU, when he clearly felt it was a case of mistaken identity.

Multiple blood tests showed a rise then a steady decline of his enzymes as he responded to treatment. His wife could not understand why Kenny would have a heart attack; she underestimated the power of genetics.

Heart attacks have a demonstrated a strong familial tendency. This means that people who have lost family members to heart attacks have an increased risk of getting heart attacks themselves. Throw in high blood pressure, high cholesterol and smoking and you have a perfect recipe for disaster.

Kenny may have stayed on the straight and narrow, but he had lost his father to a heart attack and his uncle had suffered a stroke. He couldn’t thank his wife enough for nagging him to go to hospital. Her persistence saved his life.

He has learnt that in lifestyle diseases, there is no common denominator. His best friend Alvin lives on the fast lane, always the party animal, drinking, smoking and filling up on all manner of unhealthy foods.

Alvin has never set foot in a gym and drives everywhere, even to the gate to pick the paper on Sunday, yet he is as fit as a fiddle at his annual medical checks. Alvin always jokes that he will leave a goodlooking corpse.

At younger ages, heart attacks are more prevalent among men than women. This may be attributed to the protective function of oestrogen during reproductive age. However, with advanced age, women catch up and in America for instance, they have surpassed men since 1984. This could be because on average, women live longer than men.

We may be a developing country but our heart attack rates are rising at an alarming rate. This is partly due to improved diagnosis, but also largely as a result of our changing lifestyles and food consumption.

What is troubling is that our emergency response to heart attacks is not up to speed. One could have a heart attack right in the middle of an emergency room in hospital and still die as most emergency rooms are not well-equipped.

Vital life-saving drugs are not available and most health workers are not trained in acute cardiac life support. To top it off, we do not have adequate critical care services to cater for the population.

As dietary fads continue to take centre stage among the middle class, it is worth noting that all the raw spinach juice in the world will not protect you from a heart attack if you do not mind the rest of your lifestyle and have a proper annual medical chec-kup.

Every individual must have their individual risk assessment done and be advised accordingly.