What is a Heart attack
Coronary heart disease (Heart attack)
in its various forms accounts for about 75-85% of all cardiac mortality and 35%
of all deaths in the United States (1.2). Heart attack is the leading cause of
death in most of the industrialized nations. In many countries 30% of total
mortality is attributable to this disease. In the past two decades the
mortality from heart attack has declined by 25-30%, in many countries like USA,
Canada, Australia, Finland, Italy, France etc. Favored nations include more rigorous control of hypertension, avoidance of cigarette smoking, lowered
consumption of cholesterol containing foods, a growing awareness of the
benefits of weight reduction and regular physical exercise and improved medical
management of threatened and overt heart disease (3).Earlier it was a common idea that
only the people of the affluent society would suffer from coronary artery
disease (Heart attack) but that idea lost its ground recently, since people of
all walks of life fall victim. Few years back it was not considered that
non-communicable diseases like heart attack was a problem of developing
countries like Bangladesh. Only very recently the disease has been recognized
as a potential danger in this country (4). Heart attack may result in sudden
death or disability in many who are still young. Its personal and social costs
are profound both for the individuals and families involved and for the
countries in which it is common (5).
No disease can have been so extensively studied. The work of recent years has yielded remarkable advances in our understanding, in diagnostic and international cardiology, surgery and drug therapy. The introductions of new treatment strategies have changed the long term prognosis of the coronary heart disease patient. Thrombolysis or clot dissolving medicine can reopen the occluded artery in 50 to 90% of patients suffering from acute heart attack and reduce the mortality by approximately 30 to 40% when compared to placebo (non drug treatment group) (6,7). With this injection and improved coronary care in hospital fatality rate o acute myocardial infarction is now around 7 to 15% (80 Introduction of bypass surgery in 1969 and PTCA (balloon angioplasty) in 1977 has revolutionaries the treatment strategies of the coronary heart disease (9,10). Now a days emergency balloon angioplasty has been tried in the treatment of acute heart attack and improves survival in the treatment of patients with severe heart attack with low blood pressure (11). Coronary artery bypass operation can improve quality of live and survival in patients with extensive coronary artery disease (12). So new techniques and drugs have reduced the frustration of the patients with coronary heart disease and showing them real hope. At present the situation of heart attack in Bangladesh is also alarming. The developing countries like developed notions, face an epidemic of ischemic heart disease, is signaled by a slogan of the World Health Organization in 1988. “Heart attacks are developing in the developing countries-prevent them now”. There are evidences that the relative risk of heart attack in South Asian man is the highest at early ages.
No disease can have been so extensively studied. The work of recent years has yielded remarkable advances in our understanding, in diagnostic and international cardiology, surgery and drug therapy. The introductions of new treatment strategies have changed the long term prognosis of the coronary heart disease patient. Thrombolysis or clot dissolving medicine can reopen the occluded artery in 50 to 90% of patients suffering from acute heart attack and reduce the mortality by approximately 30 to 40% when compared to placebo (non drug treatment group) (6,7). With this injection and improved coronary care in hospital fatality rate o acute myocardial infarction is now around 7 to 15% (80 Introduction of bypass surgery in 1969 and PTCA (balloon angioplasty) in 1977 has revolutionaries the treatment strategies of the coronary heart disease (9,10). Now a days emergency balloon angioplasty has been tried in the treatment of acute heart attack and improves survival in the treatment of patients with severe heart attack with low blood pressure (11). Coronary artery bypass operation can improve quality of live and survival in patients with extensive coronary artery disease (12). So new techniques and drugs have reduced the frustration of the patients with coronary heart disease and showing them real hope. At present the situation of heart attack in Bangladesh is also alarming. The developing countries like developed notions, face an epidemic of ischemic heart disease, is signaled by a slogan of the World Health Organization in 1988. “Heart attacks are developing in the developing countries-prevent them now”. There are evidences that the relative risk of heart attack in South Asian man is the highest at early ages.
What is a Heart Attack?
There is much confusion amongst people as to exactly what is meant by a heart attack. The scientific terminology of heart attack is myocardial infarction which means that a portion of the heart muscle has been destroyed by deprivation of its blood supply. Heart works all the time to provide ample amount of nutrition through blood to all parts of the body. But it also requires nutrition for its own survival. When blood supply of heart muscle decreases to a critical level a heart attack is imminent. ‘Heart gets its nutrition through two coronary arteries. Coronary arteries supply food /fuel to the heart muscle. The basic pathology of heart attack is the obstruction of coronary arteries. Coronary heart disease is also called ischemic heart disease. Ischemic heart disease (IHD) or coronary artery disease (CAD) includes both angina prospector and myocardial infarction. In angina prospector heart muscle fails to get necessary nutrition usually during exertion and there is no damage of heart muscle but myocardial infarction (MI) means death of apart of heart muscle due to complete absence of blood supply.
Why is heart attack alarming?Heart attack is a very dreadful
condition which carry high risk of mortality if not adequately treated. Even
two decades back immediate mortality from heart attack was approximately 33%,
with more than half of the deaths occurring before the stricken individual
reaches the hospital. But with the advent of modern treatment facilities like
thrombolysis (using new medicines to dissolve the clot), primary angioplasty
(immediate ballooning to release the obstruction) and new methods to treat arrhythmia's (irregular heart beat) has brought down the mortality from 33% to
only 10-30%. The most tragic part of heart attack is that most of the deaths
occur before the victims can see a doctor. Most of the deaths after heart
attack occur immediately or within 24-48 hours after the attack. So every
moment after heart attack is important. Any complication of heart attack can be
effectively treated if the patient remains under proper medical care. A timely
intervention can prevent many unfortunate fatal outcomes. So, the patient
should be immediately brought to the hospital preferably to a coronary care
unit. Any sort of negligence can rapidly progress with a cascade of dire path
physiological consequences leading to death. Though the heart attack is
devastating for a person and frustration to a family, good news is that, a
person may have very useful life even after a heart attack if he changes his lifestyle and takes medicines regularly. A patient may lead almost a normal
life if he abides by all the methods of secondary prevention of heart attack.Coronary Heart Disease among
BangladeshisIncidence of coronary heart disease
and heart attack are very high in Bangladesh. South Asians particularly
Bangladeshis, Indians and Pakistanis have the highest rate of coronary artery
disease compared to any ethnic group studied in different western countries
(13). Higher rates of incidence, prevalence, morbidity, and mortality and case
fatality from coronary heart disease have been consistently documented among
South Asians residing in a number of countries. The mortality from heart attack
is higher in South Asians, by a factor of 1.4 in comparison to whites in
England, by a factor of 3.8 compared to Chinese in Singapore and by a factor of
22.8 compared to blacks (13). Cardiovascular disease morality rates have been
known for decades to differ sharply among countries. In one study South Asians
had the worst coronary risk factor profile, Chinese had the most favorable
profile and Europeans were intermediate (14). The consistency of the high risk
of coronary artery disease in South Asian populations around the world,
affecting both sexes and with early onset, suggests a common underlying
explanation but the conventional risk factors like hypertension, diabetes, high
blood cholesterol and smoking, however, do not fully account for the excess of
heart attack among Bangladeshis, Indians and Pakistanis suggesting that other
risk factors may be more important. The prevalence of high blood pressure, high
cholesterol and smoking among the South Asians are similar to or lower than
that in other populations. Average blood cholesterol level among the South
Asians is lower than those in whites, prevalence of hypertension is not higher
than that in whites and smoking in South Asian patients is generally less
common. In population surveys, differences between South Asians and Europeans
in smoking, blood pressure, blood cholesterol or diabetes do no explain the
high risk of coronary heart disease in South Asians (15, 16).
On the basis of a study comparing Bangladeshi migrants to United Kingdom with native Europeans, it was suggested that a pattern of metabolic disturbances related to insulin resistance might underlie the high rates of coronary artery disease among Bangladeshis (17). Abdominal obesity (central obesity) appears to be an independent and strong risk factor for coronary artery disease among South Asians indicating that even modest increases in body fat with central distribution may be potentially harmful from cardiac point of view (18). Obesity and high waist-hip ratio are common among Bangladeshi population. Waist-hip ratio >0.95 are commoner in South Asians than Europeans (19). Association of high triglyceride (TG) and low high density cholesterol (HDL) as an independent predictor of coronary artery disease in non-diabetic patients have been reported in Bangladesh.
Reference:1. Wright RA, Fox KA. Prognosis of ischaemic heart disease. Med Intern 1993; 6 : 384-3882. Brounwald E. Heart Disease, 4th Ed, WB Saunders Company, 1992.3. Robbins SL. Pathologic basis of disease. 3rd Ed. Philadelphia 1984 : 551-566.4. Mobark A. Epidemiology of IHD. J Preven Soci Med 1982; 1(1) : 17-20.5. Reports of a WHO expert committee: Ptevention of coronary heart disease. Tech Rep Ser WHO 1982; 5-50.6. Gossage JR. Acute myocardial infarction-Reperfusion strategies. Chest 1994; 106 : 1851-66.7. Waiz A, Chakraborty B. Thrombolysis in myocardial infarction-current concepts and recommendations. J Bangladesh Coll Phys Surg 1995; 13: 60-72.8.Hennekes CH, Albert CM, Godfried SL et al. Adunctive drug Adjunctive drug therapy o acute myocardial infarction-evidence form clinical Irials. N Engl J med 1996; 335: 1660-7.9.Favaloro Re. Saphenous vein graft in the surgical treatment of coronary artery disease: Operative technique. J Thorac Cardiovas Surg 1969; 58 : 178-85.10. Gruentzig AR, Senning A, Siegenthaler WE. Non operative dilation of coronary artery stenosis : Percutaneous transluminal coronary angioplasty. N Engl J Med 1979; 301 : 61-68.11. Grines CL.. Rrimary angioplasty the strategy of choice. N Engl J Med 1996; 335: 1313-712. Yusuf S, Zucker D, Peduzzi P et al. Effect of coronary artery by pass graft surgery on survival : overview of 10 years results from randomized trials by the coronary artery bypass graft trialists collaboration Lancet 1994; 344: 563-7013.Enas EA, Yusuf S, Mehta J. Meeting of the International working group on coronary artery disease in South Asians. Indian Heart J 1996; 48: 727-32.14. Levy D, Kannel WB. Searching for answers to ethnic disparities in cardiovascular risk. Lancet 2000; 356: 266-7.15. McKeigue Pm. Coronary heart disease in Indians, Pakistanis and Bangladeshis: aetiology and possibilities for prevention. Br Heart J 1992; 67: 341-2.16. Enas EA. Yusuf S, Mehta H. Prevalence of coronary artery disease in Asian Indians. Am J Cardiol 1992; 70: 945-9.17. Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. Br Heart J 1991; 302: 560-418.Chakraborty B. risk factors for coronary artery disease for Bangladeshis: Do they differ from western population? J Bangladesh Coll Phys Surg 2000; 18: 44-6.19. Bhopal R, Unwin N, and White M et al. Heterogeneity of coronary heart disease risk factors in Indians, Pakistani, Bangladeshi and European origin Populations: cross sectional study. Br Med J 1999; 319: 215-20.
On the basis of a study comparing Bangladeshi migrants to United Kingdom with native Europeans, it was suggested that a pattern of metabolic disturbances related to insulin resistance might underlie the high rates of coronary artery disease among Bangladeshis (17). Abdominal obesity (central obesity) appears to be an independent and strong risk factor for coronary artery disease among South Asians indicating that even modest increases in body fat with central distribution may be potentially harmful from cardiac point of view (18). Obesity and high waist-hip ratio are common among Bangladeshi population. Waist-hip ratio >0.95 are commoner in South Asians than Europeans (19). Association of high triglyceride (TG) and low high density cholesterol (HDL) as an independent predictor of coronary artery disease in non-diabetic patients have been reported in Bangladesh.
Reference:1. Wright RA, Fox KA. Prognosis of ischaemic heart disease. Med Intern 1993; 6 : 384-3882. Brounwald E. Heart Disease, 4th Ed, WB Saunders Company, 1992.3. Robbins SL. Pathologic basis of disease. 3rd Ed. Philadelphia 1984 : 551-566.4. Mobark A. Epidemiology of IHD. J Preven Soci Med 1982; 1(1) : 17-20.5. Reports of a WHO expert committee: Ptevention of coronary heart disease. Tech Rep Ser WHO 1982; 5-50.6. Gossage JR. Acute myocardial infarction-Reperfusion strategies. Chest 1994; 106 : 1851-66.7. Waiz A, Chakraborty B. Thrombolysis in myocardial infarction-current concepts and recommendations. J Bangladesh Coll Phys Surg 1995; 13: 60-72.8.Hennekes CH, Albert CM, Godfried SL et al. Adunctive drug Adjunctive drug therapy o acute myocardial infarction-evidence form clinical Irials. N Engl J med 1996; 335: 1660-7.9.Favaloro Re. Saphenous vein graft in the surgical treatment of coronary artery disease: Operative technique. J Thorac Cardiovas Surg 1969; 58 : 178-85.10. Gruentzig AR, Senning A, Siegenthaler WE. Non operative dilation of coronary artery stenosis : Percutaneous transluminal coronary angioplasty. N Engl J Med 1979; 301 : 61-68.11. Grines CL.. Rrimary angioplasty the strategy of choice. N Engl J Med 1996; 335: 1313-712. Yusuf S, Zucker D, Peduzzi P et al. Effect of coronary artery by pass graft surgery on survival : overview of 10 years results from randomized trials by the coronary artery bypass graft trialists collaboration Lancet 1994; 344: 563-7013.Enas EA, Yusuf S, Mehta J. Meeting of the International working group on coronary artery disease in South Asians. Indian Heart J 1996; 48: 727-32.14. Levy D, Kannel WB. Searching for answers to ethnic disparities in cardiovascular risk. Lancet 2000; 356: 266-7.15. McKeigue Pm. Coronary heart disease in Indians, Pakistanis and Bangladeshis: aetiology and possibilities for prevention. Br Heart J 1992; 67: 341-2.16. Enas EA. Yusuf S, Mehta H. Prevalence of coronary artery disease in Asian Indians. Am J Cardiol 1992; 70: 945-9.17. Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. Br Heart J 1991; 302: 560-418.Chakraborty B. risk factors for coronary artery disease for Bangladeshis: Do they differ from western population? J Bangladesh Coll Phys Surg 2000; 18: 44-6.19. Bhopal R, Unwin N, and White M et al. Heterogeneity of coronary heart disease risk factors in Indians, Pakistani, Bangladeshi and European origin Populations: cross sectional study. Br Med J 1999; 319: 215-20.
