28 September 2012

The Heart of the Matter

 - In the year 2000, the World Heart Federation proclaimed Sept. 29 World Heart Day. A couple of years before that, I did a post-doc dissertation on how advances in technology had influenced the prognosis in coronary artery disease over the last decade. At that time, 2D Echocardiography was making waves and so was Positron Emission Tomography Scanning.

Pass the Stent Please

 - 2012 marks the 35th anniversary of the first percutaneous transluminal coronary angioplasty (PTCA) which was performed in 1977 by Dr. Andreas R. Gruentzig in Zurich, Switzerland. This angioplasty procedure utilized an expandable balloon, fashioned on a kitchen table in Gruentzig’s apartment by Gruentzig’s assistant, Maria Schlumpf.

  - It was an idea first conceived by a U.S. radiologist, Dr. Charles Dotter, in the early 60′s.  At the time, Dotter’s concept was deemed crazy by the surgical community and it took quite a bit of time for the concept to take hold. His idea had to travel to Europe where eventually Dr. Gruentzig heard about it. With Dr. Myler ( of San Francisco), the procedure was done first intra-operatively. Then eventually, after a few surgical cases, the procedure was done using the principle of the angiogram. What started out as a mad idea has turned into a procedure carried out by dozens of M.D.s at dozens of clinics and hospitals globally, to become a branch of Medicine on its own.

For Ladies Too

 - While heart disease has always been considered a feature of middle-aged men, the statistics show, however, that up to a fourth of all deaths in women in the U.S. are seen in females with heart disease. Two thirds of women who die suddenly of CHD (Coronary Heart Disease) have had no symptoms. This statistic alone is sufficient reason to focus our resources on increased awareness into women’s CHD. Microvascular coronary artery disease (MVD) and broken heart syndrome, also pose a risk for women. Many of the tests for CHD have focused on men. So, in effect, we still have to understand the possible different pathologic processes seen in women and determine if we can apply the same tests and the normal variants in exam results.

Anatomy of the human heart, 
in English, by Ties van Brusse
Date 30 September 2010 
Source Own work Author Tvanbr

 - In developed countries, various indicators of low socio-economic position (SEP) have clearly been shown to be associated with a higher risk of cardiovascular disease and diabetes (Davey Smith,1997). The effect of SEP on risk of CVD or diabetes in developing countries is poorly understood, given the paucity of cause-specific mortality and morbidity data. However little may be the statistics, it appears that there is a preponderance of CHD among the higher income groups in the developing countries. The particular nature of the social inequalities in CVD depends upon how lower socioeconomic position within a particular country affects the social distribution of risk factors for CVD, such as smoking, unhealthy diet and physical inactivity. 

Not Child's Play

 - The dangers of heart disease in children can occur early on, particularly in the context of congenital heart disease. The cause of congenital heart disease may be either genetic or environmental, but is usually a combination of both. In addition, an unhealthy diet and sedentary behaviors early in life can lead to heart disease in adulthood, even in children with no family history of heart disease. In developed countries, the problem of excess caloric intake has led to the preponderance of obesity in the young in the same way that it is seen in the adult population. The current trend in weight gain may spell more ominous health deterioration by the time today’s children reach adulthood. A high salt intake in the young can lead to a higher blood pressure in adolescence. With an earlier “head start” in the process of hypertensive and coronary artery disease development, the health infrastructure will have to deal with the increased burden of cost.

 - With improved and increasing technology, what was once a sure fatal disease is now better treated in many ways. Advances in imaging procedures have enabled us to better visualize the diseased heart (in addition to other organ systems). Biomarkers, such as genomic data, are now helping us see who is at greater risk for the disease. Pharmagenomics is helping us better determine what is the  best treatment for a given patient. At the center of these technological tools lie better algorithms for the detection, identification and diagnostics, and finally- treatment. However, the application of these tools lie ultimately on clinical wisdom.

 - Embrace wisdom.

 - Fernando Yaakov Lalana, M.D.

"A taste for irony has kept more hearts from breaking than a sense of humor, for it takes irony to appreciate the joke which is on oneself."

-Jessamyn West
  American writer (1902 - 1984)  

Resources and Links:

Coronary artery disease

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