‘Funny feeling inside’ may be onset of coronary heart disease – warns Cardiologist

Jul 28, 2014 News

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A “funny feeling inside” might very well be the only symptom an individual suffers at the onset of coronary heart disease.
Also known as coronary artery disease and ischemic heart disease, this condition is said to be the most common type of heart disease which most often leads to heart attacks. And according to Chief Medical Officer, Dr. Shamdeo Persaud, heart attack is currently among the leading causes of death in Guyana.
This condition, along with stroke, diabetes and a few other life threatening conditions, are gaining close attention by the Ministry of Health as efforts are being made to tackle Chronic Non-Communicable Diseases (NCDs).
But speaking specifically to heart attack, Resident Cardiologist at the Caribbean Heart Institute, Dr. Mahendra Carpen, said that this condition can be brought on by issues ranging from high cholesterol issues to diet and even genetic predisposition.
Other factors that can influence coronary heart disease are: diabetes, hypertension and cigarette smoking.
Symptoms
Symptoms of this condition can include chest pains, sweating and nausea but according to Dr. Carpen, “the majority of patients we have seen recently they however do not have the classic symptoms.”
These patients, he explained, have what is more accurately described as some kind of stress or epigastric discomfort; the latter suggesting that there is some abdominal bloating. “What some people experience is often an unusual feeling that generally makes them uncomfortable…it doesn’t necessarily have to be pain but just a funny feeling,” Dr. Carpen noted.
He however added that an individual’s condition could graduate to unstable angina which is a symptom that results from diminished blood flow and oxygen to the heart.
This is characterised by chest pains which can manifest at anytime even without an individual exhorting his or herself.  “This occurrence does not necessarily mean that it is a heart attack but it is kind of a warning of a heart attack,” asserted Dr. Carpen.
And should a heart attack result, the Cardiologist noted that there are two types that can occur – ST Elevation Myocardial Infarction (STEMI) or Non-ST Elevation Myocardial Infarction (NSTEMI).  Myocardial Infarction is usually caused by a blood clot which hinders blood flow to a section of the heart muscle.
The more dangerous of the two infarctions, Dr. Carpen said, is the STEMI, since once it manifests it means that there is already major damage to the heart that requires immediate and crucial attention.
“The most effective, proven way of treating this is by taking patients, as soon as possible to CAT Lab and putting a stent into the blockage to clear it up,” explained Dr. Carpen.
Listed as the second most effective way to tackle this challenge is the administration of certain powerful clot busters called thrombolytics, the Cardiologist informed
Currently, Streptokinase may be the only clot buster available in Guyana. It is however the oldest among the clot busters with a great deal of side effects and therefore may not be as effective as the newer generations. The newer ones are however more costly.
The manifestation of NSTEMI, on the other hand, can prove to be either high or no risk to patients, which according to Dr Carpen, may only be determined by properly assessing the coronary arteries by means of angiographic examination (a medical imagining technique).
Progression
Dr Carpen, in speaking to the progression of coronary heart disease, explained that resulting heart attacks are usually caused by two main types of pathologies.
According to him, an individual may be susceptible to a slowly progressive blockage which then becomes unstable and can then result in cloths being formed in the inner membranes of the vessel.
This can then result in little or no blood flow beyond the blockage and almost always results in a heart attack.
However, Dr Carpen noted that “you can have a not so dangerous progressive blockage but then a cloth forms acutely and those are the ones that are much more dangerous because the heart has not had a chance to adjust to any diminishing blood flow over the period of months to years…Those are the ones in particular that you see among patients who are smokers, diabetics, hypertensive or people who consume fat rich diets.”
Treatment
Once a patient would have developed coronary artery disease and suffered a heart attack it is crucial that they keep aspirins handy. This of course should be used based on the advice of a medical practitioner as according to Dr Carpen the majority of patients are required to use anti-platelet drugs in conjunction with aspirin.
And there are several anti-platelet drugs that are readily available with the one most commonly used in Guyana being the Clopidogrel.
There are, however, a number of generic versions that are fairly good as well, the Cardiologist noted.
Patients who would have suffered a heart attack can also benefit from beta blockers which are drugs such as Metoprolol, Carvedilol and Bisoprolol. Among this list too is Atenolol, but according to Dr Carpen “this is an older drug with a larger side effect profile.”
Moreover, he holds Metoprolol and Carvedilol as the preferred beta blockers he recommends to his patients since they are known to have the least side effects.
The other big category of drugs that these patients should be on at this point, Dr Carpen said, are the Statins which include drugs such as the Atorvastatin and Simvastatin which are in fact the two more common ones in the country.
Other drugs that are also known to reduce symptoms are nitrates for coronary heart disease including GTN (glyceryl trinitrate) which are tablets that can be placed under the tongue; Isordil which are tablets taken two to three times per day or Imdure.
“These are all nitrates based medications that cause a little bit of dilatation of the blood vessels to increase blood flow to the muscles of the heart,” Dr Carpen noted.

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