Talk about the more than 50 different heart conditions and images of silver-haired men close to retirement age spring to mind. This would be an accurate image if you were in the West — but not in the UAE. A cause for concern is the increasing number of younger people showing up at cardiologists' clinics with heart disease.
A youth and women problem
"I can strongly confirm this observation. The population groups most heavily affected are young males from the UAE and the Indian subcontinent, quite often with terrible coronary artery disease," says Dr Klaus Kallmayer, cardiologist and chairman of the German Heart Centre.
"Yes, we are seeing a rise in younger patients," says Dr Andre Wessels, Specialist Cardiac Surgeon at The City Hospital. "The incidence of risk factors is very high amongst the local population."
"Absolutely, there is a trend of younger and younger patients coming in and there are several reasons for that — patients with congenital heart disease are better detected than before and we're detecting it earlier," says Dr Uwe Klima, professor of surgery chief of cardiothoracic surgery at the American Hospital Heart Centre.
Also, acquired heart disease is increasing, more people start smoking at a younger age and women are catching up in comparison to men, Dr Klima said.
"Another thing is when you look at drug abuse, there is a lot of it in this region and worldwide. People use drugs at a young age and this damages the inner layer of the endothelium in the heart." However, he said the majority of his patients for procedures such as heart bypass surgery are still between the ages of 55 and 60.
Cause and effect
Junk food, obesity and the lack of exercise are the biggest culprits, Dr Wessels says.
Dr Kallmayer suggests the most likely cause is the sudden change in lifestyle among these groups that have adopted a high fat and carbohydrate diet.
"This part of the world is prone to produce heart disease because of bad lifestyle — people don't exercise because of culture and the temperature," Dr Klima says.
He also mentions that just because you may have a vegetarian diet, like people from the Indian subcontinent, it does not mean you cannot have heart disease. "Indians with a traditionally vegetarian diet eat foods that are deep fried and very oily."
Dr Kallmayer says poor lifestyle has led to a sudden surge in the so-called Metabolic Syndrome, with obesity, type 2 diabetes, high cholesterol and hypertension.
"The diabetes rate in the UAE is the second highest in the world. This effect is enhanced by the reluctance of people to do physical exercise and waddling up and down the shopping mall is about the greatest effort they may make. It is not a rare thing to see a patient whose height is 150cm and weighs in excess of 100 kilos."
Dr Fahad Omar Baslaib, head of the cardiology unit at Rashid Hospital said he commonly saw patients with angina, valvular problems and electrical problems and arrhythmias.
Dr Kallmayer said he usually saw patients with coronary artery disease, high blood pressure, palpitations caused by an abnormal heart rhythm, valve disease and heart failure. "We do treat people with heart attacks but we also see many patients with stress-related problems."
Hard facts and research
The trend is not merely supported by anecdotal information and observations of cardiologists. There are now hard facts to back up the claims that Gulf region populations, especially the youth, have a serious cardiac problems.
Last year researchers presented their findings on an extensive study on heart disease among populations in the GCC region.
The Gulf Registry of Acute Coronary Events (Gulf RACE) study was a Gulf Heart Association project and looked at more than 8,000 patients over six months from 64 hospitals in six countries; UAE, Kuwait, Oman, Yemen, Saudi Arabia and Bahrain.
The study found that patients with acute coronary heart disease in the Arab Middle East are younger than in developed countries and have higher rates of diabetes and smoking.
"With a mean age of about 56 years, Gulf RACE patients were about a decade younger than patients in Western registries. Indian patients had a mean age of 57 years similar to our patients," the findings stated.
Dr Fahad Omar Baslaib, head of the cardiology unit at Rashid Hospital and one of the investigators in the study, said the average age for patients with coronary artery disease is 60 years and the average in the UAE was more like 50 years.
"We do see patients as young as 20 with heart problems and heart attacks. The local Emirati or Gulf people are facing it at a younger age mainly because of westernised food and a sedentary lifestyle."
Dr Baslaib also added that South Asians get heart attacks at an early age. "And genetically they have small-calibre coronary arteries."
Part two of the study is under way and researchers hope to present their findings by early next year. The study, Gulf RACE 2, and the preliminary findings were similar to the first study, he said.
Information supplied by:
Dr Klaus Kallmayer, cardiologist and chairman of the German Heart Centre
Dr Andre Wessels, specialist cardiac surgeon at The City Hospital
Dr Fahad Omar Baslaib, head of the cardiology unit at Rashid Hospital
Dr Uwe Klima, professor of surgery and chief of cardiothoracic surgery at the American Hospital Heart Centre
Detecting and solving heart problems
Stress test
Also known as a stress electrocardiogram (ECG or EKG), treadmill stress test or cardiac stress test, this procedure requires patients to walk and, in the later stages, run on a treadmill until a target heart rate for their age is reached.
The technician attaches electrodes at strategic places on the torso to monitor the heart rate and they are connected to the ECG equipment. Their blood pressure is also monitored during the test.
The principle behind this test is that, when a person relaxes, there may not be a problem with the blood supply to the heart. But when a person exerts himself, the demands on the heart for an adequate supply are increased. Therefore a demand/supply mismatch may occur.
Coronary angiogram
If a doctor suspects that there is a narrowing or blockage in the arteries that supply the heart muscles with blood, he will perform a coronary angiogram.
The procedure is done in a hospital and uses X-ray imaging to examine the heart. The patient will be awake during the procedure. However, the area (usually the groin) where the catheter (a long, thin, flexible plastic tube) is inserted will be numbed.
The catheter is inserted into the artery and threaded to the heart or coronary arteries. A dye or contrast is injected through the catheter into the arteries and blood vessels while several X-ray images are taken.
If there is a narrowing or blockage the cardiologist will perform an angioplasty to widen the blood vessel.
Echocardiogram
Also called a cardiac ECHO or cardiac ultrasound, the test will demonstrate heart-valve function, heart-muscle function, dimensions of the various heart chambers and any congenital abnormality.
The procedure can be done in the doctor's office or at a hospital. As with the ECG, electrodes are placed on the patient's body. The doctor will apply a little bit of transmission gel on the patient's skin and will move the transducer (a small oval shaped device) along the chest to transmit images of blood flow in the heart on a computer monitor.
Magnetic resonance imaging (MRI)
The Magnetic Resonance Imaging (MRI) technique is a relatively new field in cardiac imaging and demonstrates heart-muscle function and valve function.
The painless MRI procedure uses a magnetic field and radio waves to create detailed images of the organs and tissues within the body.
The patient will be asked to lie very still and moved slowly into the MRI machine, which looks like a tunnel, and there cross-sectional images are taken of their organs.
Positron emission tomography(PET) scan
The PET scan is sometimes used to differentiate between areas of heart muscle which are not functioning due to dead heart muscle that is replaced by scar or heart muscle not functioning (hibernating) due to a lack of blood.
The scan shows how the tissues and organs are functioning, and also chemical activity, by injection, inhalation or swallowing of a radioactive material. The radioactive material will build up in organs and tissues that have higher levels of chemical activity and will show up as bright spots on the PET scan.
Coronary artery bypass surgery
As the name implies, this type of heart surgery involves the rerouting or bypassing of blood around clogged arteries to improve blood flow and oxygen to the heart.
Arteries carrying blood to the heart can become clogged by what doctors call "plaque", which includes fat, cholesterol or other substances. Clogged arteries can slow down or stop the flow of blood through the heart's blood vessels, leading to chest pain or a heart attack.
A coronary bypass involves a surgeon taking a piece of healthy blood vessel from another part of the body (usually a vein from the leg) to make a detour around the blocked part of the coronary artery. A patient could have more than one bypass graft, depending on how many arteries are blocked.
Keeping your heart healthy during Ramadan
For patients who have undergone heart surgery, Dr Klima says it is not advisable to fast within less than six months after the procedure. "But everybody who is at least half a year after surgery can live a normal life. If it's less, I advise patients to work on their rehabilitation rather than forcing themselves into a negative balance of calories."
For heart patients, the diet should remain as healthy as possible. "In general, all that is green is good," Dr Kallmayer says.
Doctors offer their top tips:
Vegetables and salad have many vitamins, and particularly B vitamins, which prevent arteriosclerosis as cause of heart attacks.
If cholesterol is high, the diet should be low in red meat and seafood and saturated fat such as butter. Patients should eat more fish and chicken. If patients have high cholesterol, it is easier to control with medication than a strict low-cholesterol diet, which is not sustainable.
If the patient has diabetes, low carbohydrate intake is essential and this should be assisted by a nutritionist, who will determine the amount of "bread units" the patient is allowed.
Fast food should be avoided by all means, as processed food contains, without exception, an enormous amount of the ingredients, which must be avoided. It also contains too much salt, which is bad for people with high blood pressure.
Dispelling the myths
Many people think they would know if they were having a heart attack and medical TV dramas don’t help much by way of accuracy. It’s more than just chest pain that indicates you are having one.
Myths
“One myth is that people with heart attacks must have clear risk factors, such as smoking, obesity, diabetes, high blood pressure or cholesterol. A heart attack can happen even to people who had nothing previously although this is, of course, rare,” Dr Kallmayer says.
Another myth is that women are less likely to have heart attacks. This applies only to younger women — after menopause the risk becomes similar to that of men, he adds.
What is of concern is that the diagnosis of a heart attack is much often missed in women than in men. And Dr Kallmayer also mentions that it is a myth that young people do not get heart attacks. “In this country, where the obesity and diabetes rates are high, this disease can also affect people as young as 20.”
Dr agrees. “It’s not just the elderly who have heart attacks — there is an increasing trend of the disease in the younger population group … especially apparent in those who have significant risk factors.”
Heart attack symptoms
“The typical symptoms of a heart attack are a crushing, squeezing chest pain that is difficult to localise,” says Dr Klaus Kallmayer, cardiologist and chairman of the German Heart Centre.
Chest pain is usually felt behind the breast bone which may radiate to the jaw, throat, stomach or the back or down the left or both arms. The pain may be associated with sweating and/or nausea and the patient may also feel the sensation of imminent doom and shortness of breath say Dr Kallmayer and Dr Andre Wessels, Specialist Cardiac Surgeon at The City Hospital.
Dr Kallmayer cautions that not everyone has the typical set of symptoms. “Diabetic patients, for example, often have an altered pain sensation so that they might not have any pain.”
He advises that if a heart attack is suspected, the patient should be brought immediately into a hospital or clinic, preferably with an ambulance. A hospital where a coronary angiography and cardiac catheterisation can be performed is preferred.
