Even though it’s well known that heart disease affects so many people, it still has a way of sneaking up on individuals. indicators are not always clear prior to a heart attack or stroke; sometimes people mistake the signs as symptoms of something else.
The ability to use medical imaging in a routine and cost-effective manner to catch heart disease early could have a massive impact, making the research into better imaging techniques absolutely vital.
The area of cardiac imaging has seen numerous innovations in recent years, providing radiologists with better image quality to facilitate faster and more accurate readings. Today’s medical imaging is making it possible for doctors to see in 3D, providing never-before-possible views of the heart and vascular system. These advances are improving the diagnostic and prognostic abilities of doctors to help patients who are entering heart failure; and also to identify and assess heart problems much earlier.
“The timely implication of up-to-date interventional techniques with advanced intervention tools such as low profile intra coronary angioplasty balloons, drug eluting stents, thrombus aspiration catheters, ventricular assist devices and intra coronary ultra sound and easy access to these devices within 30 minutes from patient reach to emergency department at our hospital has saved the lives of thousands of patients, facilitated their smooth recovery and allowed them to resume their work within a short recovery interval,” says Dr Ahmed I Fayadh, Interventional Cardiologist, Prime Hospital. “Nowadays, the introduction of new medicines and new bariatric surgical approaches has dramatically shifted preventive cardiology to a new era. For decades physicians have tried the passive approach, which was not obviously working well with us with statistics showing that our region has the highest rates of diabetes and obesity.”
Cardiac imaging has witnessed significant innovations in recent times, providing radiologists with better image quality to facilitate faster and more accurate readings. “Today’s medical imaging is making it possible for doctors to see in 3D, providing never-before-possible views of the heart and vascular system,” says Dr Sony Manuel M, Specialist Interventional Cardiologist, Center for Cardiac Sciences & Cardiology, Thumbay University Hospital. “Thumbay University Hospital’s Center of Cardiac Sciences is specialised in all kinds of cardiac services including both invasive and non-invasive cardiology. It is well-equipped with centrally monitored beds, ventilators, defibrillators, echocardiography, stress ECG and excellent medical supervision by highly qualified doctors and nursing staff who provide 24*7 cardiac care. In addition, the ultra-modern Cath Lab is fully equipped with state-of-art facilities and offers complete range of services from cardiac investigation to interventional cardiology.”
MRI techniques vital for atherosclerosis
There is still a lot of work to be done. For instance, for diagnosing atherosclerosis, the chief cause of heart attacks and strokes, MRIs could be the ideal imaging choice. MRIs are well-positioned to characterise plaque in the arteries non-invasively because they don’t use ionising radiation (allowing for repeated examinations) and because of their “excellent soft tissue contrast”.
Dr Syed Sakib Nazir, Specialist Interventional Cardiologist at Fakeeh University Hospital, Dubai Silicon Oasis, explains: “Atherosclerosis is a disease of the blood vessels. In this condition cholesterol or fatty substances in the blood, deposits inside the blood vessel wall causing narrowing of the lumen that may compromise blood flow. If the heart arteries are involved in this process, it may cause chest pain or even heart attack, however in the same process when the brain arteries are affected then it results in stroke.”
Atherosclerosis, if diagnosed early, can be prevented by lifestyle improvement and medicines. “At present we have CT scan, which involves radiation and can diagnose atherosclerosis by detecting the presence of calcium within the atherosclerotic (fatty) plaques,” says Dr Nazir. “The amount of calcium detected is proportionate to severity of blockages in the heart arteries. However, this technology is costly and may not be easily available. It also exposes the patient to certain degree of radiation. A promising research is in progress where a simple chest X-ray taken through two x-ray beams instead of the conventional single x-ray beam will provide similar result as the CT scan. This inexpensive, easily available, and safer imaging will enable healthcare providers to detect millions of people at risk of developing heart diseases. Fakeeh University Hospital, Dubai Silicon Oasis is equipped with all latest technological advancements for the diagnosis and treatment of heart conditions including Heart CT and Heart MRI.”
High resolution MRI has overcome the limitations of current angiographic techniques and has emerged as the leading non-invasive imaging modality of atherosclerosis. Intravascular MRI is likely to play a key role in imaging of the coronary artery plaques. “Clinically, MRI is critical to non-invasively monitor plaque modification over time,” says Dr Debabrata Dash, Consultant Interventional Cardiology, Aster Hospital, Mankhool. “This provides a platform for efficacy current drugs used in atherosclerosis as well as interventional therapy. MRI is capable of diagnosing atherosclerosis earlier. Because of identification of high-risk vulnerable plaque, MRI of atherosclerosis will likely provide better risk stratification compared to current angiographic techniques and potentially risk stratify patients beyond traditional clinical markers. Ultimately, MRI might be the key to identifying the vulnerable patient in whom medical or interventional treatment could be initiated to prevent cardiovascular events.”
Early diagnosis and detection are integral in the management of heart disease. On this World Heart Day, there should be an emphasis on screening the right cohort at the right time, utilising the evolving technologies from our vast armamentarium. “Cardiac MRI is being increasingly utilized in evaluating the anatomy and function of the heart chambers, heart valves, size and blood flow through major vessels and the pericardium, which is the sac that surrounds the heart,” says Dr Imthiaz Ahamed Manoly, Consultant Cardiac Surgeon, Burjeel Medical City. “Cardiac MRI can also diagnose a variety of cardiovascular tumors, infections, and inflammatory conditions. While it has slight limitations in giving an accurate extent of blockage in the vessels supplying the heart, it helps evaluate the effects of coronary artery disease in determining the recoverability within the heart muscle after a heart attack.”
Strengthen your heart early
While often thought of as one illness, heart disease is actually an umbrella term that covers a range of heart conditions. It includes diseases of the blood vessels, including coronary artery disease (CAD) and peripheral artery disease (PAD); abnormal heart rhythms, or arrhythmias; heart defects you’re born with, or congenital heart disease; and the thickening or enlarging of the heart, a condition called cardiomyopathy. “With advances in medical sciences during the present century different medical tests are available to help find out what your heart condition is and the best way to treat it,” says Dr Anil P Kumar, Specialist Interventional Cardiologist, Aster Clinic (AJMC), Bur Dubai. “Some of these tests are eectrocardiogram (ECG), echocardiogram (ultrasound), exercise stress test/TMT, coronary angiogram (CAG), coronary computed tomography angiogram (CCTA), and magnetic resonance imaging (MRI).”
As high blood pressure and high cholesterol often don’t lead to any symptoms, it is advised by the American Heart Association and American Diabetes Association that people get their blood pressure and cholesterol checked regularly. “Common symptoms of a heart attack are chest pain, possibly radiating to the jaw, arms or shoulders, heavy sweating, and nausea,” says Dr Liza Wong, Consultant Cardiologist, Mediclinic Deira, Mediclinic Parkview Hospital, and Mediclinic Dubai Mall. “Although not everybody who experiences chest pain is having a heart attack, people who have these symptoms should to get in touch with their doctor. Symptoms of stroke can be numbness or paralysis of the face, arm or leg. Sometimes a stroke will present itself with less obvious symptoms such as speech difficulty, loss of balance or dizziness, confusion, or severe persisting headache. The American Stroke Association uses the acronym F.A.S.T. (Face drooping, Arm weakness, Speech difficulty, Time to call emergency services) to educate people about signs of stroke.”
According to Dr Muhamed Shaloob, Specialist Cardiologist, JTS Medical Centre, primary prevention of cardiac disease should be our goal, along with early detection of occult cardiac disease. “You can lower your risk factors by identifying and reducing them,” says Dr Shaloob. “The sooner you manage the risk factors, the greater your chance of leading a heart-healthy life. A periodic cardiac check-up must be considered after 40 years of age if anyone has cardiac risk factors like diabetes, hypertension, high cholesterol, and smoking. “The primary cardiac evaluation involves understanding the vitals and to see if the blood pressure is within the accepted level, and an ECG can help the cardiologist or physician to see the health of the heart’s electrical system and to identify any evidence of ischemic changes in the heart. Additionally, an echocardiogram can help to know the functioning of heart muscles and valvular functions. A stress test helps diagnose flow-limiting blocks in blood vessels that may require Intervention/surgery. Also, a blood workup may be required to identify whether blood sugar levels, cholesterol, etc., are within the normal range.”
Heart disease can be prevented to a great extent by lifestyle modification and treating cardiovascular risk factors. We can do a lot at home to keep our hearts healthy and prevent cardiovascular disease.
“Exercise strengthens our heart and is essential in controlling the risk factors like diabetes, hypertension, and high cholesterol,” says Dr Joseph Kurian, Head of Cardiology Department, LLH Hospital, Abu Dhabi.
“Make sure to get regular aerobic exercise of at least 150 minutes per week. It improves circulation and helps our cardiac output. Aerobic exercise also reduces the risk of type 2 diabetes and, if you already live with diabetes, helps control your blood glucose.”
Obesity is the major driver of diabetes and is a risk factor for heart disease, and diet and exercise are the major means of maintaining ideal weight. Cultivate good eating habits and consume heart-healthy foods such as fruits, vegetables and fish, and fewer foods with saturated fat and trans-fat. “Maintain a stress-free environment at home and practice regular relaxation techniques such as yoga, meditation, etc,” says Dr Kurian. “It is essential to quit smoking as it is a preventable cardiovascular risk factor. Smoking at home exposes our family members to passive smoking, which puts them also at risk of heart disease.”