Ischemic heart diseases in Yemen [Archives:2007/1102/Health]

November 12 2007

Dr. Erfan Y. Al-Shammari
[email protected]

Talking about Ischemic Heart Diseases (IHD) in Yemen is based on how many patients are subjected to the series of diseases that make IHD and the risk factors for it.

High-altitude living predisposes Yemenis to cardiac diseases. They develop IHD at a younger age and have a more adverse IHD risk profile. They demonstrate more adverse outcomes, both in terms of investigational findings and clinical events.

This suggests that higher altitudes may be a risk factor for acute attacks and should be taken into account when evaluating cardiovascular risk. The type of meal (as a part of the Middle East countries) that containing a high lipid is one of the predisposing factors for the IHD we have. In addition, smoking must be regarded as one of the most likely factor that leads to IHD, which also occurs in combination of other chronic diseases like diabetes mellitus and hypertension. Stress must be regarded as one of the predisposing factors.

During my work in Yemen since February 2004, I have seen 1,459 patients complaining from IHD 468 of them had myocardial infarction and the remaining had angina pectoris. 47 percent of them had atherosclerosis; 23 percent had diabetes mellitus; 19 percent had hypertension and the remaining percentage for patients who developed IHD without causes .This is according to my study, which is based on the clinical, laboratory and different diagnostic measures.

The age groups of the affected patients showed a wide spread of IHD among middle age group. The patients, who were young, give us an alert for the possible ways to prevent this serious disease. From the 1,459 patients only 241 of them were treated surgically and the remaining patients were treated by medical ways. The surgical way for treating IHD is advisable when the patient is fit to do it.

One of my patients, a man at the age of 32, was a heavy smoker, qat chewer and has over-weight subjected to myocardial infarction at one of the nights. When we admit him to the C.C.U as he was refusing admission, he developed a sudden cardiac standstill which is corrected by D.C electric shock. He stayed for one week in the hospital then we arranged a coronary angiography for him to show an occlusion in one of the coronaries which is treated by balloon then a stint was introduced to maintain a good blood flow to the heart.

We need to educate all the people not to ignore the heart attack and to be sure that the doctor is making the right decision what ever it is to save their lives as much as he can. Also the patients must follow the order of the doctor.

The triggering factor for the IHD is atherosclerosis which leads to sloughing of the coronary arteries lining epithelium and this will create atheroma which causes narrowing and then occlusion of the coronary artery. So we have to differentiate between two types of IHD

Angina pectoris: narrowing of the coronary artery by a spasm which is either single or multiple that decreases the blood supply for the affected cardiac muscle and the patient will have recurrent chest pain appears on exertion or any physical effort, the pain will be central in chest radiated to the left shoulder, some times associated with irregular heart beats. The patient may have shortness of breath also.

Myocardial Infarction: Occlusion of one or both of the coronary arteries will cause obliteration of the blood supply to the cardiac muscles in different walls anterior, lateral and inferior walls of the heart according to the segment affected.

The patient will have a sever retrosternal chest pain radiated to the left shoulder associated with shortness of breath and chest tightness; the patient will experience other symptoms like nausea, vomiting, pallor and restlessness.

Here the symptoms are more serious and the patient needs urgent treatment in the coronary care unites (C.C.U), otherwise death will happen from irregularities of the heart beats.

The patient must be treated very well and must be handled carefully by the doctor according to the clinical findings, Electrocardiography (ECG), laboratory tests, stress ECG, echocardiography and latter coronary angiography which is an invasive method to visualize the coronaries by using a dye under control of X-ray fluoroscopy. However a lot of patients have a fear from angiography which is an accurate and easy way to diagnose IHD perfectly as we can demonstrate the site of lesion. After diagnose the site by diagnostic angiography we can treat the case by using balloon to re-open the coronary artery or putting a stent to make a patent coronary artery.

Dr.Erfan Y.Al-Shammari is a specialist in Internal Medicine,Cardiothoracic & Vascular diseases.