Heart disease is one of the top three life-threatening diseases in Hong Kong, early prevention of heart diseases and related diseases is essential for your health.

The Q&As below may help you to learn more about the causes of heart disease.

Q1: What causes a heart attack?

A “heart attack” in medical terms is the sudden blockage of heart arteries causing damage to the heart muscle. Heart attacks are the most common heart disease and could cause death. To have a heart attack there need to be two basic components: cholesterol collections in the walls of the heart arteries and a stress environment that causes damage to the artery wall and release of these collections into the blood. Once this happens, the body reacts by forming clots to contain the damage – just like if you cut your hand in the kitchen - but a clot in a heart artery will block off the blood flow to the muscle and cause damage to the cells. 

Typical “stress environments” would be emotional situations, serious illnesses such as pneumonia, running after a bus, or even during a marathon.

Q2: What’s the difference between a heart attack and a cardiac arrest?

“Cardiac arrest” is where the heart stops beating effectively and cannot supply blood to the vital organs. It can be the most devastating result of a heart attack. Other conditions can cause cardiac arrest too, such as a serious loss of blood, compression of the heart by outside factors and heart rhythm abnormalities.

Q3: Are there signs of a heart attack or heart diseases?

The classical symptoms are chest tightness or pains on the left side which go to the left arm and up the neck into the jaw.

Though things are rarely “classical” in life. Some patients describe a decrease in their exercise capacity, shortness of breath when they exert themselves, heavy or irregular heartbeats or pain in their upper abdomen.

Q4: Do our emotions affect the onset of heart diseases? 

The heart and the mind are intricately connected by nerves and hormones. When one is stressed or unhappy, stress hormones such as adrenaline and steroid cortisol are released. These stimulate the heart and other systems (preparing to fight-or-flight) and destabilise the normally silent cholesterol collections in the artery wall, leading to a heart attack.

Q5: Do men or women at a higher risk of getting heart disease?

Men have a higher risk of developing heart artery disease throughout their lives; women are relatively protected by their hormones until menopause, after which their risk increases rapidly. Other heart diseases follow different gender patterns depending on the specific disease.

Q6: How to prevent heart disease?

The classical risk factors for heart disease are:

Age, genetics, smoking, diabetes, high cholesterol, high blood pressure. The last three can be treated – we call them “modifiable”. Increasing age and a tendency to get heart disease at a young age in close blood relatives should inform the vigour with which doctors search for and treat the modifiable risk factors.

Generally a moderate lifestyle in terms of diet, exercise, sleep and emotional stimulation minimises the risk of heart disease, though this is a crude way to find those who are likely to have hidden heart problems. A thoughtful doctor would tease out unusual risk factors that put a patient at high risk and initiate appropriate mitigating measures.

Q7: What are the differences between Cardiac Stress Test and CT Heart Scan?

We are born with a lot of excess reserve heart function that we do not need when seated quietly. A stress test looks at how much reserve your heart has when put under increased demand such as running up a slope. Sometimes if there is a hidden problem, this type of test will be able to flag it out for deeper investigation.

A CT heart scan looks at the structure of the heart arteries and defines if there are any calcified cholesterol deposits in the artery wall, which, if mild or moderate in severity, might not show up on a stress test.

There are pros and cons for each test, though generally stress tests are done in health checks as they are relatively easy to perform – they are good at picking up critical arterial narrowings; CT scans involve some radiation but gives a better estimate of the general amount of cholesterol and calcium build-up in the artery walls, even if they are not causing severe narrowing.

Q8: Other than Cardiac Stress Test and CT Heart Scan, how many types of heart checkups I can choose for?

There are multiple heart tests available – MRI, stress treadmill, stress echocardiogram, myocardial perfusion, ECG etc. The personalised, appropriate tests are selected by your doctor according to your symptoms to diagnose the source of the problem.

Q9: Do I need to do the checkup if I am young and fit?

Surprisingly, “fit” people can have hidden problems. People who do lots of sport are used to working through pain and discomfort, and their bodies are highly adapted to intermittent stress situations during sport. This can mask any early signs of heart disease.

At what age does one start doing heart screenings for the heart? It depends on baseline risk such as any inherited heart problems, the presence of any of the “risk factors” I mentioned before and any symptoms. Generally I would recommend “pre-participation screening” for seemingly young and fit people who want to do high intensity sports and competitions. Otherwise 40 years old is a reasonable age landmark at which one should start doing heart checkups. 

Q10: Can heart disease be completely cured?

Heart disease is a degenerative process. The question is how early or how quickly the degeneration happens. Modern minimally invasive operations and medications are amazing – most heart diseases can be repaired very effectively now.

Source: Matilda International Hospital 

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