|
|
 |
 |
 |
| Friday, 23 January 2004 |
 |
|
 |
Features | |
| News Business Features Editorial Security Politics World Letters Sports Obituaries
|
Diabetic heart disease by Prof. Upali Illangasekera, (President, Kandy Diabetic Association) The association between diabetes and heart disease is so close that in the western countries all diabetic patients are considered to be heart cases unless proven otherwise. Those with diabetes are twice more likely to develop heart disease compared to those without diabetes and the risk of death from a heart attack too is twice as higher. The purpose of this article is to further educate the community on diabetic heart disease, so that premature deaths are prevented. The most important underlying cause of diabetic heart disease is "atherosclerosis" which means the involvement of blood vessels that supply the heart (called coronary arteries) by the deposition of fats on the wall called 'atheroma'. The fat is deposited as a layer called an 'atheromatous plaque' which later acts as a nidus for the formation of a clot called a thrombus which could block the flow of blood in the coronary arteries. This causes the patient to experience severe chest pain which is the earliest symptom of a heart attack. When the clot formation is gradual and therefore the obstruction too is gradual the patient experiences a less severe type of chest pain called angina. The clot formation is further facilitated by an increased tendency of the blood to clot. The factors contributing to atherosclerosis are indicated below. 1. High blood pressure 2. Smoking 3. High cholesterol levels 4. Proteins in the urine 5. High blood sugar Of these the first 4 are called risk factors and more severe they are the more likely that the patient would develop heart disease. However in the case of high blood sugar there is no such relationship so that a diabetic patient with a slightly elevated or normal blood sugar could still develop heart disease. This some times leads to complacency on the part of the patient (some times of the doctor too!) which could even end up in death. It therefore follows that attention to the risk factors mentioned above are equally important to prevent heart disease in patients with diabetes. In addition drugs such as aspirin and others too are useful in reducing the risk. If you are diabetic and suffering from heart disease you will have symptoms such as chest pain either as angina or a heart attack. You will then need further investigations such as stress ECG and echocardiography. If these are positive you will be subjected to 'coronary angiography' which will indicate the extent and the severity of the blocking of the coronary vessels. You would then be subjected to surgery. However the absence of chest pain does not exclude heart disease and in some patients the symptoms too are atypical. The atypical symptoms which still may indicate heart disease include easy fatigability, difficulty in breathing or indigestion. When the symptoms are absent or atypical, it is indeed a challenge to the doctor to identify the presence of undiagnosed heart disease. This needs testing for heart disease and the following table indicates (as suggested by the American Diabetes Association) the situations in which such testing should be carried out. 1. Atypical symptoms as indicated above 2. Abnormal ECG 3. Presence of disease in blood vessels supply the brain or the legs 4. Sedentary lifestyle 5. Age more than 35 years 6. Diabetes of more than 10 years duration All patients with diabetes should have an ECG at the time of diagnosis and thereafter for the detection of undiagnosed heart disease. The symptoms suggestive of disease or the blood vessels supplying the brain includes the presence of a stroke of transient loss of function of a limb. In the case of legs there will be pain on walking or absent pulses in the legs. In addition the presence of two or more of the risk factors in a patient with diabetes given below needs testing for heart disease. 1. High cholesterol 2. Blood pressure more than 140/90mm of mercury 3. Smoking 4. Family history of premature heart disease 5. Presence of proteins in the urine. The high cholesterol values include total cholesterol of more than 240mg/dl.LDL cholesterol of more than 160mg/dl or HDL cholesterol ('good cholesterol') of less than 35 mg/dl. From above, it is obvious that nearly every patient with diabetes should undergo further testing for heart disease. The lack of motivation on the part of the patient (and sometimes on the part of the doctor) to undergo such investigation would delay or prevent identification of undiagnosed heart disease leading to serious repercussions. Among the tests that are used to diagnose heart disease in diabetes, the simplest is the ECG. Even though an abnormal ECG would indicate the presence of heart disease a normal tracing would not exclude it. Furthermore, the ECG will not indicate the amount of loss of function of the heart. The following tests are useful for screening for heart disease. 1. Exercise ECG 2. Echocardiography 3. Stress echocardiography 4. Perfusion imaging Of these the last is not available in Sri Lanka at present. The exercise ECG (sometimes called a 'Stress test') is the most commonly used and will detect a great majority of patients with significant coronary artery disease. The echocardiography will indicate the wall abnormalities of the heart following reduced blood supply and also the amount of blood which could be pumped out of the heart (called the 'ejection fraction'). A diabetic patient who gets admitted to hospital with a heart attack is treated in an identical fashion to that of a non diabetic. Those diabetic patients who already have symptoms of heart disease at present or in the past or those without symptoms after having undergone the tests mentioned above and if abnormal should undergo 'angiography' which will indicate the extent of obstruction of the coronary vessels and the number of vessels affected. Depending on these findings the patient is subjected to coronary artery bypass surgery (CABS). If only one vessel is affected (rare in the case of diabetes) some times as procedure called 'angioplasty' is carried out where a baloon introduced by a catheter is inflated at the site of obstruction ('balloon angioplasty') and a 'stent' left in place to prevent closure. In addition, it is crucial to attend to the other risk factors such as smoking, high blood pressure, high cholesterol and presence of proteins in the urine. The high blood sugar values also should be controlled with drugs and diet. In conclusion, it is incumbent both on the part of the patient and the doctor to be aware of the fact that any patient with diabetes unless already diagnosed to have heart disease could still be harbouring it and therefore should undergo further tests and appropriate treatment to prevent untimely deaths. ##### Dr. Asitha de Silva at a dementia study on Centenarian Matilda Rajapakse (104 years)
Sri Lanka will participate in an Oxford University conducted Clinical trial in UK to find out new treatment possibilities for Alzheimer's disease which affects mostly the aged population. Dr. Asitha de Silva, Lecturer in Pharmacology of the Kelaniya Medical Faculty who left for UK early week to participate in this clinical trial, is also on an Oxford University collaborated dementia study project of the Centenarians in Sri Lanka with Prof. Saman Gunatilake of the Kelaniya Medical Faculty and Prof. Colvin Goonaratna, Emeritus Professor of the Colombo Medical Faculty. The Centenarians in this study are those identified by Prof. Colvin Goonaratna Centenarian Study commenced in Sri Lanka in 2001 in association with this page. (Daily News ). In the dementia study of Centenarians in Sri Lanka Dr. Asitha de Silva visited ten Centenarians in and around Colombo, and conducted the study before he left for UK.
In the name of humanitarian healing Over thirty years ago when there was a scandal about the deep-ray units at the Cancer Hospital being used for converting some semi-precious stones into sapphires it was revealed that patients from all over the island in need of deep-ray therapy had only the availability of four deep-ray machines at the Hospital for a decisive choice between life and death. I was hence shocked to hear recently that still (in the 21st century) there are only four deep ray machines at the Cancer Hospital. This situation is made all the more disgraceful by a letter from a cancer patient you had kindly highlighted in your page that a single vial of a chemotherapy injection prescribed for him by the Cancer Hospital cost Rs. 170,000. All this sounds like something out of the Apocalypse but it is also sound capitalist economics which advocates that profit has to be matched to the opportunity. So if the only Cancer Hospital in the island has been kept going on only four deed-ray units for the last thirty years just imagine how much profit the Multinational Companies that make chemotherapy drugs (researched by others) have made in the name of humanitarian healing. Stanley Nugawela, Hurikaduwa ###### From WHO office in Colombo : What is High Blood Pressure and Hypertension? * Blood pressure (BP) levels are continuously related to the risk of cardiovascular diseases (CVD). The definition of hypertension or raised BP is therefore arbitrary. Even with the normotensive range, people with lowest levels of BP have the lowest rates of CVD. * Because BP is characterised by large spontaneous variations, the diagnosis of hypertension should be based on multiple BP measurements taken on several separate occasions. Definitions are given in Table 1 below for subjects not taking antihypertensive medication. When a patient's systolic and diastolic BPs fall into different categories, the higher category should apply. ###### SLMC on foreign doctors by Edward Arambewala Foreign doctors working in BOI approved hospitals in Sri Lanka cannot work in any capacity outside the hospital to which they are attached not even conduct free health clinics, as they are on a temporary registration which restricts their practice only to their working place. So stated Dr. Ananda Samarasekera, Vice President of the Sri Lanka Medical Council in an interview with this page on this subject. He was commenting on several complaints the Council had received from the public that some of these doctors are overstepping their permitted limits to practise under the provisional Registration given to them. The Council was looking into these complaints, he said and in several cases have warned the doctors concerned to keep within the permitted area to practise. He also said that in giving temporary registration to practise in Sri Lanka the Council went on the recommendation given by the Health Ministry with regard to their qualifications and experience. The Council on its own did not check on them generally, unless it had its doubts about them. In such cases the Council had the power to satisfy itself by making its own inquiries. Dr. Samarasekera said that in fact in a few cases this had been done, and in one or two of them the sought registration had not been granted, as they were found wanting in experience. According to Dr. Samarasekera with more private sector hospitals being set up in the country, the Council was receiving about 500 applications annually for temporary registration of foreign doctors, dental surgeons, and nurses. He said the Council had the responsibility to ensure safety of patients under the care of these medical personnel and had in fact recommended to the Health Ministry certain amendments to the Council's (SLMC) Act providing for wider powers to the Council to deal with this subject. |
|
News | Business | Features
| Editorial | Security
Produced by Lake House |
