Friday, January 20, 2006

Understanding angina: Silent CAD

This is part five of our series entitled the Heart of the Matter. Part four can be found here. The usual disclaimer applies.

We began the first four parts of this series by introducing coronary artery disease ( CAD ). We will be moving into some details about the presentations, and management of angina, an important form of manifestation of CAD.

Silent CAD (the silent majority)

Perhaps the most worrying point about CAD for the general population is the fact that CAD can be silent, and strike at any time, with a catastrophic heart attack. If only we had known, we would have taken action sooner. Well, is that true? Do we take action when the car is stalling, or only when it has broken down completely?

Suffice to say that symptoms only, is not a good way to judge if I am healthy or not. We can each recount stories of people whom we know to be so strong and healthy, who collapsed suddenly.

It is worthwhile noting that almost 70% of patients with CAD do not know it. They present either with sudden cardiac collapse, or with a heart attack. For these silent majority, we depend on cardiac checks and a healthy lifestyle, to avoid catastrophe.

The recent Ministry of Human Resources move to have all male workers above 40 years and all female workers above 50 years screen is certainly a good step in the right direction. Perhaps it is a good sign to note the recent trend in the country, of more wellness centers being set up, to screen people for all kinds of illness (including cardiac checks) is encouraging as CAD is best prevented. Early detection means earlier treatment with better long-term results of treatment and less wastage of resources.

In our attempt to identify this silent group, we would advocate that anyone with 1 or more coronary risk factors should undergo a routine medical check-up. Certainly all males above forty and females above fifty should go for a cardiac check.

Important coronary risk factors include :-
1. Age, sex – males above 40yrs and females above 50yrs.
2. Hypertension
3. Smoking
4. Raised blood cholesterol
5. Diabetes mellitus
6. Family history

Wouldn't it be nice if all insurance companies gave their male clients a free cardiac check once they have reach the "big" four-oh?

The next part discussing angina peectoris can be found here.

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