Heart help! What should I do if heart disease runs in my family?

MANILA, Philippines – As the leading cause of death around the world, heart disease is no joke. It’s a dire force to be reckoned with, especially in the Philippines, where heart disease and heart failure are becoming more and more prevalent, regardless of age.

The other conditions we hear a lot among Pinoy households – diabetes, hypertension, high blood pressure, and high cholesterol – all contribute to the increased risk of heart disease and heart failure, alongside the most important factor, which is family history. This means that if a family member has been diagnosed with heart disease or has died of heart failure, the risk of it being passed down to you is greater.

This may all sound a bit scary at first, but when it comes to your health, the truth – no matter how painful at first – can set you free. If heart disease runs in your family, there’s no need to panic and think you’ve been handed a life sentence. There is hope.

Dr. Erlyn Demerre, head of the National Heart Failure Network of the Philippine Heart Association (PHA) wants Filipinos to know that when it comes to preventing heart disease, nothing beats awareness – knowing what to spot, understanding what to do, and at the heart of it all, owning the accountability for one’s own heart health as early as possible.

Shot through the heart: When and how does the heart fail?

When you say “heart disease,” some may instantly think of a heart attack or a stroke. However, in an interview with Rappler, Dr. Erlyn clarified that this is actually the umbrella term that encompasses all heart-related conditions. These can involve the blockage of heart arteries, arrhythmia (irregular heartbeat), valve problems, and many more – all of which lead to the common path that is heart failure.

When heart problems that are either acquired or congenital (from birth) are unmanaged, this is what eventually causes your heart to fail.

Heart disease can be considered as part of a “cardiovascular continuum” that may end in heart failure, if not treated right away. Dr. Erlyn noted four stages of heart failure, starting with Stage A, which is a relatively “healthy” person with a set of risk factors. Stage B includes risk factors and structural damage to the heart due to a previous stroke or heart attack, Stage C is when the patient is already physically symptomatic, and Stage D already means end stage, which Dr. Erlyn said is hardly felt by patients with heart failure.

What should always be prevented is reaching the dire stage of epithelial dysfunction – this is when your arteries are aging faster than they should. This causes cholesterol plaque to build up in the walls of arteries (atherosclerosis), narrowing the arteries that makes it hard for blood to go through (think traffic on a highway). This is how blood clots form, leading to a heart attack or stroke.

“The goal in heart failure management is to make the heart meet our body’s needs. Once it cannot meet our needs for oxygen, because the pump function is bad, that’s heart failure,” Dr. Erlyn said.

Am I at risk? What symptoms should I watch out for?

If you feel like you’re at risk for heart disease, Dr. Erlyn said to start by profiling yourself. What is your age? Gender? Do you have hypertension, diabetes, and/or high cholesterol? Do you live a sedentary lifestyle? Do you have a history of cardiovascular disease in the family? Because prevention is always better than a cure, it is very important to determine your risk profile as soon as possible

When it comes to symptoms, Dr. Erlyn cited a few to watch out for in yourself:

  • Shortness of breath
  • What you used to be able to do easily (walk, climb the stairs) now comes with difficulty
  • Excess fluid in feet
  • Can’t lay down flat on your back
  • Can’t finish sentences when you start talking

“Anything that would show that you need more oxygen is when your heart cannot meet its full capacity anymore,” Dr. Elyn said. If you can no longer move around without having difficulty breathing, Dr. Erlyn said you must seek medical help right away.

Prevention is better than a cure

“Heart disease can be chronic, progressive, and debilitating; that’s why it’s important to be able to diagnose it early on. If we are able to create that awareness, even in children, that is better,” Dr. Erlyn said, reiterating that acquired heart disease can be prevented by watching our risk factors and managing them.

After all, nobody wants to end up in heart failure – it is a physical and financial burden not only on yourself, but also on your loved ones, society, and the healthcare system. Simply put, as the quality of your life becomes poorer, so does your productivity, job performance, mental health, relationships, and more.

“You really need to start by being preventative, so you are able to deal with risk factors that make you prone to heart failure, even without family histories. If you’re too late, this could lead to sudden death, or you could become a heart transplant candidate or eligible for device therapy, which is a locally-available procedure that helps to “resynchronize the heart,” Dr. Erlyn said.

What impacts heart health? Dr. Erlyn said that it definitely starts with a healthy lifestyle – this includes a good diet, regular physical exercise, and managing both mental and emotional stress. If you’re already in the farther stages, you may also already be taking certain medications and treatments.

If you’ve already suffered a blockage, stroke, or heart attack in the past, the goal is to prevent a second attack, which is called “secondary prevention” – risk factors need to be managed even more here.

I want to be more proactive. What’s next?

“It should start with extracting your own medical history, so it’s about time that we all asked our parents, uncles, and aunties,” Dr. Erlyn said. However, your genes are not your destination – although its likely that you may inherit their medical conditions, there are still ways to “hack your genes” and take control of your health.

After this, it’s time to see a trusted doctor. Don’t hesitate to tell them that you’re doing this for prevention – your doctor will guide you on how to check your risk profile and how to manage any early risks on.

“After your doctor reviews your history, they will perform a thorough physical exam, which includes checking for high-risk factors like diabetes, high cholesterol, and hypertension (high blood pressure), which is the number one cause of heart failure and very common in the Philippines,” Dr. Erlyn said. If your conditions need to be managed with medications, Dr. Erlyn wants Filipinos to know that there is nothing wrong with that, and that this may actually save your life.

“Some may fear that they will be dependent on medications, but medication is not the enemy – high blood pressure is. We just have to determine whether you need to be medicated or not,” she added. If your hypertension is only reactive to certain triggers like stress, a high-salt diet, or high sugar intake, then it can possibly still be reversed.

“These unhealthy habits – and denying medications – may actually be pushing heart disease patients into a state that can be even more costly in the future,” Dr. Erlyn said. If unaddressed, heart failure/disease can lead to hospitalizations, re-hospitalizations, surgeries, transplants, and expensive therapies.

“As doctors, we want you to know that taking care of your heart is multi-disciplinary – one big aspect is really your awareness, and the rest comes from the support of family, friends and your community, as well as the availability of tests , physicians, and specialists in your region,” she said. It’s also important to lessen the care and knowledge gap between specialists, general practitioners, family members, and patients, so greater awareness on heart health can be spread through this multi-faceted partnership.

Tests to expect

When it comes to testing for heart diseases, Dr. Erlyn said that she refers to these tests according to “Barangay, Regional, and Supreme Court” levels. “Barangay Level” tests include medical history, easy blood tests, lipid profiles, and sometimes, an ECG (electrocardiogram), which records the electrical activity of your heart.

The “Regional Level” testing usually includes “stress tests,” which help diagnose coronary heart disease. Stress tests will check if your heart can meet the metabolic demand of physical exercise.

The Supreme Court test is usually an angiogram, which determines if you already have a build-up of plaque in your vessels.

Heart strong from home

Aside from working closely with your doctor, there are other concrete ways you can take accountability for your heart health from the comfort of your home – all it takes is a few, simple changes to your routine, like regularly taking your own blood pressure using a blood pressure monitor. Monitor your BP a few days a week, but don’t get too fixed over it that it may cause paranoia or health anxiety. Make sure you also take it when you are rested (not stressed) and not after drinking caffeine.

You can also have regular blood chemistry tests done from home, just so you can gauge how your cholesterol and sugar levels are doing a few times a year with the guidance of your doctor.

Lastly, do not underestimate the power of a healthy, balanced diet. “It’s a big thing – nutrition – to improve your genes,” Dr. Erlyn said. But what really makes a “good diet?” Dr. Erlyn said that there’s no one specific diet that applies to everyone – what matters the most is moderation.

“I don’t believe in fad diets – zero carbs, zero fats – and all those expensive diets. There’s no ideal diet, but it’s a no-brainer that if you look at something fatty, that’s not good for the heart. Also if you are spending more on high-sugar foods like milk tea, soda…you could get diabetes,” she added.

You don’t have to look far to achieve a better diet – Dr. Erlyn said that the usual, simple, Filipino diet is already great. Just have less salt, more vegetables, less red meat, and less of the greasy, fried stuff.

“It’s really a balance. You don’t have to be strictly ‘none of this’ or ‘more of this’ – moderation is key,” she said.

It’s also important to monitor your uric acid levels, because the higher they are, the more prone you are to high cholesterol. Uric acid is an inflammatory marker that can lead to heart disease if not managed; And majority of Filipinos have high uric acid because of diets with too much nuts, seeds in vegetables, sardines, and canned goods.

Which foods need to be avoided to prevent high uric acid? Dr. Erlyn offered a handy acronym that may help: “Avoid SARSI.” S for soda or sugary drinks; A for alcohol; R for red meat; S for seafood; and I for innards.

“Try to be as healthy as early as possible – even children should already be taught a good diet at an early age. The message we have for everyone is to be proactive, and that having heart failure or heart disease is not a death sentence. It has been proven that it’s preventable,” Dr. Erlyn said. That fact alone should inspire and empower you to start taking a hold of your health as early as now, and not be heartbroken – there really is nothing to lose.

Don’t lose heart – you’ve got this! – Rappler.com

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