A heart-to-heart talk with Doc Salvador

It’s not every day that you get to have a heart-to-heart talk with, yes, a heart doctor. I consider myself really lucky to have been in the company of a roomful of heart and healthcare experts at the Healthy Hearts Healthy Aging Asia Pacific Conference hosted by Bayer last year at the National University of Singapore. As a follow-up to the conference and because February is the month for lovers and all things heart-related (we should love our heart, too), Dr. David Raymund Salvador, past president of the Philippine Society of Vascular Medicine and co-author of the Regional Healthy Hearts Healthy Aging Paper, sits down with us for a most heartfelt conversation.

I tell the good doctor that I have a friend who thought she was having a heart attack and thus took an aspirin before calling 911. When she got to the hospital, her doctor told her that she did the right thing. Will taking an aspirin prevent a heart attack (sudden blockage of the coronary arteries supplying the heart with blood and oxygen)?

“Yes, aspirin has been proven to prevent heart attacks,” says Dr. Salvador. “However, your doctor will determine whether you are suitable to take this medication on a long-term basis as it is not without side effects, like abdominal discomfort and gastrointestinal bleeding. Your doctor may also be able to provide an alternative medication if necessary.”

New vs. Old-generation drugs

The most heartening news is that there are now the newer oral anticoagulants (NOACs) which are as effective as the older-generation oral anticoagulant, known as warfarin, but with less rates of significant bleeding. “There are many issues regarding warfarin use, such as regular blood extraction and monitoring to determine whether its levels are already effective,” Doc Salvador explains. “Monitoring is important as high levels in the blood may result in bleeding. The newer drugs do not require regular blood monitoring and are less affected by food and other medications.”

A lot of my elderly friends take anti-cholesterol maintenance medication like they do their daily supplements. Should they stop once their cholesterol levels normalize?

“No,” comes Doc Salvador’s unequivocal reply. “The primary reason for taking anti-cholesterol maintenance drugs is to lower the overall risk of that patient to suffer from a cardio event (heart attack, stroke, leg amputation from lower extremity artery disease) in the future and not merely to lower cholesterol levels in the short term. Once it has been determined by your doctor that your overall risk to suffer from these conditions are significant (based on age, sex, smoking history, family history of cardiovascular disease, presence of concomitant hypertension and diabetes), these medicines should be taken for the long term, usually for life.”

While you’re sleeping

Why do most heart attacks happen in the morning? How do we prevent this?

Doc Salvador affirms, “It has been commonly noted that many heart attacks occur in the early morning, after waking up. The reason has not yet been fully explained by science, but one proposed explanation is that our BP is usually lower while sleeping but characteristically increases after waking up. One other explanation is that certain hormones, which affect the heart, have higher levels in the early morning. New studies have shown that taking medicine to control the blood pressure at night may be associated with better BP control and reduced incidents of heart attacks and strokes. Consult your doctor to determine the best treatment strategy appropriate for you.”

Could you have a heart attack and not know it?

“Yes,” says Doc Salvador. “Elderly patients, diabetics, and women are more vulnerable to this. Instead of the usual symptom of a heart attack, which is chest pain or heaviness, these persons may experience sudden breathing difficulty, loss of consciousness, palpitations, confusion or body weakness associated with low blood pressure. Knowing that these symptoms may occur, instead of the usual chest pains, may help those suffering from a heart attack to seek earlier medical attention.”

Heart attack or acid reflux?

This is a commonly asked question: What are the most common symptoms of a heart attack?

Watch out for these red flags, says Doc Salvador: “Sudden chest pain, described as a heavy squeezing or crushing sensation. The pain may be felt radiating to the left arm and the upper middle part of the abdomen. Some people may mistake this for acid reflux although a heart attack may also be accompanied by cold sweats and a sense of impending doom. Seek medical attention as there are times when it is not easy to differentiate between the two. An ECG and some blood exams may help determine if the patient is, indeed, having a heart attack. In heart attacks, time is muscle (the longer the patient waits to get treatment, the more damage there will be to the heart muscle) so it’s best to get medical help asap.”

Can you die of a broken heart?

Dr. Mark De Guzman, senior medical advisor and pharmacovigilance country head, Bayer Philippines Inc. Pharmaceuticals Medical & Regulatory Affairs, chimes in, “A psychiatrist once told me that during the holiday season, like Christmas and New Year, and even on Valentine’s Day, there are more incidents of people getting depressed (or suffering from the heartbroken syndrome).”

To which, Dr. Salvador adds, “There are chemicals in the body associated with depression. These chemicals can have a cardio-depressing potential.”

Do or Diet

Is the Filipino diet heart-healthy?

You and I know it’s not. But let’s hear it from Dr. Salvador: “The Filipino diet may have some unhealthy aspects. A lot of Filipinos love ‘unli rice,’ which goes well above the usual dietary requirements for carbohydrate intake. Instead of large servings of rice, the recommended five servings of fruits and vegetables should occupy half of our plates during regular dining. Fried food increases our intake of fats while the consumption of sodium (salt), which has been implicated in hypertension, is increased by the addition of salt, patis, and bagoong to flavor our food. Of course, the guiding rule is that everything should be consumed in moderation.”

What then is a heart-healthy diet?

Here’s the doctor’s recommendation: “A useful rule to follow is to divide your plate into four. One-half of the plate should be filled with vegetables and fruits; one-fourth with complex carbs like rice, pasta or bread, preferably high fiber and non-refined, while the remaining one-fourth should be allotted to proteins such as lean meats (meat trimmed of fat, chicken without the skin) or fish. Low-fat milk and yogurt can also be sources of protein. Limit intake of food with saturated fats, such as processed meats, and avoid trans fats. Limit intake of butter, hydrogenated margarine, and gravies. Avoid sugary beverages. Instead, drink plain water or fruit-infused water.”

Aside from eating right, how else should we take care of our heart?

Take this prescription from your friendly doctor: “We can do something about the modifiable risk factors ((like diet, lack of exercise, lifestyle). Ordinarily, what’s recommended is 150 minutes of exercise every week. You can simply allot one minute of every hour of the day for exercise, everywhere you go. You don’t really have to sweat, just feel your heart race. Even just sitting down and standing up is okay. Or you can just wiggle your toes, move your feet or elevate your legs to facilitate the flow of blood from your legs back to your heart. There’s an exercise/dance jingle that’s good for one minute being circulated among members of the Philippine Heart Association.”

If we really love ourselves, we will take these prescriptions to heart.