How much do we really know about heart failure?

Dr. Zesi Ngubane speaks about heart health awareness and the misconception surrounding heart attacks

When people hear that a patient is seeing a Cardiologist, they assume it is over a heart attack.

This isn’t always correct, says Dr. Zesi Ngubane who is a cardiologist at Busamed Paardevlei Private Hospital in the Western Cape.

“If you think about the cardiovascular system, it encompasses the heart itself but also the vasculature – which pertains to the blood supply to and from the heart. So, we treat all the diseases that affect the heart muscle itself, coronaries (blood supply) but also the heart valves and the conduction system of the heart.”

She says the conduction system entails “all your rhythm disturbances.”

Dr. Ngubane says a large part of her treatment involves ischemic heart disease which is mostly a lifestyle disease although it can be genetic as well. This disease, along with hypertension forms the “major burden of heart disease.”

Lifestyle habits that lead to hypertension and diabetes, like smoking and consuming a diet high in cholesterol and processed carbohydrates put you at risk for ischemic heart disease.
She says in ischemic heart disease, plaque settles in your arteries which could lead to myocardial infarctions or heart attacks.

Dr. Ngubane says that information on wellness is in the public domain and that simple lifestyle modifications that have been suggested in the past are relevant today.

She says heart failure is another dire outcome that is related to poor lifestyle habits. “A lot of our population has hypertension and hypertension is the leading cause of heart failure.”
This is not to say hypertension is the only cause of heart failure, but it is indeed a cause that can be controlled before it results in complications.

Dr. Ngubane says that because heart disease is so prevalent in society, General practitioners also treat it. “Once your GP finds that they have reached their limit in their management, you will be referred to a specialist who has a more focused approach to treatment.”

There are typically three stages to treatment that a patient can expect. These include conservative management, medical therapy and finally more directed therapy which may involve being treated by a medical procedure which takes place in the catheterization (cath) lab.

Conservative management is basically an observation stage or a wait-and-see approach that gauges the extent of damage or dysfunction.

Medical therapy includes the use of pharmaceutical intervention to control symptoms and manage a condition.

An example of an intervention that occurs in the cath lab is percutanous coronary intervention (PCI), which is an invasive step in which an angiogram is performed; especially after a heart attack to determine where the occlusion in the vessel is located and possibly implant stents in order to re-establish normal coronary blood flow in the affected artery.

If PCI fails or is not feasible Dr. Ngubane says a cardiothoracic surgeon would be consulted. She said it was important for patients to remember the many advancements have been made in interventional cardiology, these include but not limited to transcatheter valve replacements, where an aortic valve for example can be replaced via a procedure through the groin without requiring open-heart surgery.

Aortic stenosis is a type of heart valve disease where the aortic valve is narrowed and doesn’t open fully, usually affecting the elderly due to degeneration of the aortic valve caused by progressing age.

“The field of cardiology is vast and allows for the cardiologist to treat medical conditions whilst also being very hands on and with the advances that are continuously being made in the interventional field, we can offer more extensive management options for an array of heart problems.”