Growing heart disease raises health concerns in Nepal, Dr. Bhattarai

In recent years, heart disease has been increasing in Nepal. Among non-communicable diseases, heart disease ranks first. The growing burden of non-communicable diseases worldwide has significantly affected Nepal as well. Many people in the country are dying from heart attacks. There are numerous examples where individuals suddenly collapse and die, whether while sitting in a meeting or even while speaking. According to a study conducted by the Nepal Health Research Council in 2019, about 30 per cent of Nepal’s population suffers from some form of heart disease. In this context, our Gorkhapatra reporter Saroj Dhungel spoke with senior cardiologist Dr. Anil Bhattarai. Excerpt:

What is heart disease? What kind of disease is it ?

Heart disease includes many different conditions. Although we commonly use the single term ‘heart disease,’ it actually encompasses around 40 to 50 different types of diseases. These include congenital heart disease, heart valve disorders, coronary heart disease, and disorders of heart rhythm. In some cases, patients may require the implantation of a pacemaker. Some diseases affect the large arteries originating from the heart. The heart is an organ, but it consists of several internal structures, and disease can affect any of them. For this reason, heart disease includes many different conditions. The type of heart disease a person develops can depend on factors such as age and genetic predisposition.

What causes heart disease ?

Heart disease can affect not only adults and the elderly but also children. Some children are born with heart defects, which are known as congenital heart diseases. These conditions can range from relatively simple defects, such as a hole in the heart, to very complex problems. Some cases require surgery in two or three stages, and in certain situations, surgery must be performed immediately after birth. If surgery is not carried out in time, the child’s life can be at risk.

Rheumatic heart disease is another condition, caused by bacterial infection. As the infection spreads gradually, it can damage the heart over time. Heart disease can also occur when fat accumulates in the blood vessels or when calcium deposits build up in the arteries.

 In some cases, blood clots form in the body and travel to the heart. Several risk factors increase the likelihood of heart attacks. These include uncontrolled diabetes, poorly managed cholesterol levels, highly stressful lifestyles, smoking, and excessive alcohol consumption.

 Lack of regular exercise also increases the risk. People with high blood pressure are particularly vulnerable, and over time, these conditions can lead to serious heart disease.

What are the symptoms of heart disease ?

When someone develops heart disease, they may feel weak and fatigued. In some cases, symptoms may not be noticeable in the early stages. However, patients often experience a sensation of heart palpitations. Another common symptom is a feeling of heaviness or a burning sensation in the chest. People may experience shortness of breath when walking uphill and may need to stop while walking. For example, someone who previously could climb five floors comfortably may feel breathless even when climbing a single floor. 

Chest pain that occurs during physical activity and disappears after resting can also be a sign of heart disease. As the disease progresses, it may affect the heart valves and blood vessels, and patients may develop swollen legs. They may also experience dizziness or light-headedness. Everyday activities may be difficult, and once easy tasks, such as lifting objects or moving items from one place to another, may become challenging.

What is the situation of heart disease in Nepal ?

Heart disease is not only a major problem in Nepal but also worldwide. Overall, around 30 per cent of deaths worldwide are caused by cardiovascular diseases. According to data published by the Nepal Health Research Council in 2019, approximately 27 per cent of deaths in Nepal are caused by cardiovascular disease. 

Similar to developed countries, cardiovascular disease has now become the leading cause of death in Nepal. Compared to the past, the number of heart disease cases has increased significantly in the country. In fact, diseases that cause heart attacks have doubled in Nepal over the past decade, and cases of heart attacks are rising day by day.

Who are at risk of heart disease ?

People with a family history of heart disease are at higher risk. If someone in the family has died from heart disease or is taking medication for heart-related conditions, other family members face a higher risk as well. Individuals with high blood pressure are also at greater risk. 

Those with genetic predispositions or hypertension should be particularly cautious because they may develop heart disease in the future. Except in cases of congenital heart disease, individuals over the age of 30 should have their hearts examined once a year. This helps determine whether they currently have heart disease or whether they are at risk of developing it in the future.

Obesity is another major risk factor. In simple terms, physically inactive people are more likely to develop heart disease. 

Even people who do not smoke or drink alcohol sometimes develop heart disease. One reason is that they may not be aware of their cholesterol levels, which may be high. Another reason could be a lack of regular physical activity. Excessive smoking and alcohol consumption also increase the risk. In addition, individuals with diabetes, those who sleep very little, and people who live under constant stress are more likely to develop heart disease. Stress hormones in the body can indirectly damage the heart over time.

Cities such as Kathmandu have high levels of pollution. Does this affect the heart ?

Yes, pollution is also a risk factor. The air we breathe contains various toxins. These toxins not only affect the lungs, but they can also damage blood vessels. Inside our blood vessels, there is a layer called the intima. Blood vessels have three layers, and blood flows through the inner layer. 

Pollution can damage this inner layer, causing blood cells to accumulate there. Over time, this affects the small arteries and can lead to heart disease. If it affects the arteries that supply the heart, it can cause heart attacks. If it affects the arteries in the legs, it may even lead to conditions that require amputation. In particular, pollution damages the inner lining of arteries through which clean blood flows, and this damage increases the risk of heart disease.

How is heart disease tested in Nepal ?

Heart disease can be diagnosed through various methods. For people over the age of three, health packages can be used to check cholesterol and blood sugar levels. After that, a basic test called an electrocardiogram, or ECG, is performed. An ECG measures the electrical activity and rhythm of the heart and can indicate whether there may be problems with the heart’s blood vessels. It can help detect heart problems at an early stage. Another test is echocardiography, which is essentially an ultrasound of the heart. This test shows the condition of the heart valves and the strength of the heart walls. Based on this, doctors can determine whether certain heart conditions may be present.

However, these tests alone may not detect every heart disease. If symptoms persist despite normal results, more advanced tests may be required. For example, if there are concerns about irregular heart rhythm, a Holter test may be conducted. This involves monitoring the heart’s rhythm for 24 hours using a portable device. Doctors may also perform a CT scan to check whether the heart’s arteries are blocked. Another important test is coronary angiography, in which a thin wire is inserted through a blood vessel in the arm or leg, and a special dye is injected into the coronary arteries to visualise them on imaging. 

This test helps determine whether there are blockages in the heart’s arteries, the percentage of blockage, and which artery is affected. In more complex cases, doctors may also evaluate the heart’s pumping function and the viability of the heart muscle. Congenital heart diseases can be examined through catheter studies, which can also measure pressure within the heart chambers.

How can people find out whether they have heart disease?

Since heart disease is one of the most common diseases worldwide, everyone over the age of 30 should have their heart examined once a year. This includes undergoing an ECG test. If any abnormalities are suspected, echocardiography should also be performed. Blood tests should be done to check cholesterol and sugar levels. 

Kidney function tests can also provide useful information about overall cardiovascular risk. If people begin regular heart checkups from the age of 30, a heart condition that might otherwise appear at age 50 could potentially be delayed until 60 or 70. Even simple tests such as ECGs and blood tests for cholesterol, kidney function, and sugar levels can help predict the likelihood of developing heart disease in the future.

What kinds of heart surgery technologies are available in Nepal ?

About 95 per cent of heart disease treatments are available in Nepal. Only a few procedures are not yet widely available, such as artificial heart support devices and heart transplantation. Apart from these, most types of heart disease can be treated in Nepal. Surgeries are performed to repair holes in the heart, treat severe heart diseases, and correct complex congenital heart defects. Some patients require multiple surgeries, and these procedures are now performed successfully in the country. 

Technologies used worldwide for heart valve repair and replacement are also used in Nepal, including those commonly used in the United States.

In Nepal, angioplasty procedures using stents are performed to open blocked arteries. Pacemakers are implanted in patients who experience severe irregular heart rhythms and sudden fainting. In some cases, holes in the heart can be closed using catheter-based techniques without open surgery, although this is not possible in every case. 

When angioplasty is not suitable, open-heart surgery may be performed. One common procedure is bypass surgery, which can be done either by temporarily stopping the heart or while the heart continues beating. 

Doctors in Nepal are also treating patients with conditions where the heart becomes enlarged or ruptures. Today, there is generally no need for Nepali patients to travel abroad for most heart treatments. In fact, doctors in Nepal have even performed surgeries on foreign patients. Nepal has made significant progress in the treatment of heart disease, although heart transplantation is still not available in the country.

What should people do to keep their hearts healthy ?

The most important step in maintaining heart health is regular physical exercise. If a person exercises regularly, the risk of developing heart disease can be reduced by about 50 per cent. Even people in their 40s or 50s who maintain consistent physical activity can significantly lower their chances of developing heart disease.

Could you explain heart attacks in detail ?

A heart attack is a serious and life-threatening condition, and everyone should be aware of its dangers. A heart attack occurs when blood flow to the heart muscle is suddenly blocked. The heart receives blood through three major blood vessels known as the coronary arteries. If any one of these arteries becomes blocked, the heart cannot pump blood effectively. 

As a result, blood pressure drops, and the person may collapse suddenly. Blood pressure can fall to extremely low levels, such as 80/40 mmHg. At that moment, the person may lose consciousness. If someone nearby immediately recognises the situation and provides chest compressions or emergency treatment, the person may survive. However, if help does not arrive in time, the lack of blood flow can lead to death.