The aim of taking medicine is to prevent the long-term ill effects of this high blood pressure. It will prevent stroke, heart attack, heart failure, kidney failure and other organ failure. Therefore, you may feel well today without any medicine, in years to come, your organs will be damaged and this will lead to unnecessary sufferings.
This is one the most common misconception that patients have. To go straight to the point, there is no law against stopping your medicines. You can stop taking your medicines or stop seeing your doctor any time you chose to.
Taking your medicines is like paying for insurance premium. As long as you pay your premium, you are covered against accidents. Taking your medicine for high blood pressure, high cholesterol or even diabetes is like paying your insurance premium. As long as you are taking them, they protect you against getting serious disease like stroke or heart attack. You may stop them anytime. But the risk of getting stroke or heart attack returns to the same level as before you started treatment. Therefore while you can stop your medicine, it is really not advisable. Compliance with your medication will greatly reduce your chances of getting serious complications and lets you live a full life.
Like high blood pressure, high cholesterol also produces no symptoms. The damage done is slow and over the years. Arteries slowly become blocked. Eventually, it will lead to stroke and heart attack. This is why cholesterol has to be lowered.
The level to which cholesterol is lowered is dependent on the person’s risk profile. Those who have had a heart attack, blocked artery, stroke or diabetes will need to have lower levels than those who don’t. Therefore, while 2 people’s cholesterol levels may be the same, their risk profile may be different, thus requiring slightly different target for treatment.
Thankfully, not all chest pains are due to heart attack. In fact, statistically, around 80% of people who turn up to the clinic with chest pain, have nothing wrong with their heart. But it is the other 20% we are most concerned with. The only way to be sure that you do not fall into the other 20% is to see a doctor when you get chest pain.
The doctor will need to assess your symptoms carefully. He will have to know where is the pain, what is the character of the pain and what might set the pain off. He will also have to assess your risk factors for heart attack such as presence of high blood pressure, diabetes or family history of heart disease.
After which, tests may need to be performed to make sure your chest pain is not originating from your heart. These may include some form of stress test, CT angiogram or even coronary angiogram.
As the artery becomes more narrowed by the collection of cholesterol, the wall over the cholesterol pool becomes thinned and fragile. This compromised wall may sometime crack open, exposing the cholesterol underneath. Once this cholesterol is in contact with the blood, a chain reaction takes place resulting in the rapid and total blockage of the artery. You will then experience a severe chest pain like that described above. However, this pain will last much longer and will not ease with rest. This usually results in permanent damage to your heart muscle if treatment is not started immediately. This is a Heart Attack.
The 1st is in the setting of heart attack. The 2nd is in the setting of stable ischaemic heart disease.
In the 1st scenario, it is well proven that stenting of the affect artery saves lives and lowers the probability of having repeated heart attack. The use of stents here is absolutely necessary.
In the 2nd scenario, more factors have to be taken into account. These will include your symptoms, such as if you are experiencing any angina and how severe they are, if your stress tests were abnormal, how severely blocked are the arteries and how many blocked. Therefore, this is a more complicated issue. You would want a doctor whom you feel is able to give you a balanced opinion and who can explore with you the alternatives. There are cases where a by-pass operation is best suited to you and some times just medication would be better for you.
Breathlessness can originate from the heart or the lungs, sometimes a combination of both. You will need to see a doctor to be properly assessed. He will need to ask you questions about the character of your breathlessness. When does it come, what makes it worse and if there are other symptoms associated with it.
For the heart doctor, an echocardiogram will be a useful tool to assess the function of your heart. This will check your heart muscles and the valves’ function. Sometimes, a stress test may also be useful.
If your symptoms sound more like it has originated from the lungs, then your doctor will refer you to an appropriate specialist.
However, if you or your family members already have any one of these conditions, you should start and continue regular screening at an even earlier age such as 30 years old.
Sadly, the answer is ‘No’. At best – ‘Not yet’. Chelation therapy involves injection of a substance called ‘EDTA’ into the blood stream. The idea is that it will remove the calcium deposited in the blocked artery. Thereby improve the artery’s function and relieve the blockage.
There are very few well-conducted studies. One notable study called ‘Program to Assess Alternative Treatment Strategies to Achieve Cardiac Health’ (PATCH) trial showed no benefit what so ever between placebo and active therapy. On the other hand, there have been cases of adverse reaction reported from its use. Therefore, until there is evidence for the use of this alternative therapy, it is best avoided for now.
These devices are not new. They have been around for the last 10 years or so. There are 2 main types. One that bites off the cholesterol plaque and one that drills through the plaque. But as experience and data in these devices accumulates, it is found that they don’t perform better than stents. In fact, the device that takes bite out of the plaque has stopped production. The drill called ‘Rotablator’ has a niche market in treating heavily calcified plaques. Therefore, they are still in use, but only in specific circumstances. Stents are still the best therapeutic option.