Belle interviews Dr. Tilluckdharry to investigate the leading cause of death among Caribbean women.

Heart disease is rampant throughout the Caribbean. Hence, BELLE has decided to bring to you first hand information from a leading Cardiologist in Trinidad about this disease. After all, knowing about the disease is your greatest weapon in your fight against it!

BELLE: Dr. Tilluckdharry, can you tell us if there is a difference between ‘heart disease’ and a ‘heart attack’?

“ Yes. The term ‘heart disease’ encompasses disease of all structures of the heart such as muscles, valves, nerves and so on, whereas ‘heart attacks’ are as a consequence of disease.”

BELLE: So, does heart disease always lead to a heart attack?

“Well, heart disease can manifest in ways other than heart attacks. Heart failure, palpitations, dizziness, blackouts, poor exercise capacity, and severe shortness of breath are all ways that heart disease can present itself. Some heart diseases can be silent or asymptomatic at first, and then present with sudden collapse and death; the so-called Sudden- Death Syndrome.”

BELLE: As a doctor, do you consider heart disease to be a large problem in the Caribbean?

“Heart disease, also categorized as Cardiovascular Diseases, are the most common cause of death and distress in the westernized world. The Caribbean is well included and ranks high. This is still the leading cause of death.”

BELLE: How many people a month do you see with serious, or potentially serious heart problems?

“Most medical offices, casualty departments, hospitals and hospital clinics are overcrowded daily with cardiovascular or heart disease patients.”

BELLE: How many of these patients are women?

“Women form a high percentage of heart disease patients. The risk of women dying from heart disease is as high as one in three (35%). The occurrence of heart disease increases with age, from one in nine (1 in 9) in the 45-64 age group, to one in three (1 in 3) after age 65.”

“The risk is considerably higher than cancer of the breast and other cancers even though cancers are so dreaded by most women.”

BELLE: I have heard that women who have not yet gone through menopause are protected from heart disease by the production of the hormone estrogen in their bodies. How true is this?

“ The female hormone does offer some protection before menopause, but this protection can be eroded by other risk factors, which women can have from an early age, such as diabetes mellitus, elevated or abnormal cholesterol levels, and cigarette smoking. Usually when women have heart attacks before menopause, they are either diabetics or smokers. On the whole, women tend to develop heart disease six to ten years later than men.”

BELLE: How can women take care of themselves and their families to prevent heart disease?

“The first step is to educate themselves to the fact that heart disease can affect and kill them. Secondly, from an early age they should look into monitoring and modifying their risk factors for development of atherosclerosis. A strong family history of early deaths (due to heart problems), high cholesterol, hypertension, or diabetes should ring bells. Also, attempts should be made to maintain optimal weight, exercise 150-200 minutes/week and control stress.”

BELLE: What about diet? Are there any specific foods that help to prevent heart disease?

“The best diet is one high in fruits, vegetables, low fat dairy products, legumes, beans, fish, chicken, turkey, and low in refined carbohydrates (white flour, sugar, soft drinks and fruit drinks). Fats should be high in monosaturates such as almonds, walnuts, peanuts, avocado, flaxseed and polyunsaturates like canola and soyabean oils.

BELLE: What type and duration of exercise is most beneficial for women in staving off heart disease?

“Exercise is very helpful in preventing Heart Disease, by its benefit in weight control, preventing and helping diabetes and hypertension. Any amount of exercise helps, but to get optimal benefit, one should aim for 200 minutes of intense exercise a week, approximately 120 minutes aerobic, and 80 minutes resistance exercise. Of course a programme like this has to be started cautiously, after cardiac assessment and be modified if there is existing heart disease or limitation.”

BELLE: What other things (habits, activities, food, lifestyle) should be avoided?

“Excessive weight gain should be avoided. Abdominal obesity increases the tendency to develop diabetes, hypertension and abnormal lipids, which has a multiplying effect in causing atherosclerotic plaque. Cigarette smoking should be avoided like the plague. Excessive psychological stress, domestic stress and passive aggression are all patterns of behaviour that lead to premature heart disease.”

BELLE: Is there anything that should be done or added to our lifestyles to maintain a healthy heart?

“Maintaining a balanced perspective when it comes to life, work, home and relationships is one way to maintain good health. A glass of wine, Concord grape juice or an occasional alcoholic beverage is not detrimental. One should also keep an eye on cholesterol levels, blood sugar levels and blood pressure, especially after the age of 40.”

BELLE: Are there symptoms or warning signs we should look for that indicate the oncoming of heart disease or a heart attack?

“The symptoms are usually different in women and men. Women are more likely to experience shortness of breath, weakness, fatigue and sleep disturbance. The anginal pain which is usually in the chest in men, tend to occur more in the neck, jaw, and back in women and to a lesser extent in the chest, where it may be associated with nausea. Because the symptoms are different from men’s, where the pain radiates to the arm and shoulder, the symptoms in women may be overlooked or misdiagnosed as stress or anxiety.

BELLE: What type of heart disease affects women most?

“The most common is atherosclerotic heart disease, which causes angina and Heart Attacks.

(Atherosclerosis is a chronic, progressive disease of the arteries in which “plaques” made up of cholesterol deposits, calcium, and abnormal cells develop on the inner lining of the arteries, impeding blood flow).

BELLE: What is angina?

“Angina is the term used for the pain which a person experiences from having a blocked artery. The pain usually arises from the lining of the heart, which senses a reduction in the flow of blood (and hence oxygen) to the heart muscle below it. The pain can radiate to the left or right shoulder, down the left or right arm, to the neck or jaw, on to the stomach pit. It is usually aggravated by exertion and relieved at rest. If a pain like this persists more than 20 minutes, it can suggest that a heart attack is developing.

BELLE: What should you do if having a heart attack yourself, and you are alone?

“The first thing that you should do is call for help. Call the Emergency Health Services, as well as a relative. Chew an aspirin 325mg tablet while waiting. Request to be taken to an institution that has the facilities and can deal with chest pain urgently.”

BELLE: What about if a loved one is having a heart attack. How can you help?

“As before, call for help and give an aspirin tablet to the person to chew on. Try to keep the person calm while getting him to an institution that can deal with the symptoms and complications urgently. If there is collapse, a few chest thumps followed by C.P.R. may be helpful.”

Dr. Roy K. Tilluckdharry
M.S.,B.S., D.M., (Int. Med.) F.C.C.P., F.A.C.C.
Consultant Cardiologist

Dr. Roy Tilluckdharry has been a practicing Cardiologist for the last 24 years. He studied at the University of the West Indies, Mona, and University of Western Ontario, London, Canada. He is a Fellow of the American College of Cardiology and Fellow of the American College of Chest Physicians. At present, he is the Director of the Coronary Care, Chest Pain and the Cardiac-Pulmonary Diagnostic Units and Medical Director, Cross Crossing Medical Centre, San Fernando.