Coronary Artery Disease - A Worldwide Killer

"Coronary artery disease is the most common form of heart disease and is responsible for 15 million deaths worldwide. Nine million of these deaths occur in developing countries. Moreover, millions of victims remain alive yet hopelessly crippled." This was stated by Dr Sajid Dhakam, Assistant Professor and Consultant Cardiologist at Aga Khan University Hospital (AKUH), Karachi . Dr. Dhakam was giving a presentation on 'Coronary Artery Disease - Options in treatment' at 'Signs, Symptoms and Care', a health awareness programme held on October 5, 2004 at Hotel Sheraton Deira, Dubai and on October 6, 2004 at Hotel Intercontinental, Abu Dhabi .

Audience at Signs, Symptoms and Care on coronary artery disease. As part of its societal commitment to creating awareness of early diagnosis and timely treatment, AKUH has organised over 150 Signs, Symptoms and Care programmes in Karachi, Hyderabad and the UAE, benefiting over 33,000 people.

"Narrowing of coronary arteries is caused by deposits of cholesterol-rich material in blood vessels," explained Dr Dhakam. "The subsequent formation of a clot leads to a heart attack and 50 per cent of patients who suffer an attack do not survive. In fact they do not even make it to hospital."

Dr Sajid Dhakam, Assistant Professor and Consultant Cardiologist at Aga Khan University Hospital (AKUH), Karachi.

According to Dr Dhakam, the risk factors associated with blockages in coronary arteries include age, male gender, positive family history, diabetes mellitus, high blood pressure, high cholesterol levels, smoking, lack of exercise and obesity. "Such risk factors may be modified to prevent and control the disease," Dr Dhakam added.

Coronary angiogram is the gold standard for the diagnosis of coronary heart disease and provides vital information for management planning. "It is a low-risk procedure and the overall risk of major and minor complications is less than 0.5 per cent," disclosed Dr Dhakam, adding that coronary angioplasty is a therapeutic procedure which involves opening blockages with a balloon.  "It is not a surgical procedure. Metallic stents are used after opening the artery and this helps keep the arteries patent. Moreover, the new medicated stents reduce the re-stenosis, or recurrence of blockage, rate."

Dr Saulat Fatimi, Assistant Professor and Consultant Cardiothoracic Surgeon at AKUH.

In a presentation titled 'Heart Surgeries in Adults and Children in the 21^st Century', Dr Saulat Fatimi, Assistant Professor and Consultant Cardiothoracic Surgeon at AKUH, described recent advancements in cardiac surgery. "Today new breakthroughs in surgical procedures are redefining cardiac surgery and dramatically improving patient outcomes," said Dr Fatimi.

The 21^st century, he added, is not only witnessing new procedures but also the increased safety of existing methods. "Adult cardiac surgical procedures such as coronary artery bypass surgery, valvular repairs and replacements, aortic surgery, surgery for congestive heart failure, placement of assist-devices for failing hearts and heart transplantations are routinely performed all over the world with minimal morbidity and mortality," he explained. The same holds true for congenital cardiac surgeries and general thoracic surgery. "Industry has paralleled the growth and development of cardiac surgery. More efficient heart-lung machines, improved heart valves, and smaller and more durable pacemakers are all products of technology applied to improve the safety of cardiac surgery," said Dr Fatimi.

Dr Fatimi pointed out that this trend is not limited to the western world. "All adult and paediatric cardiac surgeries, such as coronary artery bypass surgeries - even those on failing hearts - valve replacements, aortic surgeries, repair of ventricular and atrial septal defects, repair of Fallot tetralogy and right-heart bypasses in univentricular hearts are routinely performed in our part of the world with success rates of approximately 99 per cent," revealed Dr Fatimi. He further said "coronary artery surgeries in cardiogenic shock or ongoing heart attacks and open heart surgeries in very small infants, which are undertaken only at specialised centres in the West, are now routinely performed at AKUH with excellent results."

The Chief Guest, Amanullah Larik, Pakistan Consul General

In terms of post-operative care, said Dr Fatimi, "most centres in the developing world are not comparable with those in the West. But a number of centres do provide excellent post-operative care." Cardiac surgeons, he stressed, must be primarily responsible for the post-operative care of their patients, including that provided in the intensive care unit. "While some of that care may be shared with nurses and other physicians, it is only the cardiac surgeon who is fully cognizant of all aspects of a patient's condition and retains the responsibility for continuity of care. This includes not only the pre-operative status and operative management but also post-operative care, he explained. "Cardiothoracic surgeons at AKUH share this philosophy and that is why our results are comparable to North American STS standards," he informed. 

Talaat Tyabji, Director, Marketing and Public Affairs, Aga Khan University

In her welcome address, Talaat Tyabji, Director, Marketing and Public Affairs, Aga Khan University , informed the guests that AKUH is a philanthropic not-for-profit institution committed to the delivery of quality health care to all segments of society. "This academic medical centre is a 654-bed facility which is being sequentially phased into service. At present 550 beds are available. The Hospital's multidisciplinary to diagnosis and care ensures a continuum of safe and high quality care for patients - all services under one roof. It has become a major referral centre in Pakistan and regularly receives patients from the Middle East , Bangladesh and East Africa .

AKUH's Representative Office in Dubai was inaugurated in May 2002 and is located at the Oud Metha Office Complex, providing convenient access to AKUH's high-quality and cost-effective services to patients in the United Arab Emirates.

As part of its societal commitment to creating awareness of early diagnosis and timely treatment, AKUH has organised over 150 'Signs, Symptoms and Care' programmes in Karachi , Hyderabad and the UAE, benefiting over 33,000 people.

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