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Heart Disease -

Definition:

Ischaemic heart disease is disease of the heart that results from insufficient oxygen supply to the heart. It occurs as a result of narrowing of the arteries to the heart by deposition of debris, known as atheroma, in the inner lining of the arteries.

Symptoms and implications:

The typical symptom of reduced oxygen supply to the heart is angina, which is a symptom complex comprising crushing chest pain that may radiate into the arm or jaw and may be associated with nausea, sweating and shortness of breath. Typically it is brought on by exertion or stress and passes if the exertion is immediately stopped or medication that dilates the arteries is taken soon after onset of the symptom.

When reduced oxygen supply to the heart reaches a critical level, some of the heart muscle dies. We call this myocardial infarction, which is more widely known as “heart attack” and can result in sudden or delayed death.

Risk factors for ischaemic heart disease include:

• Family history of ischaemic heart disease
• Cigarette smoking
• Abnormal cholesterol profile: high LDL, low HDL and high triglycerides
• High blood pressure
• Diabetes, especially type 2 with insulin resistance
• Obesity
• Lack of exercise

Effects of bariatric surger:

Treating morbid obesity with bariatric surgery results in significant, sustained weight loss, as well as reversal or improvement in the hypertension, type 2 diabetes and hyperlipidaemia. The lower blood pressure reduces strain on the heart muscles, thus reducing oxygen demand by the muscle. The weight loss means that less effort is required to move the heavy body around, so also reducing the strain on the heart. Improvement in the diabetes and lipid profile results in reduced deposits of atheroma (artery debris), so the narrowing of the arteries will be curtailed.

Nevertheless, because irreversible damage to the coronary arteries may have already taken place, ongoing, long-term follow-up will still be required.