Doc: Don’t overlook symptoms amid high repeat-attack, death rates

One in six of the 556 heart attacks recorded at the Queen Elizabeth Hospital in 2022 was not the patient’s first, figures presented by the Heart and Stroke Foundation have revealed. One in three patients did not leave the hospital alive.

Fitness trainer and general practitioner Dr Vicky Estwick gave the figures in a keynote speech at the foundation’s Annual World Heart Day luncheon at the Lloyd Erskine Sandiford Centre, held under this year’s theme, Using heart for action.

“The numbers are not pretty,” Dr Estwick said. “This is our own data from 2022. There were 556 heart attacks recorded at the hospital in 2022. Out of those 556, 14 per cent, so about one in six persons, it was not their first time having a heart attack. One out of every three did not leave QEH alive, and that is why the Heart and Stroke Foundation exists.”

The data was the foundation’s own, she stressed, adding that the organisation returns to the subject every year, even when people are tired of hearing it.

“The numbers are staggering, and something needs to be done,” she said. “We need to have some action.”

Dr Estwick’s speech focused on recognising the signs of heart disease, steps individuals can take to protect their heart health, and the role of policymakers and organisations in addressing the issue. She stressed that tackling the problem requires collective action, not placing responsibility solely on individuals.

Too many warning signs go unnoticed because people explain them away as tiredness or stress, she said.

“Females and persons with diabetes and other conditions that may affect how your nerves work actually do not get the typical chest pain.

“Sometimes it shows up as heartburn, indigestion, upset stomach, just feeling a little… lightheaded. I really love to blame things on air,” she said, describing a man who came to her with what he took to be heartburn after working in his garden.

The symptoms she listed also included fatigue, a fast or fluttering heartbeat, shortness of breath, leg cramps, chest pain and weakness.

Clinicians needed “a high index of suspicion”, she said, because hypertension and other cardiovascular risk factors are common in Barbados and many people go undiagnosed simply because they do not see a doctor.

“If you are over 30, go and book a yearly medical,” she said.

She warned against assuming good health without evidence. “If you have not had your blood pressure checked recently, you cannot say that you do not have hypertension,” she said.

Dr Estwick cited the World Health Organisation’s definition of health as a state of complete physical, mental and social well-being rather than merely the absence of disease, and said stress alone was enough to disqualify someone from calling themselves healthy.

She stated that on a plate, half should be fruit and vegetables, a quarter starch and a quarter protein – proportions she said which were usually reversed in the Caribbean. Macaroni salad, potato salad and dessert all count as starch, she said.

The fitness expert also underscored the importance of keeping active and moving. 

“Of course, mental well-being is very important, especially in persons with chronic disease. So, about one in five persons who have chronic disease have experienced some episode of depression.

“Let’s start with small sustainable changes. Let’s start with not changing your eating right now, but just add some vegetables to whatever it is that you eat.”

But she was blunt about why wholesale change fails.

“Don’t go and throw everything out of your fridge, and decide you exercise six days a week,” she said. “I can guarantee you, by next week, you’re not going to be doing it.”

She maintained that good governance was “a way that we put thought into action”, and that the part most often overlooked was equity and the social determinants of health.

Citing a London study that found that life expectancy tracked economic status, she said: “People with more money lived longer, and had a better quality of life. Not surprising, but this is an inequality that can happen even in a smaller place like Barbados, unfortunately.”

Meetings and speeches were not enough, she said: “We need to do more than just tick boxes.”

She pointed to the island’s free outdoor gyms as a measure few people knew existed. “If you drive around, there are some green and black structures around the island. Those are not play parks or jungle gyms. Those are free outdoor gyms for us to exercise, and they all have the instructions on them. 

“When one group of people does something and doesn’t tell the other group of people that they’re doing that thing, they can’t coordinate.”

Chronic disease costs the economy twice, the medic said: “One hour lost to sick leave from the chronic diseases, and two, the treatment of the chronic diseases because these medications are not cheap, and I know I always hear people say I pay my [National Insurance] contributions. I can tell you that your monthly NIS does not even cover the monthly cost of some of these medications, in addition to the other care received. So we really do need to work on this together.”

(LG)