Restricted blood flow, Is your heart pumping well?

 

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The heart has to work very hard if you have aortic stenosis, a condition where the aortic valve narrows and blood cannot flow normally.

OUR heart’s main job is to supply oxygen-rich blood to the body.

Our life literally hangs on how well blood is pumped through our four heart chambers with the help of four heart valves (aortic, mitral, pulmonary and tricuspid), which open and close with each heartbeat.

Imagine the precision and intricacies of a healthy heart – it beats 100,000 times a day during which the mitral and tricuspid valves control blood flow between the heart chambers.

The pulmonary valve controls blood flow to the lungs while the aortic valve controls blood as it flows out from the heart’s lower left chamber to the aorta, the main artery bringing blood to the rest of the body.

A life-threatening condition 

 

When the aortic valve does not function optimally, blood flow is restricted due to the narrowing (stenosis) of the area where blood is moving out of the heart.

Your heart will then need to work harder to pump blood to the rest of your body, affecting your health and limiting your daily activities.

This condition is called aortic stenosis and it’s a progressive disease that ranges from mild to severe.

Often, this condition may go unnoticed as patients go about their daily lives discounting the irregularities in their well-being.

Aortic stenosis is the most common valvular heart disease worldwide, with its prevalence increasing with age.

It is estimated that up to 12.4 % of people over age 75 have aortic stenosis, and about 80% of adults with symptomatic aortic stenosis are male.

Symptoms generally occur when narrowing of the aortic valve is severe.

However, some people with aortic stenosis may not even have symptoms for many years.

If you demonstrate symptoms such as chest pains or discomfort during physical activity, dizziness, fatigue, shortness of breath and an irregular heartbeat, don’t dismiss it.

Consult a physician. 

Understanding the disease

If diagnosed with aortic stenosis, it means your aortic valve is not opening or closing properly.

This limits the amount of blood pumped out to your body and strains your heart.

Over time, the left ventricle of your heart can thicken and enlarge.

Heart muscles will weaken and this can lead to heart failure and complications such as stroke, blood clots, bleeding, irregular heart rhythms and infections of the heart.

Left untreated, it can be fatal. It is important to understand the difference between aortic stenosis, atrial fibrillation and myocardial infarction.

While all are cardiovascular related, they are different and require different treatment approaches.

Atrial fibrillation is a disorder that originates from the atrium (upper chambers of the heart).

When the atrium does not contract effectively, irregular and rapid heart rhythm occurs.

Blood can pool in the heart, running the risk of blood clots which may lead to stroke.

Myocardial infarction, commonly known as a heart attack, occurs when there is a rupture of an atherosclerotic plaque in a coronary artery.

This causes a blood clot that obstructs blood flow.

Very simply put, aortic stenosis is a valve disorder, atrial fibrillation is an irregular heart rhythm and myocardial infarction is a heart attack caused by a blocked coronary artery.

Root cause 

Aortic stenosis is commonly due to a build-up of calcium compounded by contributing factors such as age and existing congenital heart defect.

Some individuals may be born with aortic valve disorders and are more prone to aortic stenosis later in life.

Other causes include infection of the heart, chronic kidney disease, heart disease risk factors such as diabetes, high cholesterol and high blood pressure, or a result of radiation therapy.

Diagnosis and evaluation

If aortic stenosis is suspected, your cardiologist will recommend diagnostic tests, as outlined below, depending on the assessment of your condition.

> An ultrasound imaging test called an echocardiogram to visualise the aortic valve and assess its structure and condition.

This test identifies weakened muscles and determines the severity of the aortic stenosis.

> An electrocardiogram or ECG measures the electrical activity of the heart and detects any potential issues with the heart’s chambers.

> A chest x-ray determines the condition of the heart and lungs and detects if there is swelling in 
the aorta and/or calcium build-up on the aortic valve.

> If needed, a cardiac computerised tomography (CT) scan or a cardiac magnetic resonance imaging (MRI) may be done.

> Only when needed or when other non-invasive test are inconclusive, a cardiac catheterisation or a cardiac angiogram may be recommended.

Treatment modalities

Lifestyle modifications are necessary, regardless of the stage of your aortic stenosis.

Start consuming a hearthealthy diet.

Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish and whole grains.

Avoid saturated and trans-fat and excessive salt and sugar.

If you are overweight, lose weight through regular exercise; brisk walks each day are recommended.

Manage your stress levels. Indulge in wholesome activities.

If you are a smoker, consider quitting.

In cases of mild aortic stenosis, your cardiologist will prescribe medications which are a non-invasive.

It can provide a temporary relief of symptoms and may reduce risk of complications.

However, medications alone do not address the underlying valve issues.

Patients may risk a decline in their condition over time.

Thus, it is essential to diligently keep your regular heart checkups to monitor the progression of your condition.

In more severe cases, aortic stenosis patients may have to undergo procedures to repair or replace their defective valves such as :

> Balloon valvuloplasty (BAV) 

This is a non-surgical option which involves a balloon being inflated in the aortic valve to improve blood flow. This treatment typically provides only temporary relief of symptoms and patients risk restenosis of the valve over time.

> Surgical aortic valve replacement (SAVR)

This offers a longer lifespan for the replaced valve and is often the conventional treatment for aortic stenosis.

However, being an open-heart surgery, it carries inherent risks especially for elderly patients and those with underlying health conditions.

These surgical valve replacements may also wear out over time and can start to fail and causes stenosis and regurgitation (valve does not fully close and blood flows backward through the valve).

Patients are advised to stay in the hospital for seven days.

> Transcatheter Aortic Replacement (TAVR)

This is a minimally invasive procedure performed between one to two hours as compared to an invasive open-heart surgery.

A small cut is made in the groin, neck or between your ribs so that a thin, flexible tube with the TAVR can be guided and placed in your diseased valve.

The new valve will then work immediately, and the tube is removed.

TAVR is designed to work like your own heart valve as the materials used allow the frame to mold itself to your anatomy.

It’s worth noting that the artificial TAVR valve can be made of porcine or bovine materials.

This procedure is suitable for patients who are considered highrisk or unsuited for open-heart surgery.

Patients can consult their cardiologist for other suitability criteria.

This involves shorter hospital stays of about three days as patients recover faster.

Institut Jantung Negara (IJN) was the first hospital in Malaysia to do a TAVR procedure in 2009.

At that time, some in the medical fraternity shared their uncertainty about the durability or longevity of a TAVR and thought it may only last for five years or less.

They preferred conventional surgery which was known to last for about 10 years.

The TAVR has since grown in acceptance and has been proven to stand the test of time.

For 83-year-old aortic stenosis patient, Siti Rahmah, who was implanted with a TAVR in 2011, it has still been functioning effectively.

She recently shared, “I am very pleased with the progress I have made. It has been 12 years since I did the procedure. I am thankful that I can go about my daily activities quite comfortably. My condition has been well managed.”

Take action

Those at-risk patients and 65 years and above should never undermine the importance of regular heart check-ups to detect irregularities of the heart.

Aortic stenosis is a serious cardiovascular condition.

Left untreated, it can lead to significant health problem while early diagnosis and a personalised treatment can prolong life.

By Datuk Dr Shaiful Azmi Yahaya is a senior consultant cardiologist at Institut Jantung Negara. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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HGH function

Any exercise, resistance or aerobic, brings about a significant increase in human growth hormone (HGH). Insulin-like growth factor and growth hormone are responsible for increased collagen synthesis after exercise and aids muscle recovery. Growth hormone itself does not directly cause muscle hypertrophy but it aids muscle recovery and thereby potentially facilitates the muscle strengthening process.[15] The accumulation of lactate and hydrogen ions (eg in hypoxic training) further increases the release of growth hormone. [13]

High intensity training has been shown to down regulate myostatin and thereby provide an environment for muscle hypertrophy to occur.[12] Myostatin controls and inhibits cell growth in muscle tissue. It needs to be essentially shut down for muscle hypertrophy to occur. 

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We need to get out of the well from rejecting letters not in Bahasa Malaysia

 

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A decision to reject all letters not in bahasa malaysia is likely to lead to mono-lingual government officers with little ability to deal with the ever-cosmopolitan world, with many living under the proverbial ‘tempurung’.

A FEW weeks ago, a little girl wrote to our Prime Minister, complaining about the toilets in her school.

Calling him Uncle Anwar, the nine-year-old said the cubicles were dirty and did not have sitting toilets, only the hole-in-thefloor squatting type.

She asked Datuk Seri Anwar Ibrahim to come visit and help. The Prime Minister was gracious in his reply.

“Thank you, Maryam,” he told the girl in a Facebook posting. “I will try to thoroughly and quickly solve this problem for the well-being of the children at school.”

I am so glad the Prime Minister did what he did, and not reject the letter outright.

Maryam had written to him in English, not the national language.

Anwar had replied in English, too.just days later, the same Prime Minister announced that all letters to government departments and universities should be sent back to the senders if they are not written in Bahasa Malaysia, the national language.

Maryam would have been disappointed.

Rejecting or sending letters back to senders just because they are not in BM cannot be the answer, in my opinion.

When people write to the Prime Minister or the government, they are usually seeking help or services that are due to them.

Ignoring or rejecting these letters could lead to a government that’s not in touch with its people or even result in important matters being missed.

A government should not be arrogant or condescending towards its own citizens. No government has ever refused to collect taxes from those who do not speak the national language. So, why should it then refuse services to tax-paying citizens who do not write efficiently in the language?

Governments, after all, exist to serve the people.

And no, I am not saying people can ignore BM. Far from it.

The national language is the glue that binds us as a nation. Almost every day, we squabble over race, religion and geographic locations, with some claiming to be superior to others. The language is about the only thing we share without fighting.

What I am saying is – there are other ways to encourage people to write in Bahasa Malaysia.

For one, the government could set up a translation unit, which would translate all such correspondence into the national language before they are sent to the person or department they are directed to.

The government has people who can do that. I believe the Home Ministry has staff who read all newspapers, portals and periodicals in all languages and translate them into BM for the perusal of the ministers and top officials.

They could do the same with these correspondence.

Of course, there is a catch. Any letter that goes to the translation unit will be delayed by weeks (or even months, knowing how most government departments work) before they reach the person they are intended for.

Who in his right mind would then want to write a letter in Tamil to a minister, knowing that it would be months before the minister reads it?

And we have a win-win situation. The writers will stick to BM for the best results, and the government comes across as one that caters to all and not a draconian one.

Letters aside, there is another issue here. Any policy that restricts people to only one language will be a stifling one, a regressive step.

We need people who are bilingual, or even trilingual. Anwar himself is known for his ability to speak fluent English. He even peppered his last Budget speech with Chinese and Tamil, quoting from Chinese philosopher Mencius and Tamil poet Thiruvalluvar.

Knowledge of other languages will not affect the national language. Bahasa Malaysia, I believe, can hold its own against any other language. In fact, it becomes richer that way.

And what of Sabah and Sarawak? They both have constitutions that say English is one of two official languages. Can the federal agencies deny service to the Borneo States if they write in English?

Did the Prime Minister speak with the leaders of these two states before making his announcement?

The leaders of the two states have already put their collective feet down. They are not about to ban letters in English or any other language.

Sarawak’s Federal Secretary Datuk Ahmad Nadzri Mohd Hassan made it clear.

He said federal government agencies would still accept letters in languages other than Bahasa Malaysia.

And he has also proposed the “translation unit” solution.

“We will accept letters written either in Malay or English. Even if the letters are written in other languages, we will entertain them. We will get them translated,” he said.

I think he is on the right track. Sabah and Sarawak are being progressive and accepting of all cultures. They are even thinking ahead, wanting to go their own way in terms of education and examinations.

The peninsula, on the other hand, seems to be going backwards and may soon see a government service that will be proficient only in one language.

Are we headed for a one-state, two nation system? A great divide splitting the two sides of the South China Sea?

The leaders on the peninsula need to rethink their priorities.

Instead of pandering to mono-lingual government officials, we should encourage them to learn more languages and widen their scope.

With China and India rising, liaising with these two countries will become important. English is also not about to lose its value anytime soon.

Take Singapore.

Many of their leaders can switch easily to different languages. Lee Hsien Loong speaks English, Malay and Mandarin equally fluently. President Tharman Shanmugaratnam – Shang Daman to the Chinese press – speaks English, Malay, Tamil and Mandarin.

Both are held in high regard, just like our own Prime Minister, who is fluent in BM and English while dabbling in other languages.

He should help spawn a new breed of politicians and government servants who can efficiently switch between at least BM and English. Limiting them to reading letters in just one language, while rejecting all others, will only stunt them.

It reminds me of a Bahasa Malaysia idiom: “Katak dibawah tempurung”.

By DORAIRAJ NADASON newsdesk @thestar.com.my The writer wishes all readers a Happy Deepavali, Selamat Hari Deepavali and Deepavali Nalvazhthukkal. Sadly, he does not know how to say it in Chinese.

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How the Israel-Palestinian Conflict Mirrors Malaysia's Apartheid Issue

How the Israel-Palestinian Conflict Mirrors Malaysia's Apartheid Issue

The Israel-Palestinian conflict has polarized people worldwide, and in Malaysia, it has stirred strong emotions, especially among Malays and non-Malays. This conflict has revealed deep divides among races in the country. Some politicians from DAP have openly supported the Palestinian cause, separating this discussion from the actions of Hamas.

Non-Malays often identify with the Palestinians, feeling like victims themselves due to inequalities in their own country. They struggle to understand why Malays are so sensitive about this international conflict when Malays enjoy privileges that non-Malays do not. These privileges include preferential treatment in public universities, access to scholarships, and opportunities in government services. The conflict becomes a mirror reflecting local disparities, leading to further tension and division among Malaysians.

I am curious about the human mind, especially in the context of how different communities perceive and respond to the Israel-Palestinian conflict. Among my non-Malay friends, their reactions likely stem from a desire for empathy. They might want Malays to understand the frustration and sense of inequality they experience as second-class citizens in their own homeland.

This sentiment is often heightened among non-Malays who are not recent migrants but have roots in Malaysia that span multiple generations. For them, the connection to the land goes back several decades, if not centuries, and they might feel a deep sense of injustice when they perceive disparities in treatment and opportunities. Their reactions to the Israel-Palestinian conflict could be a way of expressing their own struggles for equality and recognition within their home country. It reflects a complex interplay of historical context, identity, and a quest for fairness and understanding among different communities.

In situations where certain groups are suppressed, particularly in areas like education and economics, an interesting psychological phenomenon often occurs: the victims tend to become stronger and more resilient. This resilience stems from a deep human drive to overcome adversity and succeed despite challenges.

In Malaysia, the Chinese community, in particular, has instilled a culture of excellence in their children. They emphasize the importance of being not just the best locally, but on a global scale. This mindset has driven many to excel internationally.

Surprisingly, those who were given advantages and opportunities haven't always proven to be the best, even within the Malaysian context. This has led to a situation where foreign workers are brought in to fill gaps left by disillusioned Malaysians seeking better prospects abroad.

Addressing the issue of brain drain requires acknowledging the core problem: unequal opportunities for all citizens. When equal opportunities are provided, individuals are more likely to invest their talents and skills in their home country, fostering a sense of belonging and encouraging them to contribute to the nation's growth and development.

The Israel-Palestinian conflict, rooted in millennia of history and recent events, serves as a poignant reminder for nations like Malaysia about the importance of equitable treatment and opportunities for all individuals. The shared affiliation to Jerusalem by both parties emphasizes the deep historical and cultural connections that people have with their homeland.

In the context of Malaysia, the conflict underscores the vital lesson of not depriving anyone of opportunities and treating each person equally as a human being. By ensuring fairness and equal opportunities, societies can foster harmony and prevent deep-seated grievances from festering. When diplomacy fails to address these grievances, conflicts can escalate into wars. In Malaysia, while physical conflict hasn't reached the point of violence, there are social and political tensions that reflect underlying issues.

As we witness conflicts around the globe, it becomes evident that none of us are truly safe from the repercussions of injustice and inequality. To navigate these challenges, societies must learn from these global conflicts and work toward inclusive policies and equal opportunities. Being prepared to address these issues constructively is essential to prevent societal explosions, promoting a more peaceful and harmonious coexistence.

Written by Dr. Kamsiah  Haidar

- a lecturer in dentistry UM some years ago.

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We need to get out of the well from rejecting letters not in Bahasa Malaysia

 

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