Prevention Of Heart Disease - Part 1

Prevention is better than cure

Prevention is better then cure and it is certainly desirable -- and at the moment, fashionable -- to direct as much effort as possible to the prevention of disease. 'Primary' prevention refers to the prevention of disease before it occurs, and 'secondary' prevention attempts to halt or delay the recurrence of a disease. Unfortunately, too little is known about the basic causes of most of the diseases quoted in this text for primary prevention to make any great impact.

The causes of congenital heart disease are largely unknown. The effects of infection and of drugs on the unborn have been mentioned in Treatment Of Heart Disease - Drugs, but these only account for a minute proportion of congenital defects. The only infection of any significance is German measles (rubella). All girls should try to have this infection before reaching child-bearing age, thereby achieving natural immunity; alternatively, immunization is now available. Any woman who is pregnant and who comes into contact with the disease should seek medical advice as soon as possible , as she may now receive infections of antibodies (the body's natural defence mechanism) to block the effect of the virus. it should be remembered that the virus causes damage in the early stages of pregnancy when the pregnancy may not have been positively diagnosed.

Ever since the thalidomide tragedy, all drugs have been tested for possible detrimental effects they might have on unborn babies. However, drugs can only be tested on animals and therefore there will always be risk in humans. For this reason, most drugs, especially those introduced in recent years and thus not completely understood, present a small risk and should be avoided if possible.

The heredity element in heart defects is very small, and the chance of a person with congenital heart disease producing a child with a defect is little more than for a parent with a normal heart. The major exception to this rule is in some forms of certain heart muscle diseases (cardiomyopathies) which, particularly those involving thickened muscle (hypertrophic), do seem to occur in successive generations. The seriousness of the disease varies enormously from one generation to the next and cannot be predicted.

Little can be done to prevent valve disease except to avoid rheumatic fever. Real strides have been made here in the prevention of heart diseases. Due largely to improved living conditions during this

century, the incidence of rheumatic fever has fallen so much that new cases are now fairly unusual. Young patients who have had attacks should receive until the age of 20 or 25 to prevent recurrence, because the disease is initiated by, though not directly due to, infection with a bacterium called streptococcus.

Most other kinds of valve disease which we have mentioned are congenital of unknown cause or occur as by-products of other diseases such as coronary disease, hypertension, cardiomyopathy, etc. and it is the prevention of these diseases which should be aimed for. An important element of secondary prevention has already been of the secondary on valve disease. Any person with a valve defect — of whatever cause and however trivial -- is at risk from an infection called infective endocarditis. infection can enter the body through the gums during dental treatment, via a gums during dental treatment, via a wound or during a surgical  procedure (especially those involving the abdomen), during childbirth and sometimes during medical  investigations, including those involving the passage of catheters into the body. These procedures should therefore be 'covered' with antibiotics — the initial dose one hour before — preferably by injection, and continuing by mouth for at least three days afterwards. For dental treatment, penicillin is best, but for other procedures the so-called 'broad-spectrum' antibiotics should be prescribed. This fairly simple precaution cannot be over-stressed.

When most people talk about preventing heart disease, they refer mainly to corona heart disease as this is a major cause of deaths involving the heart. Although this is a  controversial subject, few would disagree that the major primary cause of coronary artery obstruction remains unknown, and thus there is no absolute its prevention. Nevertheless, many 'risk factors' are known which accelerate the course of this disease and every effort should be directed towards removing or diminishing these.