Some time ago, Dr Jason Ko treated a heart patient in his 20s whose dying wish was to eat a hamburger and French fries.
Ko, a consultant in cardiology at Hong Kong Adventist Hospital – Stubbs Road, said the patient had been suffering from a fatal genetic disease called Duchene Muscular Dystrophy, which causes the muscles to deteriorate at a rapid rate, leading to severe heart and lung failure.
“As a doctor, I naturally advised against unhealthy fast food and tried to give him a positive outlook on life,” Ko says, and the man never ate the meal he wanted.
“The patient passed away a few days later with little support from his family.”
After the patient’s death Ko began to reconsider his role as a doctor.
“In medical school, we are taught to ‘do no harm’… but I realised that we never learned what it means to ‘do no good’,” he says. “Sometimes, we have to think what is best for the patient.”
From this experience, Ko realised the importance of emotional support for those who are ill, either with terminal conditions or those recovering from surgery.
He saw how critical it was in helping them face and overcome the fear of potential long-term suffering or death.
The American Psychological Association, for example, says that those patients who may have come close to death during a heart attack should enlist the support of friends, family, and work colleagues.
“Talk with them about your condition and what they can do to help,” the association says. “Social support is particularly critical for overcoming feelings of depression and isolation during recovery from a heart attack.”
This is important advice, as heart disease is incredibly common, for both men and women. The World Health Organisation says cardiovascular diseases (CVDs) claim the lives of 17.7 million people each year – 31 per cent of all global deaths.
In Hong Kong, heart diseases have been the third leading cause of death since the 1960s.
In 2016, about 11 Hongkongers died from coronary heart diseases every day, with the male-to-female ratio being 1.5:1.
Yet despite this dire figure, many patients undergo successful surgery and live full and active lives, even if suffering complicated conditions caused by genetic factors.
For Ko and others in the field, there are a set of official protocols and lifestyle changes that help achieve this.
Emotional support – while very important – is considered only one aspect of the after-care for those patients who have undergone heart procedures.
Firstly, hospitals, such as Hong Kong Adventist Hospital – Stubbs Road, aim to provide high quality care to ensure the patient can safely return home and resume his or her daily routine.
Ko says a patient could usually be discharged the next day after a planned coronary procedure, rather than one carried out as an emergency, where a stent – an expandable cobalt chromium metal alloy scaffolding – is placed inside a narrowed, diseased artery to widen it again.
However, a survivor of a heart attack or cardiac arrest may need to stay in hospital for one or two weeks, depending on their rehabilitation needs.
After-care in an outpatient setting involves patient monitoring to check for high blood pressure, blood sugar and cholesterol levels, as well as continuing assessments of drug dosage and side effects and to make the appropriate adjustments if needed.
The hospital also realises that everyone’s path to recovery takes a different course and therefore it adopts a personalised approach by offering a patient individual lifestyle medicine consultations with its experienced physician and registered dietitian.
Yet what can patients also do to best aid their recovery?
Maintaining a “heart healthy lifestyle” is the key because it will be the best defence against suffering heart disease and a stroke.
“Heart patients who are smokers must stop immediately otherwise the disease may progress and then all previous treatment efforts will be wasted,” Ko stresses.
“This is one of the most crucial commitments a patient can make following a heart procedure.”
Furthermore, patients must adopt a diet that is low in salt, sugar and fat.
Last, but not the least, they must do exercise.
“The World Health Organisation recommends 30 minutes of aerobic exercise five days a week to strengthen the heart muscles,” Ko says.
How much – and when –patients can start moving again will be dictated largely by their fitness level before surgery, the kind of procedure they have gone through and their particular heart problem.
For example, the British Heart Foundation suggests that gentle walking each day could be resumed “when you feel ready” after surgery for a heart attack. Based on the recovery timeframe, the patient can increase the intensity of daily activities.
“Your breastbone and the muscles in your chest take time to heal, so do not do lifting or heavy arm activity in the first 12 weeks [after surgery] as it could delay the healing process,” the foundation says.
Of course, every patient is an individual case.
One arrhythmia patient – a condition which causes the heart to beat with an irregular or abnormal rhythm – who underwent heart surgery at Hong Kong Adventist Hospital – Stubbs Road was able to get back to doing stringent sports in two months (stay tuned for ‘Health Matters’ episode 4, September 27).
Was his recovery from surgery typical? “This depends on the type of heart condition [of the patent] and whether the treatment is curative or not,” Ko says.
“If what he had was a short circuit in the upper half of the heart, a minimally invasive radio frequency ablation [the surgical removal of body tissue] would have been able to provide a permanent solution.
“However, if the short circuit occurred in the lower half of the heart and caused cardiac arrest, treatment would have been implantation of a defibrillator [an apparatus that administers a controlled electric shock to restore the heart’s normal rhythm] instead.
“Rigorous sports are discouraged in this case to prevent recurrences.”
Ko says that regular check-ups for post-heart surgery patients, as well as those who are simply health conscious, is the key to improving heart health and getting the right treatment should a problem arise.
“It is often those people who do not undergo regular health check-ups that end up having heart attacks and being sent to the emergency department with severe coronary artery disease,” he says.
“[For those who have undergone surgery] if the cardiac risk factors are not regularly monitored, the coronary artery disease is going to progress.”
Finally, Ko reminds patients that some post-surgery heart drugs cause side effects at a later date. These may not be so obvious initially and so must be assessed by blood tests.
“If left unchecked, these side effects may lead to major consequences,” Ko says.
Indeed, to “unbreak your heart” as effectively as possible, the best medical advice is the same worldwide: make sure you quit smoking, avoid too much alcohol, get regular exercise (if post-surgery, do this based on advice from your physician) eat less salt, sugar and processed foods, seek emotional support from family, friends or professionals – and do have regular health check-ups.