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12th February 2021

Q And A With Professor John Beltrame

Cardiologist Professor John Beltrame

As you know, cardiovascular disease is a complex health condition. We asked Cardiologist Professor John Beltrame to answer the most common questions around heart health.

What is heart disease?

The heart is an amazing organ, it beats 70 times a minute, which is more than one beat every second. Each time it does that, it pumps out 70ml of fluid around the body – that’s five litres of fluid over a minute and it does this for our entire lives. If it happens to stop, then that’s the end.

As you can expect, things can go wrong and that’s when you get disease of the heart. I often tell my patients the simple way to consider the heart is like a car engine. Things can go wrong with a car at the manufacturing level at the factory, like an engine block.

The heart is like a big pump so there could be something wrong with the pump function or the blood vessels. In cardiology, we have sub-specialties that address various issues of the heart and heart function.

Is heart disease hereditary?

It depends on the type of heart disease. There’s some heart disorders that have a very strong genetic component so if a parent has this type of heart condition, there’s a 1 in 2 chance that the offspring will also be affected. We now have genetic testing to try and minimise the chances of this happening. However, there are some other forms of heart disease where genetics plays a less significant role and in those, it’s the classic argument of nature versus nurture. It’s a combination of the genetics you’ve got, plus the environment you’re exposed to.

How would you recommend I maintain a healthy heart?

I get this a lot from my patients in the clinic and many ask how they can prevent themselves from having a heart attack. Going back to the car analogy, the more you make sure everything is well maintained and looked after, you’re less likely to have a car accident. The same principle applies to your heart health. You need to look after your cholesterol through your diet, as well as maintain your blood sugars, otherwise that can lead to diabetes (see story page 4). We know that people who have diabetes have a higher risk of developing heart disease. We also know smoking is one of the biggest causes of heart disease. The bottom line is you’re much more likely to have a heart attack if you don’t do the right thing.

Can I have a heart attack if I don’t even have blocked arteries?

The most common cause of a heart attack is when one of your three main arteries is blocked. The interesting thing is, some people present with chest pain but on examination, don’t have any blocked arteries. By listening to how the heart runs, we can try and work out what the problem is. I also try to get clues through X-Rays to see what’s going on.

Unlike the fuel lines in cars where it goes into the engine, what happens in the human heart is the arteries break up into smaller and smaller blood vessels, so the big blood vessels are up to 5mm in diameter and the microscopic blood vessels are less than 0.1mm in diameter, which we can’t see. So when something goes wrong, they can give the exact same problems, but we can’t actually see them. By measuring the pressure of the heart, we can actually work out what’s going on and then try to treat that, which is somewhat challenging but it’s what our research is focusing on.

Do men have more chance than women of having a heart attack?

It depends on the sort of heart attack. About 90 per cent of heart attacks are caused from a blockage in the big arteries but 10 per cent of patients present with no blockages in the big arteries, which is often the case in women. In fact 75 per cent of men are much more likely to have a blockage in the big artery, but when it comes to women who have heart attacks, half of them have no blockages. So there’s a different problem occurring which goes back to the microscopic arteries I previously mentioned that could be causing the heart attack.

What research progress has been made in heart disease in the past decade?

In terms of heart research it’s enormous because each of those areas I’ve talked about, there is a lot of research going on. My area of work is looking at problems when there’s difficulty in the blood vessels of the heart. As mentioned previously, people can have a heart attack with no blockages in the heart. It’s by conducting specialised tests that we start to appreciate there’s a problem and try to rectify it. We’re doing some studies looking at particular treatments to try and improve those symptoms to make the heart run more efficiently.

Can people live a normal life if they have heart disease?

Absolutely! Obviously some people who are severely disabled by their heart disease will have some difficulties, but generally, after many heart attacks people can have a good life and certainly should remain active.