Interview - Dr.Kosin Thupvong

How Well Do You Take Care of Your Most Trusted ‘Hard Worker’ who Toils Every Hour, Minute and Second!

An Interview with
Bangkok Heart Hospital’s
Dr.Kosin Thupvong

Did you give your special someone little heart shaped candies on St. Valentine’s Day? Do you ever cross your heart when making a promise that you really, really mean? Or tune in to a music channel to hear a guy or gal singing about a broken heart? Hearts, it seems, are everywhere. A long time ago, people believed that their emotions came from their hearts, perhaps because the heart beats faster when a person is scared or excited. Today we all know that emotions come from the brain, and in this case, it is the brain telling the heart to speed up. So then, what’s the heart doing? The heart is a vital organ responsible for sending blood around the body. Blood provides your body with oxygen and nutrients and carries away waste. Before each beat, your heart fills with blood. Then its muscles contract to move the blood along. Your heart does this all day and all night. You could even say the heart is a hard worker that toils every hour, every minute and every second nonstop to keep you alive!

Perhaps it’s time to take a look at how well we take care of our most trusted worker. If we really knew the importance of our heart and the complex job it does to keep us active, maybe we wouldn’t be doing any of these harmful things, like smoking, drinking too much alcohol, consuming fatty, oily and salty foods, feasting on sugary sweets and desserts, or idling away our time building up flab.

Sadly, today’s busy but sedentary lifestyle makes many of us prone to a number of diseases, particularly heart disease, which is considered one of the biggest killers!

A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because coronary arteries that supply the heart with blood can slowly become clogged and hardened from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis.

When a plaque in a heart artery breaks, a blood clot forms around it. This blood clot can block the artery and shut off blood flow to the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI) in medical parlance.

The process of carotid endarterectomy. Figure A shows a carotid artery with plaque buildup. The inset image shows a cross-section of the narrowed carotid artery. Figure B shows how the carotid artery is cut and how the plaque is removed. Figure C shows the artery stitched up and normal blood flow restored. The inset image shows a cross-section of the artery with plaque removed and normal blood flow restored.

According to a statement issued by the Public Health Ministry in July, the mortality rate owing to heart diseases in Thailand was 2.6 per cent, and the consumption of alcohol, smoking, as well as consuming excessive fat, sugar and salt were stated to be the contributing factors. The ministry’s 2009 Health Policy states that cardiovascular and heart diseases were two of the five major causes of death among Thai people.

In light of this, it is worthwhile to know about Thailand’s first private heart hospital – Bangkok Heart Hospital – that has been providing the highest standard of professional medical care to sufferers of heart ailments.

Set up in 1989 initially as a dedicated department of the Bangkok Hospital, the now-standalone Bangkok Heart Hospital maintains a strong team of experienced adult & pediatric cardiologists, heart failure specialists, MRI cardiologists, cardiac surgeons, cardiac anesthesiologists, cardiac rehabilitation physicians and radiologists (all trained and experienced in such countries as USA, Australia and Japan), highly qualified and experienced nurses, technicians and paramedic personnel to provide 24-hour professional care to local and international patients.

The cardiothoracic surgeons’ team of the hospital is headed by Senior Director Dr.Kosin Thupvong, who has over 35 years of experience in USA. Dr. Kosin successfully performed bypass surgery on thousands of cardiovascular cases, including such dramatic emergency procedures as ruptures of the aorta and heart, while working in six different hospitals in Indiana.

ELITE recently met Dr. Kosin, who joined the hospital just a few months ago, to know about the current trends in coronary healthcare and the advanced treatments being offered by the hospital to heart patients. Excerpts:

What is open heart surgery?

Open heart surgery is a type of surgery where the chest is opened to correct the heart muscle, valves, arteries or other heart structures. The term “open” refers to the chest, not the heart. The heart may or may not be opened, depending on the type of surgery. A heart-lung machine (also called cardiopulmonary bypass) is usually used during conventional open heart surgery to help provide oxygen-rich blood to the brain and other vital organs.

What significant advancements in respect of open heart surgery have been achieved in the last five decades?

Open heart surgery has come a long way since the first operation was performed about 50 years ago. When I was undergoing training some 40 years back, I saw that only half of the patients undergoing bypass surgeries survived. Now there’s hardly anyone who dies. At that time doctors did not fully know how to protect the heart while doing the surgery. Heartlung machines were very primitive at that time. While performing open heart surgery, we used to use 10 pints of blood in those days just to prime the machine. Now there’s a whole lot of difference! We can now do the surgery without giving blood or even stopping the heart in some cases, and without further damage to affected heart muscles. Thanks to state-of-the-art surgical techniques and skilful surgeons, it is now much safer, faster and convenient.

What is the most common heart ailment in Thailand?

Coronary artery disease, or CAD, is the most common. However, patients used to have problems associated with heart valves some 20 years back. Those who had an infection in the heart when they were young suffered from enlarged valves at that time. But the problem is insignificant now. About 70% of surgeries performed now are CAD-related.

How advanced are the surgical procedures and facilities at the Bangkok Heart Hospital?

The equipment and facilities here are as advanced as they are in USA, thanks to the late Dr. Kitipan Visudharom, former director of the hospital. Senior to me by one year, Dr. Kitipan was trained in Minnesota where there’s a big heart center. I knew him personally for a long time and it was he who brought everything from there to here. With the exception of heart transplantation, which requires a bigger team, we can do all other surgical procedures on the heart here. There’s absolutely no need for people in this region to travel to USA, Germany or UK for heart surgery. We can do it here.

How important it is to have a concerted team of cardiac surgeons?

Cardiac surgeons, or any surgeon, no matter how proficient they are, cannot operate alone. You need a good team that is ready for any emergency. You also need a thoroughly sanitized operating theatre and equipment, along with life-support machines. At Bangkok Heart Hospital, we have a very capable and well-concerted team comprising skilled cardiac surgeons, experienced operating room nurses and qualified anesthetists. We also have state-of-the-art operating theatres and heart-lung machines, among other life support devices.

Among meats, what can be considered as friends and enemies of heart?

Red meats, including beef, which have high-fat content, are bad for the heart. Pork has fat as well, so you have to eat only the leaner parts. Fish and other forms of seafood are much better as they are lower in cholesterol and saturated fat. Fish are also a good source of Omega-3 fatty acids, which serve as a lubricant for the artery. It was once believed that crustaceans such as lobsters and shrimp were not good for the heart, but this is not true. They are, in fact, good for your heart as well.

What preventive measures and lifestyle changes do you suggest to avoid heart problems?

Prevention measures are vital to combat heart diseases. People need to stay active, control their weight and avoid consuming foods high in fat. They should exercise regularly, which is very important for a healthy heart. Those who smoke and drink should quit their habits. People over 40 should get their diabetes, hypertension, cholesterol levels and other factors monitored regularly. For older people, light exercise such as walking a golf course during a round of golf is very helpful. As for me, no matter how tight my schedule is, I always find time for my exercise and favorite activities - golf and fishing - which serve as essential channels for releasing tension.

What are the symptoms of heart attack and when should a person at risk seek medical advice?

A classic symptom of heart attack is tightness in the chest, though not all patients may experience it. A patient may feel as if someone is sitting on his or her chest. Some may also feel a shortage of breath and pain in the chest. Those who used to walk briskly before may find it difficult to walk even slowly. Some may not be able to walk even a single step. Some patients may feel weakness or get tired easily. A few may even feel as though they are fainting. These people are obviously at a greater risk. Diabetics and people who have high blood sugar may go on to suffer a heart attack without having any pain. If you experience any of these symptoms, you should seek immediate care.

Now we can all agree that the heart doesn’t look like a valentine, but it sure deserves to be loved for all the work it does. It started pumping blood before you were born and will continue pumping throughout your whole life. So please take good care of your heart to live happier and livelier!