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A Heart-Loving-Heart by Dr. Prithwish Banerjee

I deal with heart disease and encounter smoking related heart disease almost everyday. Smoking is a principal, preventable cause of premature death in the developed world. It is a major cause of coronary artery disease (CAD), a condition where the blood vessels supplying the heart muscles become narrowed leading to chest pains (angina) or heart attacks. The image below shows a coronary artery (blood vessel supplying the heart) with a tight narrowing affecting the mid segment. This is often a finding in smokers.

For comparison, this next image of the same heart artery shows a normal artery with no narrowings.

Heart attacks lead to damage of the heart muscle, which can lead to the failure of the heart to pump adequately. This can cause fluid build-up in the lungs as well as in the limbs. This condition, called heart failure, is very common and associated with a very high rate of disability and death.

The first link below is to a short movie clip (AVI file - 459K) of an ultrasound scan of a heart damaged by a heart attack. The main chamber of the heart called the left ventricle (LV) is enlarged, with damaged, thin walls, and does not contract well. Stasis of blood in this chamber has also led to a 'smoky' appearance inside the chamber. The second link, for comparison, is a clip (AVI file - 348K) showing a normal heart with good contraction of the left ventricle (upper right hand chamber).

Damaged Left Ventricle      Normal Left Ventricle

Smoking multiplies the effect of other risk factors for CAD like high blood pressure, high cholesterol and diabetes. Men who smoke have a 60%-70% greater death rate than those who don't. Sudden death may be the first manifestation of CAD in young male smokers. Women smokers have a 10 times increased risk of developing CAD than non-smokers.

Low tar cigarettes and smokeless tobacco are not effective substitutes for discontinuing the use of tobacco products. Passive smoking in those who have never smoked increases the risk of CAD.

Smoking cessation produces immediate and long-term benefits. There is a substantial decrease in the risk of a heart attack within 1 year of stopping smoking. Those who quit smoking prior to the age of 50 have half the risk of dying in the next 15 years compared to continuing smokers.

Below you'll find a few poems I've written which my wife thinks are a waste of my time but I hope will help open your mind to where smoking is leading you and how much you stand to lose.

Dr. Prithwish Banerjee, Dip Card, MD, MRCP Department of Academic Cardiology The University of Hull, England

Special thanks to Dr. Justin Ghosh for his help in acquiring the above images.

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Life as a junior doctor in a busy job can be tough. If both husband and wife are junior doctors in busy jobs it gets tougher. When, on top of this, they have a baby to look after with no other family around, the situation can be near extreme. My wife and I were in that situation 3 years ago. I only have confused memories of those days but do remember feeling quite emotional at times. While rummaging through the drawers recently I discovered a poem I had written at the time that expresses feelings that we medics often have at some stage of our career. It is called 'I Love My Baby.' I offer it here as no loving relationship should be destroyed by chemical dependency. I wish you a healthy heart-loving-heart!