By Zanita Careem

Dr. Zacky Haniffa, Secretary to Sri Lanka College of Cardiology at Durden’s Hospital, is a distinguished Royal College alumnus who graduated from the University of Colombo and furthered his medical education in London.With his expertise and dedication to cardiac care, he has made a meaningful contribution to the field of heart health. His work reflects the growing importance of early detection, preventive care and greater public awareness of cardio vascular disease, In an exclusive interview with Zanita Careem, Dr. Haniffa speaks about his medical journey and the importance of protecting the heart through greater awareness, early detection and timely care. From understanding risk factors to encouraging people to take charge of their health, before symptoms appear, he offers a timely and valuable perspective on protecting the heart. His association with Durdans Hospital adds another dimension to his career, connecting his expertise with one of o Sri Lanka’s long established private healthcare services, Durdans, founded in 1945, has developed a reputation for medical excellence and innovation.

(Q)What are the most common heart conditions you see today?

(A)The most common problems we see are coronary artery disease, heart attacks, high blood pressure, heart failure and abnormal heart rhythms (beating). We also see a significant number of patients with heart-valve problems.

Globally, cardiovascular disease remains the leading cause of death, with approximately 20.5 million deaths in 2025. The encouraging news is that a large proportion of cardiovascular disease is preventable.

(Q) Why is heart disease increasing among younger adults?

(A) Young people often feel, “I am young, so nothing can happen to me.” That is a dangerous assumption.

Heart disease is not only a disease of old age anymore. I am seeing many younger people with risk factors, such as diabetes, high cholesterol, high blood pressure, and obesity.

Further, our lifestyle has changed dramatically. We are sitting more, moving less, eating more processed and high-calorie food, sleeping poorly and living under considerable stress. Smoking, alcohol, other illicit drugs also remain important risks.

Your 20s and 30s are not too early to start looking after their heart. They are exactly the right time.

(Q) What are the biggest risk factors people tend to ignore?

(A) As mentioned, the biggest ones are surprisingly ordinary: Smoking, high blood pressure, diabetes, high cholesterol, obesity, physical inactivity and an unhealthy diet.

The problem is that several of these cause no symptoms at all. They silently damage the blood vessels for many years before a person feels any symptoms.

(Q) How can people tell the difference between a heart attack and heartburn?

(A) Unfortunately, you cannot always tell the difference with certainty, based on symptoms alone.

Heartburn usually produces a burning sensation in the upper abdomen and or behind the breastbone, often related to meals or lying down. But a heart attack can also feel like burning, indigestion, heaviness or discomfort in the chest.

A heart attack may cause pressure, squeezing or discomfort in the centre of the chest, sometimes spreading to the arm, shoulder, back, neck or jaw. Breathlessness, sweating, nausea, dizziness or unusual weakness may also occur. The symptoms might be very subtle in elderly, diabetics and women.

My advice is simple: if you are unsure, do not assume it is gas.

It is far better to go to hospital and discover that it was heartburn than to stay at home thinking it was heartburn when it was actually a heart attack.

(Q) What are the early warning signs that should not be ignored?

(A) Never ignore new or unexplained chest discomfort, especially if it occurs with exertion or is associated with breathlessness, sweating, nausea, dizziness or pain spreading to the arm, back, neck or jaw.

Also pay attention to symptoms such as unusual breathlessness, unexplained reduction in exercise capacity, fainting, persistent palpitations or swelling of the legs.

Women, in particular, may sometimes have less typical symptoms, including unusual tiredness, nausea, breathlessness, back or jaw discomfort.

One of the biggest mistakes, I see, is people waiting to see whether the symptoms will disappear.

When it comes to a heart attack, time is heart muscle. The earlier treatment begins, the better the chance of saving heart muscle and saving a life.

(Q) What are the three most important habits for maintaining a healthy heart?

(A) If I had to reduce it to three things, I would say:

Move regularly. Eat sensibly. Don’t smoke.

And I would add a fourth: know your numbers—your blood pressure, blood sugar, cholesterol and Body Mass Index (BMI).

You don’t have to become a professional athlete or follow an impossibly strict diet. Small, consistent changes made over many years are much more powerful than occasional bursts of healthy living.

(Q) How much exercise is enough to maintain a healthy heart?

(A) For most adults, a good target is at least 150 minutes of moderate-intensity activity a week, such as brisk walking, or 75 minutes of vigorous activity. Ideally, add muscle-strengthening exercise at least twice a week.

That sounds like a lot, but it is only about 30 minutes on five days a week.

And please don’t think that exercise only counts if you go to a gym. Brisk walking, cycling, swimming, dancing, gardening and active household work all count.

If you currently do very little, don’t wait until you can do 30 minutes. Start with 10 minutes. Then build up. Some movement is better than none.

(Q) What role does diet play in preventing cardiovascular disease?

(A) Diet plays a huge role—but a heart-healthy diet does not have to be expensive or complicated.

Eat more vegetables, fruits, pulses, whole grains, nuts and fish, and reduce highly processed foods, sugary drinks, excess sugar, saturated fats and trans fats.

For Sri Lankans, I would emphasise one particular issue: salt. We traditionally use a lot of salt in cooking and may also consume considerable amounts through processed and packaged foods. WHO recommends keeping salt intake below five grams a day—roughly one teaspoon in total from all sources.

We don’t need to abandon our traditional food. We need to make our traditional food healthier—less salt, less oil, less sugar, more vegetables, more pulses and sensible portions.

(Q)How have advances in cardiology improved patient outcomes?

(A) The changes have been remarkable.

Today, we can diagnose heart disease much earlier and treat many conditions that were previously extremely difficult to manage.

For heart attacks, modern angioplasty and stenting can rapidly restore blood flow. Better imaging allows us to see the coronary arteries and heart structures in much greater detail. We have sophisticated treatments for heart failure, modern devices for abnormal rhythms and minimally invasive procedures for certain valve diseases.

Even in heart failure, the treatment landscape has changed enormously, with newer medicines.

The exciting part is that cardiology is moving increasingly toward earlier diagnosis, personalised treatment and less invasive procedures.

But I always tell my patients: the best heart attack is the one we prevent. Technology can save lives, but prevention is still more powerful than any procedure.

(Q) When is angioplasty recommended instead of open-heart surgery?

(A) Angioplasty—usually called PCI—is an excellent treatment for many patients, particularly during an acute heart attack, when reopening a blocked artery quickly can be lifesaving.

But angioplasty is not automatically better than bypass surgery.

The decision depends on the number and location of blocked arteries, the complexity of the disease, diabetes, heart function, age, other medical conditions and the patient’s overall situation.

Recent evidence continues to support making this decision individually rather than taking a “one treatment fits everyone” approach.

The important thing is that the decision should be made by the heart team and the patient together, based on the best available evidence.

(Q) What are the biggest misconceptions people have about heart disease?

(A) There are many.

“Heart disease happens only to old people.”

Not true.

“If I feel healthy, my heart must be healthy.”

Not necessarily. High blood pressure and high cholesterol can remain silent for years.

“I don’t smoke, so I don’t have to worry.”

Not true. Smoking is one risk factor among many.

“Heart disease is mainly a man’s disease.”

Definitely not. Women can develop serious heart disease, and their symptoms may sometimes be overlooked.

“If I have a heart problem, I should avoid exercise.”

Many heart patients actually benefit greatly from appropriate physical activity and cardiac rehabilitation, under medical guidance.

“I’ll see a doctor if it gets worse.”

For a heart attack, waiting can cost precious heart muscle and the life.

(Q) Is there a patient story that changed your perspective as a doctor?

(A) I think every cardiologist has patients who stay with them long after they leave the hospital.

“One patient I will never forget was a 31-year-old young father who came to the emergency department around midnight with severe chest pain, accompanied by his 26-year-old wife and their six-month-old baby.

His ECG showed a major heart attack. We immediately took him for angioplasty and successfully opened a completely blocked coronary artery.

The next morning, I saw him smiling in the ICU bed. Three days later, he walked out of the hospital completely well.

Secretary to Sri Lanka College of Cardiology

That experience reminded me that behind every blocked artery is a person, a family, and an entire life that can change within minutes. It reinforced why, as doctors, we must act decisively and quickly—but never lose sight of the human story behind the disease.

What changes us as doctors is not simply seeing a heart attack—it is seeing what that heart means to a family.

I have seen patients who arrived frightened and critically ill, and then, after treatment, return months later with their families, smiling and grateful simply to be alive.

Those moments remind me that we are not treating an ECG, an angiogram or an echocardiogram. We are treating a person—a parent, a husband, a wife, a son or a daughter.

Medicine has technology, machines and procedures, but ultimately it is about giving someone more time with the people they love.

(Q) What message would you like to share with Sri Lankans about preventing a heart attack?

(A) My message is very simple:

Please don’t wait for your heart to give you a warning before you start taking care of it.

Know your blood pressure. Know your cholesterol. Check your blood sugar. Don’t smoke. Keep your weight under control. Walk every day. Eat less salt and processed food. Eat more vegetables, fruit and pulses. Sleep properly. And if you have been prescribed medication for blood pressure, diabetes or cholesterol, take it regularly rather than stopping when you feel better.

And if you develop symptoms suggestive of a heart attack, don’t wait at home and don’t try to diagnose yourself. Seek emergency medical care immediately.

We cannot choose our genes, gender or our age. But we can choose many of the things we do every day.

(Q) What inspired you to specialise in cardiology?

(A) What attracted me to cardiology was the combination of science, technology, urgency and, most importantly, the opportunity to make an immediate difference in someone’s life.

There are very few areas of medicine where you can see a patient arrive critically ill and, within a short period of time, use modern medicine to restore blood flow, correct a dangerous rhythm or stabilise a failing heart.

But over the years, what has kept me passionate about cardiology is not simply the technology.

It is the people.

Every patient reminds you that behind every heartbeat there is a life, a family and a story.

(Q) What has been the most rewarding part of your career?

(A) Without question, seeing patients return to their normal lives.

A successful procedure is satisfying, but seeing a patient come back months or years later and say, “Doctor, I am working again, I am walking again, I am watching my grandchildren grow up”—that is the real reward.

As doctors, we sometimes focus on numbers: the ECG, the blood pressure, the cholesterol level, the ejection fraction, the angiogram.

But ultimately, the greatest outcome is not a perfect test result. It is a person getting back to living their life.

That is why I believe cardiology is not only about treating heart disease. It is about protecting the life that depends on that heart.

In summary:

“I would like people to remember one thing: your heart does not suddenly become unhealthy on the day you have a heart attack. The process often begins many years earlier, silently. That means we have a tremendous opportunity to prevent it.

Please don’t wait for symptoms. Know your numbers, move your body, eat sensibly, don’t smoke, and seek help early when something doesn’t feel right.

We cannot prevent every heart problem, but we can prevent many heart attacks and strokes. And sometimes a small decision made today—going for a walk, checking your blood pressure, stopping smoking, reducing salt, or seeing your doctor—can give you many more years with the people you love.”