Is your heart under attack?

By Esther Williams

Prasanna took a digestive aid when he felt a burning sensation in his chest. When the pain persisted three hours later he decided to see a doctor. Rather than ask for assistance, he drove himself to the hospital and walked up the stairs to the consultation room. Little did he know that he was experiencing a heart attack and that he could have collapsed at any moment. Had he not taken such a risk he could have saved himself some of the damage to his heart.

A heart attack is a terrifying experience. By learning the signs and what immediate steps you should take when it happens, you could probably save a life - maybe your own.

Consultant Cardiac Surgeon Dr. Kesava Dev says that contrary to common belief, heart attacks do not always occur all of a sudden as in the movies where a person experiences intense pain causing him to collapse and die. Many heart attacks develop gradually as a mild pain or discomfort. Symptoms may wax or wane over minutes or hours during the attack. (See box for warning signs).

Sudden attacks leading to death may occur if the blood clot occurs in the left main artery or when the heart fibrillates and is unable to pump blood soon after a heart attack. The symptoms may come and go, all patients will not have the same symptoms and the same symptoms are not repeated for every attack. However, even one of the signs such as sweating can indicate the onset of a heart attack.

What happens during a heart attack? The heart muscle requires a constant supply of oxygen-rich blood. The coronary arteries provide the heart with blood. People suffering from coronary artery disease have a plaque build-up (made up of fatty matter, calcium and stray cells) on the walls of the arteries, narrowing them. Many of the plaques are hard on the outside and soft on the inside.

When the plaque ruptures, platelets (that aid clotting) come to the area and blood clots form around the plaque blocking the artery. If a blood clot totally blocks the artery, starved of oxygen and nutrients, the heart muscle is permanently damaged.

Who is prone to heart attacks? Normally, those with risk factors (see box) are prone to heart attacks. When heart attacks occur at around the age of 35, it is usually due to a hereditary predisposition or inherent high cholesterol. Unfortunately, those with diabetes can have a heart attack without their knowledge. "Their sensation is blunted and hence their condition only comes to light when the damage is noticed during a health check," the surgeon adds.

Women too are at risk, especially in South Asia. Today 25% of heart patients are women who experience the same symptoms as men.

Signs are misinterpreted: "During each heart attack, some muscle dies. Hence if we save on time, we can save a muscle," Dr. Dev explains, emphasizing that time is of essence. While those over 60 are mentally tuned to have heart problems, younger people may misinterpret or suppress indications, attributing the symptoms to gastritis, muscle pain or Cervical Spondylosis.

Yet others do not want to trouble family or simply postpone seeing a doctor. The index of suspicion should be high, the doctor advises, adding that patients would do well to check every symptom. "Heart attacks follow no age pattern, often occurring also in those who are thin and among vegetarians." Notwithstanding the symptoms, some fail to realize the seriousness of their condition and drive themselves to the hospital, walk up stairs or exert themselves in other ways thereby worsening their condition.

How can we recognize and respond to a heart attack?

It is vital that patients reach the hospital fast - for quicker the treatment, the better the chances of recovery. Until help arrives patients are advised to take an aspirin. Further, the patient should rest and under no condition drive a vehicle. Patients who are at the point of collapsing should also be encouraged to cough as it would help keep the blood circulating.

Dr. Dev explains two ways of treating a heart attack once the routine tests are done. They could administer a key clot-busting drug which needs to be given within a certain time after the attack failing which it would be ineffective; or perform a primary angioplasty by which a stent is placed in the area of the block. Surgery is required occaasionally if pain persists, if the patient has triple vessel disease or in case of complications such as valve leakages.

Currently most people are aware that proper diet, exercise, control of diabetes and BP are crucial. However, we have a lax attitude towards diabetes, he warns, adding that South Asians have higher incidence of diabetes with most suffering from Metabolic Syndrome. Those with the condition are insulin resistant, have larger tummies and increased triglycerides, all of which are predispositions for heart attacks.

Need for CPR Training: Today heart attack victims can benefit from new medications and treatments unavailable to patients in the past. Dr. Dev recommends a large scale public information programme not only to educate the public but also on teaching techniques of cardio pulmonary resuscitation (CPR) for a heart attack victim until help arrives.