By Dr Pradeep Pereira
Mangaluru, Sep 29: India has witnessed an alarming rise in the occurrence of heart disease, stroke, diabetes and cancers in the past 25 years and is showing an increasing trend. Heart disease alone is now the leading cause of deaths in India and the world. Heart disease and stroke together contributed to 28·1% of total deaths in India in 2016.
During early part of the last century, deaths from heart disease were the leading cause in developed countries like Europe and North America which presently is showing a declining trend because of awareness and lifestyle modification. However currently 75% of heart disease related deaths in the world occur in developing countries. This increase is driven by industrialization, urbanization and related lifestyle changes. Do we need to ponder a moment about the numbers mentioned above? Probably yes.
This article intends to throw light upon a common heart ailment i.e. ‘Heart Attack’. Here are answers to few frequently asked questions related to it.
Heart is a pump which receives the bad (de-oxygenated) blood utilized by the different body parts, gets it cleaned (oxygenates) by the lungs and pumps it back into circulation. Our heart which is a muscle itself needs fuel (oxygen/blood) to pump continuously is provided by 3 pipes (arteries) which wrap around it. Heart Attack occurs due to clogging of these pipes by cholesterol plugs compromising the fuel supply for pumping.
What are blocks in the heart and heart attack?
Heart blocks and heart attack are not synonymous. When the arteries supplying blood to heart muscle get blocked by cholesterol beyond 70% of its width, it may not get enough blood especially when it needs more i.e. during a person’s physical activity. It shows up as chest pain or breathing difficulty indicating to stop the activity. This is a slow process building up over time. People with this type of problem carry on for some time before it becomes severe enough to seek help.
Heart attack on the other hand is due to a sudden TOTAL (100%) block in an artery due to cholesterol and blood clot. This is an emergency. If the blocked artery is not opened at the earliest a part of the heart gets permanently damaged within few hours. Heart muscle unlike other body parts, cannot be revived once damaged.
Who are at risk of having heart attacks?
Although anyone can have a heart attack, it occurs mostly in those who have diabetes, high blood pressure, obesity, excess cholesterol, sedentary life style, smoking habit and in those with a family history of heart attacks.
What are the problems of having heart attack?
Sudden death is the dreaded complication. If an individual survives the initial phase, heart’s pumping efficiency comes down leading to feeling of breathlessness, swelling in legs etc which is termed as heart failure. Early treatment can restore the heart to near normal state.
What are the common symptoms of blocks in the heart?
Pain, heaviness, discomfort or burning sensation at the centre and left part of the chest sometimes extending to both arms and neck, occurring during any physical activity like walking uphill. However pain at rest or during sleep is often not heart related unless it is severe and prolonged. Elderly and diabetics frequently experience breathing difficulty rather than pain on effort.
What are the symptoms of heart attack?
Chest pain which is severe, prolonged accompanied with sweating, that occurs even at rest is highly suggestive of heart attack. Some experience extreme fatigue, sinking sensation and dizziness.
Is there any first aid or home remedy for heart attack?
Unfortunately no.
What should I do, if I get a heart attack?
Visit the nearest health care facility/hospital at the earliest. Vital time is lost whenever diagnosis and treatment is delayed. Once heart attack is ascertained, medications like blood thinners are given to clear the blocks. Equipped hospitals can treat a heart attack by a procedure called angioplasty which is the preferred treatment option. Best time for treatment is within 6 hours of onset of pain.
Can I get heart attack or blocks even if I do not have risk factors?
Though it is common in those with risk factors it can be seen in anyone. Scientific reason for this is understood incompletely. Our genes, diet, abnormal blood clotting and environmental pollution have been proposed as possible reasons.
Can I get heart attack if I am less than 40 years of age?
Even though less likely, no age is exempt from it. Indians suffer heart attack a decade earlier when compared to western population.
Who should visit a cardiologist for a routine heart check up?
Those individuals with risk factors mentioned above and men above 40 years of age and women after 50 years of age. Younger people should visit if they have symptoms or if multiple family members have heart disease.
Should I visit doctor even if I do not have any problems?
It is prudent to get tested if you have symptoms. For people who do not have any problems, it is advisable to undergo testing once if you have risk factors.
What are the common tests to be done for the heart check up?
Usual tests done are ECG, Echocardiogram to find out pumping efficiency of the heart and TMT (treadmill test) test to know about presence of block and exercise capacity.
Echocardiogram (left) and Treadmill Test
If my ECG is normal, is my heart healthy?
No. ECG would be normal in majority unless they have had heart attack in the past. It is advisable to undergo Treadmill test (TMT) / ECHO and if needed an angiogram test for proper evaluation. Each test individually has short comings in giving a clear answer.
What is coronary calcium scoring test?
Calcium gets accumulated in the arteries wherever blocks are formed. More the calcium deposition in the heart, more are the chances of blocks. With CT scanning of the heart, amount of calcium can be ascertained and it is scored. Whenever score is beyond 400, it is significant. It is done when someone cannot do or complete treadmill test (TMT). It is unrelated to blood calcium levels or calcium medication intake.
What is an angiogram? Who should undergo it?
It is a procedure done by cardiologist to visualize the arteries supplying the heart and to look for the presence and extent of blocks. It is done in individuals who have abnormalities in their ECG/ECHO/TMT/calcium scoring tests.
What is an angioplasty?
It is a procedure wherein blocks in the arteries are removed through a tube and spring like ‘stent’ is placed at the blocked site to keep the artery open.
Image of angioplasty
What is heart bypass surgery?
It is a surgical procedure done when all the three arteries are extensively blocked and are not amenable for angioplasty correction. Here new supply is given to the heart using arteries from hand and leg.
How to keep your heart healthy and avoid Heart attacks?
Most important is to follow a healthy diet and life style. This includes avoiding saturated and trans fats commonly found in bakery products, junk and fast foods. Liberal consumption of vegetables, fruits and whole grains, moderate intake of lean proteins such as fish, chicken and eggs is advisable. Boiling and grilling should be the preferred method of cooking than frying.
One should exercise regularly. Physical activity such as walking, jogging, yoga or swimming for 30 min /day at least 5 times a week is advisable. It is equally essential to maintain a good control of diabetes, blood pressure, body weight and to quit smoking.
Conclusion
Presence of heart disease not only drains one’s family emotionally but financially too. Hence it is prudent to follow few preventive principles. To conclude its suffice to say moderation in our food habits , regular physical activity and less stressful life style would go a long way in prevention of majority of Heart related illness.
Dr Pradeep Pereira
MBBS, MD, DM (Interventional Cardiology)