Heart attack -- causes, symptoms, diagnosis, treatment and prevention

Here are all your questions about a heart attack answered by our expert Dr Tilak Suvarna.

Having a heart attack is a serious condition and can, in some cases, be fatal. But apart from fearing the onset of this condition, most of us do not really know what a heart attack actually is. In this post, Dr Tilak Suvarna, Senior Interventional Cardiologist, Head of the Cardiology department at the Asian Heart Institute tell you everything you need to know about the condition.

What is a heart attack? Why does it happen?

Known medically as a 'myocardial infarction', A heart attack is a serious medical emergency in which the supply of blood to the heart is suddenly blocked usually by a blood clot or deposits of cholesterol called plaques. This lack of blood flow to the heart can seriously damage the heart muscle. A heart attack is usually due to the rupture of one of the plaques, causing a blood clot to develop at the site of the rupture. This clot may then block the supply of blood running through the coronary artery, triggering a heart attack.

Who is at risk of suffering from a heart attack?

Risk factors for developing a heart attack are divided into two main categories nonmodifiables (factors that cannot be changed) and modifiables (those factors that can be altered).

Nonmodifiables

Age: The older you get, the more likely you are to develop some degree of coronary heart disease.

Sex: Men are 2-3 times more likely to have a heart attack than women.

Hereditary: If you have a first-degree relative (a parent, brother or sister) with a history of heart disease such as angina, heart attack or stroke you are twice as likely to develop similar problems, compared to the general population.

Modifiables:

Smoking: Chemicals in cigarette smoke damage the lining of the coronary arteries, leading to increased risk of formation of blood clots. Smokers are four times likelier to suffer a heart attack than a non-smoker. Read more about the 25 things that happen inside your body when you smoke.

Diabetes: The increased levels of blood glucose associated with diabetes can damage the coronary arteries, making them more vulnerable to heart attack. It is estimated that people with diabetes are 2-5 times more likely to develop coronary heart disease than the general population. Read more about diabetes.

High cholesterol: If you eat a diet high in saturated fat, your blood cholesterol levels will rise. This leads to an increase in your risk of heart attacks.

High blood pressure: Having poorly controlled high blood pressure (hypertension) can weaken the coronary arteries, making them more vulnerable to heart attacks. The higher your blood pressure, the greater your risk of heart attacks. Read more about hypertension.

Obesity: Being overweight or obese does not directly increase your risk of heart attacks, but leads to related risk factors that do. In particular, people who are overweight or obese have an increased risk of developing high blood pressure, tend to have higher levels of cholesterol as a result of eating a high-fat diet and have an increased risk of developing diabetes.

Sedentary lifestyle: Lack of exercise is not directly related to an increased risk of CHD (coronary artery disease) and heart attacks. However, it is linked to an increased risk of being overweight or obese and having high blood pressure.

Air pollution: Research has found that exposure to air pollution specifically traffic pollution can cause a significant rise in your chance of developing coronary heart disease and, in turn, heart attacks.

What are the common symptoms of a heart attack?

Symptoms of a heart attack include:

• Chest pain: This is felt as a sensation of pressure, tightness or squeezing in the centre of your chest.
• Pain in other parts of the body: This usually feels like the pain is travelling from your chest to your arms (most commonly the left arm is affected, but it can affect both arms), jaw, throat, neck, back and abdomen.
• feeling lightheaded or dizzy
• Profuse sweating
• Shortness of breath
• Nausea or vomiting
• An overwhelming sense of anxiety (similar to having a panic attack)
• Coughing or wheezing

Although the chest pain is often severe, some people may only experience minor pain, similar to indigestion. In some cases, there may not be any chest pain at all, especially in women, the elderly and people in people with diabetes. It is not uncommon for the heart attack symptoms to be confused with acidity or gas, leading to delay in correctly recognizing the symptoms and seeking prompt medical attention, which can lead to fatal consequences.

How is a heart attack diagnosed?

If a heart attack is suspected, you should be admitted to hospital immediately. You will usually be admitted to the emergency department or ICU for evaluation. A heart attack is usually suspected by typical clinical symptoms, and is confirmed by carrying out the following tests:

• ECG
• Blood test: This blood test is done to detect the presence of cardiac enzymes which are raised during a heart attack.
• 2D-Echocardiogram: This is an ultrasonographic examination of the heart, which is especially helpful in the early periods of a heart attack and in cases where doctors are not sure of the diagnosis. This is a non-invasive test which, if confirmed, helps the doctor provide immediate treatment.
• Coronary angiography: Rarely, this test has to be performed to confirm diagnosis. It can also help determine the exact location of blockage in the coronary arteries.

Once the cause of the heart attack is zeroed in on, what are the treatment options one has?

A heart attack requires emergency assessment and treatment. It is important that you are treated quickly to minimise damage to your heart. Loss of precious minutes could lead to irreversible loss of heart muscle.

The treatment options you might have are:

• Thrombolysis: This is an intravenous injection of clot busters which can dissolve the blood clot, open the artery and re-establish flow.
• Primary angioplasty: This involves performing a coronary angiography, locating the blocked artery and opening the block with a balloon and finally implanting a stent at the site of the block, to keep the artery open and your blood flowing freely. This is the preferred mode of therapy if accessed in a timely manner.

What is the prognosis of the condition?

The prognosis depends upon several factors:

• How early could the patient reach the hospital?
• How early & effectively was the treatment initiated?
• Were there any complications after heart attack-like irregular or abnormal heart rate, low blood pressure, lung congestion, need for ventilator support, etc.

Overall with better organization, early recognition and timely treatment, the prognosis in heart attack patients worldwide has improved.

How can one prevent the onset of this disease?

Making lifestyle changes is the most effective way to prevent having a heart attack (or having another one). Here are the main steps you can take to help prevent a heart attack:

• Eat a healthy, balanced diet (avoid excess fat/ oil/ meat ; include more of green veggies, fruits, nuts, fish).
• Avoid smoking and excess of alcohol.
• Try to keep your blood pressure, blood sugars and cholesterol within normal limits.
• Exercise daily.
• Manage stress in a healthy manner.
• Yearly health check ups with a physician.

You may also like to read:

• 10 things that happen during a heart attack
• New method to treat bad cholesterol effectively
• Eggs good or bad for health?
• Cholesterol is manageable: Dr Vijay Surase, cardiologist
• 8 natural cholesterol busters

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