PICTURE this: You’re walking or exercising and suddenly you experience a pressure, tightness, or squeezing directly behind or slightly to the left of your breastbone, possibly radiating up and down your arms, back, neck, and jaw. You sit down, catch your breath and the discomfort subsides in two minutes.
Heart attack? Most likely – and heart attack results from heart disease. In the Philippines, diseases of the heart and the vascular systems rank first and second top leading killers. Everyday, 243 people die of heart diseases. “With such a prevalent disease, heart disease exerts a tremendous yet unseen burden on the Philippine economy,” comments Dr. Willie Ong, one of the country’s top cardiologists.
Heart attack is one of the most treacherous diseases as it strikes anytime – in the office, while attending a party, or even resting at home. “A heart attack usually occurs when a blockage in a coronary artery, which supply the heart with oxygen and nutrients, severely restricts or cuts off the blood supply to a region of the heart,” explains The Merck Manual of Medical Information. “If the supply is cut off or greatly reduced for more than a few minutes, heart tissue dies.”
Coronary thrombosis, as heart attack is known in medical parlance, may cause sudden death, usually due to abnormal heart rhythm, which prevents effective pumping. Severe persistent pain in the center of the chest is common, and it may lead to shock or lung congestion.
A blood clot is the most common cause of a blocked coronary artery. “Usually, the artery is already partially narrowed by atheromas,” the Merck manual says. Atheroma is a degenerative condition of the arteries. The inner and middle coats of the arterial walls become scarred, and fatty deposits (cholesterol) are built up at these sites. Blood circulation is impaired, and it may lead to such problems as stroke and heart attack.
“An atheroma may rupture or tear and create more blockage, which promotes clot formation. The ruptured atheroma not only restricts the flow of blood through an artery, but also makes platelets stickier, further encouraging clots to form,” the Merck manual points out.
An uncommon cause of a heart attack is a clot from part of the heart itself. In some instances, a clot forms in the heart, breaks away, and lodges in a coronary artery. Another uncommon cause is a spasm of a coronary artery that stops blood flow. Spasm may be caused by drugs such as cocaine or by smoking, but sometimes the cause is unknown.
Are there telltale signs that a person will know that he’s experiencing a heart attack? Yes, according to the Merck manual. It says that about two out of three people who have heart attacks experience intermittent chest pain, shortness of breath, or fatigue a few days beforehand. The episodes of pain may become more frequent even after less and less physical exertion. “Such unstable angina may culminate in a heart attack,” warns the Merck manual.
Generally, the most recognizable symptom is pain in the middle of the chest that may spread to the back, jaw, or left arm. It may also spreads to the right arm, although this is less often. The pain may occur in more or more of aforementioned places and not in the chest at all.
“The pain of a heart attack is similar to the pain of angina but is generally more severe, lasts longer, and isn’t relieved by rest or nitroglycerin,” the manual states. Angina is a suffocating, choking pain, usually used in reference to angina pectoris, which is felt in the chest. The pain if felt or brought on by exercise and relieved by rest, and occurs when the blood supply to the heart muscle is inadequate.
Other symptoms of a heart attack include a feeling of faintness and a heavy pounding of the heart. Irregular heartbeats may seriously interfere with the heart’s pumping ability or may cause the heart to stop pumping effectively (cardiac arrest), leading to a loss of consciousness or even death.
During a heart attack, a person may become restless, sweaty, and anxious and may experience a sense of impending doom. The lips, hands, or feet may turn slightly blue. An elderly person may become disoriented.
Despite all the possible symptoms, as many as one out of five people suffering a heart attack have only mild symptoms or none at all. Such a silent heart attack may be recognized only on a routine electrocardiogram (ECG) some time afterward.
The ECG is a record of the changes in the heart’s electrical potential made on an instrument called an electrocardiograph. A person is connected to the equipment by leads on the chest and legs or arms. A normal trace has one wave for the activity of the atria and others relating to the ventricular beat. Abnormal heart activity is often indicated in the trace and it therefore forms a useful diagnostic aid.
Anyone can suffer from heart attack but he following characteristics increase an individual’s risk of suffering a heart attack: having a family history of heart disease or hypertension; being male or a post-menopausal woman; being 65 years of age or older; having diabetes; being a cigarette smoker; being overweight and having high cholesterol; leading a sedentary lifestyle and having high levels of stress.
“A heart attack is a medical emergency,” says the Merck manual. “Half of the deaths from heart attack occurs in the first three to four hours after symptoms begin. The sooner treatment begins, the better the chances of survival. Anyone having symptoms that might indicate a heart attack should get prompt medical attention.”
Recent studies have shown that aspirin helps prevent heart attacks. The clot-dissolving drug streptokinase, taken upon the onset of chest pains, has reportedly reduced deaths from heart attack. After a heart attack, many doctors recommend one baby aspirin, one half of an adult aspirin, or one full adult aspirin taken daily. “Because aspirin prevents platelets from forming clots, it reduces the risk of a second heart attack by 15 to 30 percent,” the Merck manual says.
Meanwhile, it’s the first few minutes of a heart attack that count in terms of “doing something” to help the victim, according to a heart specialist of Ohio’s University Hospital in Cleveland. He advises anyone who might be faced with such an emergency to take prompt action because what he does can save the life of the person having a heart attack.
If a person suddenly complains of pains in the chest, loses color, sweats, contorts his face and collapses, do this before doing anything else – even before calling the doctor or an ambulance:
Lay the victim flat on the floor – don’t let him remain in a heap. See if you can detect any breathing or a pulse by feeling the artery in the neck. If not, pinch the nostrils and tilt the head back with one hand. With the other hand, hold the neck up and begin breathing into the victim’s mouth – two breaths, then rest. During the rest, put the head down, release the nostrils and place one hand on top of the other on the center of the victim’s breast bone and press down firmly. Do this 15 times, about once a second, then go back to breathing two breathes into the mouth as before.
“Repeat this procedure until you can detect a pulse or until the patient has resumed breathing on his own… then rush to a telephone and call an ambulance,” the heart specialist instructs. “Scream for help or have someone else phone, but don’t ever leave the victim until you see that he is breathing on his own.”
Most people who survive for a few days after a heart attack can expect a full recovery, but about 10 percent die within a year, according to the Merck manual. Most deaths occur in the first three to four months. (Next: Cardiac arrest)
