Eeek! Is this a heart attack?

Whew! Thats one question anyone would like to know!

'Heart attack' as most people perceive it ranges from various degrees of chest pain, accompanied or unaccompanied by sweating, nausea, a 'fear of death' which could put a person in immediate peril.

Like all horrible things, 'heart attack' also usually comes with fore-warning (diabetics may not have this advantage as their nerves may not recognize the pain). The fore-warning is in the form of 'chest pain' which initially comes on and off, is provoked by physical exertion usually after meals or in cold and also by anger or other excitement. This will usually settle with rest. The pain may not always be in the left side of the chest contrary to popular belief. It can be below the sternal bone (so it is often mistaken for the common gastritis), can radiate to the left arm or even the left lower jaw! It is frequently a crushing kind of pain. Some deviant varieties can present with pain on lying down, pain in the night (caused by vivid dreams in sleep), pain that occurs without provocation (even at rest) and a special type that can occur in women with positive stress test but no findings in an angiogram.

If the pain is not investigated and treated, the effects can be disastrous as we all know. The pain may progress and not be relieved even at rest or may suddenly throw up an excruciating painful episode with sweating, nausea or vomiting and a terrifying fear.

This indicates the 'warning pain' or 'angina' has progressed to a full-blown heart attack! A heart attack needs immediate treatment. The sooner the patient is in a hospital, the better.

We must remember that diabetics often do not have the luxury of a fore-warning pain like this. They tend to not feel the pain, as their nerves have become insensitive; so they are in danger of 'Silent MI' which can be fatal.

If someone gets angina, what do you do next?
Rest. Once the heart slows down with rest, there is more time for the coronary arteries to fill with precious oxygenated blood to deliver to the oxygen-deprived heart muscle. Besides, as the heart slows, its work becomes lesser, making it's need for oxygen also lesser. So it can survive on lower levels for some time.
Get to a doctor as soon as you can and find the cause of the pain, the extent of the disease and the options for treatment.
These are done as simple OP procedures in the form of a physical check up by a doctor (including recording your blood pressure, pulse rate and rhythm, looking for swelling in your feet, etc), complete blood profile for cholesterol, blood sugars, haemogram, an ECG, an ECHO cardiogram, followed by a Treadmill stress test (remember to do the stress test only after confirming your heart can stand it by earlier ECG and ECHO). If these show an indication for angiography, then an angiography is done.

During an angiography, if blocks are found, some are relieved by inserting stents during the angiography itself (this depends on the number of blocks, the extent of block and the site of the block). Others may require surgery.

There are many options now available, so we can be of good cheer! People are even trying stem cell implants to revive portions of the heart that have got 'infarcted' or sort-of 'died' in an earlier heart-attack, in heart-attack survivors!

Prevention though, is always the best though not all factors that cause a heart attack are preventable. We can try to modify what we can to decrease the risk we face:
1. If you are a smoker, QUIT SMOKING! That's like tying a noose around a suffocating man's head! Medicines can't help you beyond an extent if you don't! Besides, after you do stop, it takes 12 to 23 months for the risk level to begin to fall and a much longer time for the risk to fall to baseline levels of non-smokers!
2. Eat sensibly. Don't overdose on fatty stuff especially those fried food and fast food. Happily go overboard on salads and fish (Salmon, Sardines, Mackeral, Albacore tuna, Herring, Sword fish and Lake trout are recomended with an intake of at least two portions per week totalling of 120gms).
3. Try to get some exercise (other than walking around the house).
4. Get yearly health check especially if you have a family member who has had a similar problem (even if you are only 35 or even if you are a woman).
5. Cholesterol gets deposited in the arteries as yearly as 2 years on! So keep the kids also off unhealthy diet (once in a while a stop at the pizza joint or burger stall should be ok!).

If you have any questions, feel free to ask! We have a cardiac team on our panel!