Are You Having A HEART ATTACK?

In the movies, heart attacks are easy to recognize. The victim, sweaty and pale, suddenly clutches his chest and complains of terrible pain just before he drops to the floor. "That’s the typical textbook definition of what it should look like," says noted cardiologist Dr. Benjamin Alimurung, head of the Cardiac Catheterization Unit and medical director of Makati Medical Center. "But if you’re older, female or diabetic, you’re less likely to experience the classic symptoms of a heart attack."

Heart disease is one of the leading causes of death in the Philippines. Every year, thousands of people have heart attacks and about a third of these are fatal. Almost half of heart attack deaths occur within one hour after symptoms appear and often before the person even gets to a hospital. Thus, it is very important that you know its symptoms and act quickly when these appear — it may save your life. It is equally important that one realizes that some symptoms are atypical, some you might not even think are related to the heart.

Warning Signs

A heart attack occurs when blood flow to a part of the heart suddenly becomes obstructed, usually by blood clots that form at the site of a damaged artery (see illustration). The heart cells that are deprived of fresh blood and oxygen die over a period of a few hours. A heart attack may develop gradually or begin with only mild chest discomfort that may not seem alarming at first. In some patients, symptoms may come and go.

The typical signs that may indicate a heart attack include chest pain, breathlessness, nausea, and vomiting. One telltale serious sign, Dr. Alimurung warns, is the combination of any heart attack symptom with shortness of breath. "Difficulty of breathing is bad, particularly when breathlessness is not because of normal physical exertion. If one who usually can walk up five flights of stairs without breathlessness can suddenly only climb one or two, that’s a problem."

Missed Signals

Sometimes, symptoms may not fit the typical pattern. The pain may not be in the chest, but rather along the left arm, in the stomach area, or even the jaw. The reason for the unusual pain locations is because the heart lacks the type of sensory nerves found in the fingers and in other pain-sensitive parts of the body. "The heart tries to send pain messages, but it does not have the right nerves to send them correctly so it sends a jumbled message over the wrong cable," Dr. Alimurung explains.

Pain is not the only sign of a heart attack that one easily mistakes. Other symptoms can easily be mistaken for other much more benign problems such as heartburns. Although there may be other explanations for your symptoms, it is best to get to a hospital quickly and let a doctor examine you to make sure you are not having a heart attack.

Women, the elderly, and people with diabetes are most likely to have the kinds of unusual symptoms that are easily missed. Women (and their doctors) sometimes overlook symptoms because they mistakenly assume that heart attacks more commonly afflict men; in fact 64 percent of all women who die suddenly of coronary heart disease have no previously recognized symptoms. Seniors often mistake the signs of a heart attack for symptoms of other diseases or even of the aging process itself, even though they have a higher rate of heart disease than any other age group. Diabetics may have no symptoms at all, even though they’re at higher risk for heart attacks. High blood pressure and high cholesterol, conditions that increase the risk for diabetes and heart disease, are often symptom-free, so many people don’t realize they have these important risk factors.

What To Do

It often is not possible to self-diagnose a heart attack. The old adage is true: It’s better to be safe than sorry. When you develop a heart attack, every minute counts. Emergency department staff will work quickly to determine if a full-blown heart attack is in progress or whether you need hospital confinement for further close observation and additional tests before the diagnosis of a heart attack is confirmed or ruled out.

Once you’ve called for emergency help, it is generally recommended that you immediately chew and swallow an aspirin — unless you’re allergic to this medicine or have a stomach ulcer that bled recently — to help thin your blood. When you arrive at the hospital, you can expect a flurry of activity. It may seem as though your blood pressure levels, heart rate, and temperature are being checked all at once, even as a brief medical history is taken. Blood tests may be done, and you may be hooked up to a heart monitor. An electrocardiogram (ECG) test helps to determine whether a heart attack is occurring. Other accurate indicators of a heart attack are revealed from the initial blood tests. An elevation in certain markers may appear in the blood as a result of damaged heart muscle. However, these blood test markers may not become abnormal until a few hours after a heart attack.

Heart Attack!

If markers indicate you may be having a heart attack and you have access to a medical center, you may be sent immediately to the cardiac catheterization laboratory — commonly called a cath lab. There, a doctor quickly performs coronary catheterization or angiogram. If the angiogram detects a blockage, the same catheter may be used to open the blocked vessel with a tiny balloon (coronary angioplasty) and most often, will place within the artery a tiny expandable steel mesh-like slotted tube device called a stent. The procedure immediately restores blood flow to the heart muscle, effectively limiting or preventing the heart attack. Studies in the Philippines and other countries show that coronary angioplasty can cut a patient’s risk of dying by 40 percent if done promptly and within less than two hours of heart attack onset. Doctors typically call this important critical time frame as the "golden window of opportunity."

If you don’t have ready access to a medical center with a cath lab, the next best therapy is with intravenous (IV) clot-buster medications, called thrombolytics. These dissolve blood clots that form and block the coronary arteries. Thrombolytics are most effective when given during the first two hours after the symptoms appear and usually not later than 12 hours after. If multiple blocked or narrowed coronary arteries are detected, coronary artery bypass surgery may be recommended. The surgery will likely be scheduled several days to weeks after a heart attack. The delay allows your heart to stabilize.

Hospital Time

If you have had a heart attack, you can expect to spend several days in the hospital. During your hospital stay, tests such as chest x-rays and echocardiograms may be done to determine how well your heart is functioning and if you have any evidence of fluid buildup in the lungs that could indicate congestive heart failure due to poor pumping capacity of the heart. Before discharge, a treadmill or other stress tests may be done to determine if more areas of the heart are at risk from blocked vessels and to see how well your heart functions with physical exertion.

Certain well-known drugs have been shown to be of clear benefit to people who have had a heart attack. These include drugs such as aspirin and clopidogrel (Plavix), which are used to help reduce the risk of blood vessel clotting. Statin-type cholesterol-lowering drugs may be used both to rapidly improve cholesterol to target levels and for their ability to stabilize blood vessel walls, which may also help stop future clots from forming. In addition, most people who have had a heart attack will be advised to take angiotensin converting enzyme (ACE) inhibitors and beta blocker class drugs. These prescription medications have been shown to improve long-term outcomes for people who have had a heart attack.

Time Is Muscle

If you experience chest pains that persist for 15 minutes or have any other reason to believe you may be having a heart attack, don’t delay. Call for emergency help. Time is critical when a heart attack is under way because the heart muscle is dying. What should you do if you’re not sure? Make the call anyway or rush to the hospital and get emergency help. When it comes to heart attacks, the earlier you are treated, the more heart muscles will be saved, and the faster, better, and more complete your recovery will be.

Save this article and read it again. What you learn now may save your life later!

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