How Do You React To A Heart Attack?

Get your facts right on heart attack: 

Atherosclerosis is the commonest cause of heart attack.  There is no single cause for this disease and it is multifactorial in nature.  It is observed that people with certain risk factors are more prone to developing this disease and in turn heart attack than the rest of the population.

 Our heart is a pump.  Its work is to pump out blood to all the organs of our body.  Every tissue requires oxygen for its survival.  The required oxygen is carried in the blood. The heart muscle also requires blood and oxygen for its smooth work.  The blood supply to the heart is accomplished by two major coronary arteries – the right coronary and left coronary arteries.

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Normally the coronary arteries are free of any disease obstruction. Due to age and other factors like high blood pressure, diabetes mellitus etc. cholesterol and unwanted blood cells deposit over the inner aspect of the coronary artery obstructing the smooth blood flow. This deposit is called atheroma and the disease process is called atherosclerosis.  With time this deposit grows in size causing severe obstruction depriving the heart muscle of blood and oxygen. This deprivation of oxygen to heart muscle manifests as angina pectoris or simply angina, colloquially called heart pain.

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What is angina?

Angina is chest experienced beneath the breastbone, compressing, burning, squeezing in nature.  Sometimes it may radiate to the left shoulder, left arm and jaw. Usually it is associated with sweating. Rarely giddiness may accompany the pain.

 Although angina can occur at any time, it is most common after meals, during physical activity, during exposure to cold weather or when one is emotionally upset.  Each episode of pain lasts between a couple of minutes to 10 minutes and when it is brought on by physical exertion it is relieved by rest and nitroglycerin tablet.

When does one get a heart attack?

The deposit of cholesterol and blood cells – atheroma may get complicated by superadded blood clot over it and may complete obstructing the coronary artery thus stopping the blood and oxygen to that particular portion of the heart muscle.  This situation is called heart attack or myocardial infarction in medical jargon.

This leads to the worst form of angina.  The pain becomes unbearable, usually accompanied by profuse sweating, sometimes nausea and vomiting.  Heart attack symptoms are usually more severe than angina and last longer more than 20 minutes

What is Atherosclerosis?

This is a process by which arteries are narrowed due to deposition of gruel like material made up of cholesterol and blood cells.  It is a vessel clogging disorder.  There may form a blood clot over this deposit leading the total obstruction to blood flow.

Risk factors for heart attack:

• smoking
• high blood cholesterol
• high blood pressure
• diabetes mellitus
• men above 45 years of age and women above 55 years of age and all postmenopausal women
• family history of heart attack

Apart from these major risk factors, the other factors that contribute are:

• sedentary lifestyle or physical inactivity
• excess weight
• mental stress and depression

All of the risk factors except age, sex and family history can be managed and modified.

Blood lipids

Lipids is a broad term to include several fractions of cholesterol and related components.  Generally lipids are divided into good cholesterol and bad cholesterol bad cholesterol includes low-density lipoproteins and triglycerides.  High density lipo9protein is other wise called good cholesterol, actually, it prevents the deposition of bad cholesterol in the arteries.

Blood lipids  (mg/100ml of blood)

Excess weight or obesity

Obesity is characterized by an excessive accumulation of body fat through an increase in the size and number of fat cells.  Obese persons have more body fat and a higher level of blood glucose, cholesterol and triglycerides.  Higher abdominal fat is considered a greater risk factor than the accumulation of body fat around the hips.  These persons tend to have high blood pressure too.

The weight to height ratio is a simple accepted method which estimates total body mass.  It correlates very well with the amount of body fat.

Body mass index (BMI)  : weight in kgs/square of height in metres

Ideally this index should be between 20 – 25.  BMI of 25 – 30 is an indication of being overweight and above 30 indicates obesity.

Smoking

Nicotine and Carbon monoxide in the smoke damage the inner wall of arteries and help the process of atherosclerosis.  Smoking not only causes heart attacks, it increases chronic lung disease and lung cancer.  Smokers harm not only themselves but their neighbours as well.

What to do if one gets an Angina?

(For those who have coronary artery disease and have already been worked up)

• Stop what you are doing
• Sit or lie down
• If the angina is not gone within 2 – 3 minutes, place a nitroglycerine tables (sorbitrate or isordil 5mg) under the tongue and let it dissolve.
• If the angina persists after five minutes, take another tablet and continue to rest.
• Take a third nitroglycerine tablet if angina persists after 10minutes.
• If still angina persists go the nearest doctor or emergency. This might be a heart attack.
• Aspirin 300mg (Disprin) may be chewed at this time.
• Don’t delay in calling your doctor because the blood clot causing the heart attack can be dissolved by powerful clot busting drugs only if you call within one hour (Golden hour)

How does one prevent a heart attack?

1. By modifying our life style we can prevent heart attack and other heart disorders to a great extent.
2. smoking should be quit immediately and permanently
3. a balanced diet with lot of vegetables and fruits should be adopted.
4. required energy per day otherwise called calorie intake per day should be sufficient to maintain ideal body weight
5. total fat intake should be between 15 – 30% of total calories
6. cholesterol should not exceed 300mg/day in the diet
7. carbohydrates should constitute 55 – 65% of calories
8. proteins should provide around 10 – 15% of calories
9. sugar should be less than 10% of total calories
10. salt intake should be less than 6mgs/day
11. dietary fibre should be around 40gm/day
12. Foods to be avoided : Cakes, pastries, fried items, egg yolk, cheese, butter khoa, condensed milk, milk, cream, prawns, shrimp, all types of meat, coconut oil, vanaspati, sweets, icecreams, all processed food and refined food.
13. Regular exercise. Brisk walking is one the best method of exercise to keep oneself fit and fine. 30 minutes of brisk 4-5 times a week should be sufficient.
14. Avoid stress and mental depression. In order to cope with stress, priorities have to be spelt out, so that one can work towards a goal with a clear idea of what one would like to achieve and at what cost. Yoga and mediation may help overcome stress.
15. Your doctor will help control your blood pressure and keep your sugar levels within accepted range by giving you appropriate drugs and if necessary Insulin.
16. Maintain a body mass index between 20 – 25.