You may remember scenes from Bollywood movies, where a man clutches his chest when he gets bad news and then passes out. The family doctor comes to his house, checks his blood pressure and tells the family that everything will be ok. Sounds familiar, right? Unfortunately, real life is not so simple.
Heart attacks do happen, and they happen often. I’ve mentioned it over and over again that Indians are especially prone to heart disease because of the smaller size of our arteries, the structure of our cholesterol (smaller but more dense) and the prevalence of untreated high blood pressure and diabetes in our community. Heart attacks are unfortunately the number one cause of death in the world. I want to spend some time in this month’s article explaining what a heart attack is, what signs to look out for, and how it can be treated. Next month we will review what important steps can be taken to prevent a heart attack.
The heart has three major arteries that supply blood, oxygen and the required nutrients to its muscle. If you develop significant blockages (meaning greater than 70%) in these arteries, symptoms can begin to develop. Unfortunately there are nearly no symptoms that develop before there is a 70% blockage (stay tuned for next month’s article on how to prevent these blockages from developing). If a blockage advances to 100%, then that muscular area of the heart is deprived of blood and oxygen. This is essentially what we call a heart attack, or myocardial infarction. With a heart attack, time is of the utmost essence! The faster that we can restore blood flow to that area, the better the chance that it will not be damaged forever.
We often think of chest pain as the primary symptom when having a heart attack. While it is definitely one of the symptoms, most people experience a variety of other symptoms. When asked to recollect their initial symptoms after having a heart attack, most people say that they did not experience a sudden onset of excruciating chest pain that made them stop in their tracks (think Bollywood scene mentioned earlier). Instead, the range of symptoms can be as follows: a tightness in the chest or indigestion feeling that won’t go away, shortness of breath that is out of the ordinary, nausea, heartburn, not feeling well, neck or jaw pain, or arm pain or numbness. The point is – heart attacks don’t just give chest pain. Women and diabetics especially tend not to have the typical chest pain.
If you develop symptoms such as above, it is important that you immediately call your doctor or go to the emergency room. I would advise you to call an ambulance, rather than drive yourself or have someone drive you. Take an aspirin as well. Remember, time is of the utmost essence and our goal is to get the blocked artery to open up as soon as possible! If you attempt to drive yourself to the hospital and get sicker in the car, then you are stuck. If someone else takes you and you get stuck in traffic, then that can be just as dangerous. An ambulance is the safest and quickest way to get to the hospital. An ECG performed on the ambulance can also expedite treatment.
Once at the hospital, a heart attack can be diagnosed by electrocardiogram (ECG) and blood work. Based on these findings the doctors may recommend different treatment options. The first being cardiac catheterization and angioplasty. Cardiac catheterization is where a very long but small tube is inserted into the artery (usually in your leg) and then dye is injected into the three main arteries around the heart. The doctors can see where the blockages are by placing you under an x-ray machine and taking pictures of your heart as they inject the dye into the arteries. They can then inflate a tiny balloon tied to the end of that long tube to open up an area of blockage (balloon angioplasty) and then place a small metal stent (looks like a very, very small metal spring) into the artery. The stent therefore provides mechanical support to keep the originally blocked artery open.
If there are multiple blockages, then you may even require open heart surgery, also called bypass surgery. This is a major surgery and involves using veins or arteries from the legs or arms to create a bypass around the blocked arteries.
The final and very important piece to treatment is medications. There are several medications that patients with heart attacks need to be taking. Multiple scientific studies have shown that these very medications help prevent future heart attacks and help people live longer.
The key point that I want to make people aware of is that not all people having a heart attack will have severe chest pain or collapse. Many people don’t recognize the symptoms as a heart problem until it too late. Next month we will focus on how to prevent blockages and a heart attack from happening. New research on heart disease shows some very interesting and important facts especially in Indians, so stay tuned!
We welcome any questions regarding this article or any other medical concerns. If there are any physicians who would like to contribute to our future editions, please email us at shehjar.doctor@gmail.com
*Anu Munshi-Khandhar was born and partly raised in Kashmir. She moved with her family to the USA during the mass exodus of Kashmiris in 1990. She currently lives in Pittsburgh with her husband and works at the Critical Care Department at University of Pittsburgh Medical Center. 