PHILIPPINES: Heart attack? What to Watch Out For and What To Do

_____________________________________________________________________ Last week while we were playing badminton, one of our playmates, a 55-year-old executive of an accounting firm, complained of chest pain. We did not know what to do but we brought him to the hospital when he started having difficulty breathing. It turned out he had a heart attack. He is still in the ICU. What are the symptoms of a heart attack? What should a witness to one do? — Robert F., San Carlos City _____________________________________________________________________ MANILA, Philippines (Manila Bulletin), November 6, 2007: Heart attack: What to watch out for and what to do By Dr. Eduardo G. Gonzales A heart attack or myocardial infarction is the most common fatal manifestation of heart disease. In years past, most heart attacks resulted in death even with treatment. Nowadays however, the available medications for the condition are far more effective than those that existed a decade ago such that the chances of survival of heart attack victims are much higher now. But these life-saving drugs have to be given in a hospital setting, and to be effective, they must be administered relatively quickly, within an hour, after the onset of the symptoms of an attack. Thus, a heart attack is a medical emergency where time is of the essence. It is therefore important that the public is aware of the signs and symptoms of a heart attack so victims are brought to the hospital as soon as possible. The most common manifestation of a heart attack is pain in the middle of the chest that lasts for more than a few minutes. The pain is typically squeezing or pressing in character and may spread to the left arm or jaw, and the back. Less often, the pain is felt over the right arm. Rarely, it is felt over the abdomen and may even be relieved by belching. At times, the pain goes away only to come back again. Although chest pain is the most common symptom of a heart attack, about a third of people who suffer an attack do not experience chest pain at all. The other common symptoms of a heart attack, which may occur with or without chest pain, are faintness, heavy sweating, nausea, shortness of breath and pounding of the heart. The symptoms of a heart attack can appear suddenly and may be so severe that they cannot be mistaken for anything else; but usually, a heart attack initially manifests with mild symptoms that slowly become more severe. A heart attack is often the end result of an underlying coronary artery disease, a condition in which the coronary arteries, the blood vessels that supply the heart tissues with oxygen get narrowed because of deposition of cholesterol and other fatty materials (called atheroma or atherosclerotic plaque) in their walls. It takes many years of gradual build-up before an atherosclerotic plaque can significantly impair the blood flow through a coronary artery. This plaque build-up is facilitated by several conditions called risk factors: advancing age, family history of coronary heart disease, smoking, hypertension, dyslipidemia (persistently high blood levels of cholesterol), obesity, diseases like diabetes mellitus, sedentary lifestyle and chronic psychological stress. A heart attack occurs when a coronary artery gets completely clogged, as when a blood clot develops or lodges in the artery. This results in the death of the heart tissue that the artery supplies. A blood clot can arise within the coronary artery itself (a narrowed artery is predisposed to development of a clot) or the clot can originate elsewhere in the body and get stuck in the narrowed coronary artery. There are now drugs that can dissolve a blood clot in a coronary artery. These drugs can stop or ease the damage of some heart attacks; they increase the chances for survival and prevent permanent disability of victims, but as mentioned previously, they have to be given very early after an attack. What should you do in case you witness a heart attack? When you suspect (you need not be sure) that a person has a heart attack, stop the person from further performing any physical activity, not even walking. If aspirin is available, make him chew one tablet. Carry him gently and bring him immediately to a hospital. Remember that in a heart attack, time is of the essence; half of deaths due to the condition occur within three to four hours after the event. Incidentally, a history of chest pains is not necessary to suspect heart attack. Although most people who have a heart attack experience intermittent chest pains for days, months or years before the attack, in about a fifth of heart attack victims, the attack itself is the first and only presentation of the underlying heart disease. Copyright © 2001-2005, Manila Bulletin.