'Help! I'm having a heart attack'

Health

'Help! I'm having a heart attack'

Sunday, January 17, 2021

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It is all too familiar for many of us in Jamaica: we know or have heard of someone with chest pain who was later diagnosed with a heart attack. The thought of a heart attack (myocardial infarction) can be quite scary, especially if fatal. We will discuss the condition today by providing answers to often asked questions:

•What is a heart attack?

•Who gets it?

•How do I know if I am having one?

•What should I do if I get one?

•What are the available treatments?

•What is the definitive treatment?

•How can I prevent a heart attack?

What is a heart attack?

There are many causes for chest pain but one of the most serious is related to the heart. This pain may be related to activity or it may be at rest, possibly crushing and severe with sweating. Heart-related chest pain occurs when there are atherosclerotic (fat and calcium) plaques which reduce the blood flow in the blood vessels on the heart which supply the organ's muscles (coronary vessels). If there is partial blockage, then this will result in chest pain with activity (angina). As the blockage becomes more severe, then you may have chest pain at rest or with minimal activity (unstable angina). Total blockage results in a myocardial infarction, commonly referred to as a heart attack. If the blockage is greater than 50-75 per cent, then the blood supply is inadequate to meet the needs of the heart.

Who gets a heart attack?

Ischemic heart disease is the leading cause of death across the world and Jamaica is no exception. There are many risks factors for a heart attack. Most are related to lifestyle issues and chronic non-communicable diseases. Diabetes mellitus, especially if uncontrolled over many years, uncontrolled hypertension, high cholesterol, obesity, sedentary life style, postmenopausal female and cigarette smoking are the main culprits.

How do I know if I am having a heart attack?

The symptoms of a heart attack can vary in their presentation and duration, may last over several days or occur suddenly or acutely.

•Feeling of tightness, pain or aching in the chest

•Pain moving from chest to left side of neck and down left arm

•Crushing chest pain (feeling like an elephant on your chest)

•Profuse sweating

•Feeling cold and clammy

•Heart burns or “gas pain,” nausea and vomiting

•Dizziness

•Feeling of doom, panic attack

•Coughing, chest wheezing

•Unfortunately, some people may go into shock, which may lead to death.

What should I do if I get a heart attack?

Heart attacks can be fatal, so it is important to recognise the warning signs early and immediately go to the hospital or contact your cardiologist. Recognising the early signs of a heart attack can save lives. It can also prevent significant damage to your heart and thus decrease heart failure symptomatology in the long run if one survives.

What are the available treatments for a heart attack?

On arrival to hospital, all patients with a suspected heart attack will be attended to immediately. Monitoring of the heart rate and blood pressure as well as an electrocardiogram are done. Some patients may require oxygen and be given medications such as aspirin, nitroglycerin tablet or spray under the tongue, pain killers such as morphine, a diuretic to remove fluid from the lungs and extremities and medications to improve the function of the heart. At times a balloon pump may need to be inserted in the aorta; this is a life-saver in many instances. If there is very rapid beating of the heart, called ventricular arrhythmia, patients may need to receive a shock using a defibrillator.

In addition, there are a number of tests that will be performed on admission to hospital. These include blood tests such as: cardiac enzymes including Troponin I and a chest X-ray. A stress echocardiogram may be done to determine if exercise may induce symptoms or cause abnormalities in heart function, indicating blockages.

If after performing these tests blockages are detected, the interventional cardiologist will perform a coronary angiogram. This test involves the administration of a dye in a blood vessel (an artery) in the groin or the hand. This dye will enter the blood vessels on the heart and a special X-ray machine will reveal if there are any blockages.

Comprehensive treatments for a heart attack are available in several public and private centres in Jamaica. It is imperative that patients go to any of these centres immediately.

What is the definitive treatment for heart attack?

If there are blockages of the coronary vessels, then treatment is required. If there are one or two significant blockages, the interventional cardiologist will insert a coronary artery stent. However, if more than two arteries are blocked then the interventional cardiologist will refer the patient to a cardiac surgeon for surgery. This surgery is called a coronary artery bypass graft operation (CABG). Both interventional cardiology and cardiac surgeons are present in Jamaica and regularly treat patients with heart attack. The long-term outcome is dependent on several variables, particularly the swiftness with which they seek medical care. I encourage all patients with symptoms suspicious of a heart attack to get emergency treatment.

Dr Joseph Blidgen

Consultant Cardiothoracic Surgeon and Associate Lecturer

National Chest Hospital and University of the West Indies

Email: josey702001@yahoo.com


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