How to tell you are having a heart attack

A heart attack will be an inevitable part of life for many of us. Recognizing the symptoms and seeking prompt treatment may better our chances of survival, writes Dr. Koo. Chee Chong, a consultant cardiologist at Gleneagles Medical Center in Singapore. This health column is jointly run by The Jakarta Post and Singapore-based Parkway Group Healthcare.

SINGAPORE (JP): A heart attack happens when the blood supply to the heart is suddenly blocked. This usually occurs when the surface of the narrow segment of the blood vessel suddenly "ruptures". A blood clot forms, which totally blocks the blood flow to the heart muscle, starving it of oxygen.

The longer the blood flow is interrupted, the more extensive the damage to the heart; one in four patients dies from their heart attack! Hence, early detection and treatment of heart attacks is essential.

Even if we eat right and exercise, we may suffer a heart attack at some point in our lives. But the ever younger age for heart attacks is a concern. It is no longer rare to see males with their first heart attack in their mid-30s! It is tragic as these people are in their prime and have many responsibilities. Yet, it is worrying that in 2001, a significant proportion of the population is still not aware of the symptoms of heart attack.

Consider this: A 36-year-old male complained of severe chest pain after his regular game of squash. He was fine until that day but he smoked. A 47-year-old engineer on regular medication for mild hypertension was fine until the day of his heart attack! A 42-year-old successful businessman was having lunch with his daughter when he suddenly complained of severe chest pain. He was later treated for an acute anterior myocardial infarction.

Fortunately, the majority of patients present classic symptoms of heart attack i.e. severe central chest pain lasting for at least half an hour, associated with profuse sweating. The pain may radiate to the left arm, throat or jaw. In older patients, they usually complain of persistent chest discomfort rather than chest pain. This may be mistaken as heartburn or indigestion; a 70-year old man felt heartburn after he ate a pepper steak, but it turned out to be a heart attack.

Why do people feel chest pain during a heart attack? When the blood supply of the heart is suddenly blocked, this irritates the nerve endings of the damaged heart. The latter is perceived as pain. Seldom is heart attack pain localized to the left side of the chest even though the heart leans toward the left. Typically, it is felt mid-chest and spreads across the whole chest like a constriction.

Still, one out of four heart attacks happen without any chest pain. Scenarios of atypical heart attacks include:

1. Suddenly feeling breathless and sweating profusely without any obvious reasons.

2. Persistent and "bad" stomachaches, especially if someone is not known to have gastric problems. A 50-year old man visited his doctors on three occasions on the same day with stomach pain associated with sweating. Initially, he was treated for gastric problems. He was third time lucky when another doctor decided to do an ECG. This confirmed an acute anterior myocardial infarction.

3. Persistent left shoulder pain. A 46-year-old man complained of recurrent left shoulder pain for about two years. He was treated for rheumatism. On his recent return from the United States, he had persistent left shoulder pain radiating to his left neck. ECG and blood tests confirmed that he had a heart attack.

4. Upper back pain. A 52-year-old businessman complained of pain in his upper back after his Saturday soccer game. An hour later, he felt unwell as his chest and back felt uncomfortable. Subsequent tests confirmed that he sustained a heart attack. 5. Blackout associated with profuse sweating. A 60-year-old fainted and woke up with profuse sweating. When attended by a doctor at the nearby hospital, he felt fine except for a small bruise on his left temple. He was reassured and was discharged. Later that day, he fainted at home again and was referred back to the same hospital. On this occasion, he had an ECG, which confirmed that he had a heart attack. However, he did not complain of any chest pain.

Why some patients do not complain of typical severe chest pain during the heart attack is not entirely clear. Generally, older patients and diabetic patients are less aware of heart attacks. It is this group of patients whose diagnosis is not readily recognized by both patients and doctors.

What can you do to improve your chances of surviving a heart attack?

1. Always take chest pain seriously.

2. Seek medical attention early if the chest pain is persistent, painful and associated with profuse cold sweat.

3. Check with your doctors if you have an "unexplained" episode of blackout, profuse sweating, breathing difficulties, persistent stomach pain or feel very tired!

4. If in doubt, always go to the nearest hospital's emergency room as soon as possible.

5. During a heart attack, every second counts. Time is the heart muscle.

6. Never postpone a hospital visit because of such reasons as the rest of the family is asleep, it's a weekend or a public holiday.

7. If possible, dial for an ambulance with intensive care facilities to treat any complications on route to the hospital.

8. Make sure the hospital staff attends to you as soon as possible.

9. Do not go home without an ECG.

10. If there is any doubt, do stay overnight for observation. Sometimes, the full-blown picture of a heart attack is not apparent until some hours later.

Readers are encouraged to e-mail their questions to features@thejakartapost.com.