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Don't ignore chest pain

Tuesday, November 27, 2018

Heart attacks are life-threatening medical emergencies so seek immediate attention if you have any symptoms, says Dr Sandeep Gore

In recent times, heart attacks have emerged as a major cause of death and disability in India. They are responsible for more than 35% of deaths in individuals aged 35 years and above. A heart attack is a life-threatening medical emergency, which occurs due to sudden blockage of blood supply to the heart muscles. This blockage occurs due to blood clot(s) in major blood vessels supplying oxygenated blood to the heart. If it is not treated promptly, it permanently damages heart muscles, which may lead to death by cardiac arrest.

Symptoms of a heart attack

Central chest pain spreading to left arm, shoulders, back, neck and jaw

Profuse sweating

Difficulty in breathing

Blackouts.

What one should do?

If one experiences heart attack symptoms, he/she must seek urgent medical help. Meanwhile, he/she must avoid physical exertion. Always remember, every chest pain is cardiac pain unless proven otherwise.

DIAGNOSIS Diagnosis can be done in emergency departments by medical professionals through tests like electrocardiogram, cardiac enzymes, chest X-ray and sometimes echocardiography. Sometimes, serial ECGs and blood cardiac enzymes are needed to rule out the cardiac cause.

TREATMENT Initially, the patient gets stabilised in the Emergency Department where s/he receives Analgesics (morphine), blood thinners (anti-platelets and anti-coagulant drugs), nitrates and statins. Primary angioplasty is considered as the gold standard treatment in a heart attack (acute myocardial infarction) which should be carried out within 90 minutes of arrival of patient to the emergency department In primary angioplasty, the blood flow in the vessel supplying oxygenated blood to the heart is restored by removing the blood clot, and a stent is placed in it to keep the vessel open. At centres where primary angioplasty is not available or not possible due to other reasons, then thrombolysis (dissolving the blood clot by giving medicines) should be offered to patients as early as possible. If thrombolysis is opted for, then it should take place within 30 minutes of arrival of the patient to the Emergency Department.

PREVENTION Prevention is always better than cure in heart attacks. To prevent a heart attack, one must be aware about the modifiable risk factors which can lead to it. Modifiable risk factors can be reduced by making lifestyle changes: 

  • Being overweight and obese
  • Smoking
  • High cholesterol
  • Hypertension
  • Diabetes Mellitus
  • Stress
  • Sedentary lifestyle.

If one has five risk factors, then the chances of suffering a heart attack are 30% in the next 10 years. This is equivalent to the risk of recurrence of a heart attack in a patient who already had one. So reduction in risk factors is of paramount importance.

Preventive steps

Quit smoking, smoking kills, it is lethal The number of cigarettes smoked is directly proportional to the risk of heart attack and death due to it. One must quit smoking; counselling and sometimes Nicotine Replacement Therapies are needed.

Consume a healthy diet One should avoid junk food, fast food and red meat. A diet rich in vegetables and fruits prevents a heart attack. One should opt for a high-fibre diet; carbohydrates with low glycaemic index should be preferred. Monounsaturated fatty acids and Omega-3 fatty acids should be included in the diet.

Maintain normal body weight Nowadays obesity and being overweight is surpassing smoking as a leading modifiable risk factor in heart attacks. There is a linear relationship between being overweight and obese with morbidity and mortality associated with heart attacks. One must bring down the Body Mass Index to less than 25 by diet and exercise.

Do regular physical activities Studies have demonstrated that if one does regular aerobic exercise or moderate to intense physical activity for 150 minutes per week, s/he will have significantly less chances of a heart attack than those who don’t. Even modest aerobic exercise like a brisk walk for 25 minutes per day reduces the significant risk of a heart attack.

Control the blood cholesterol level One must undergo lipid profile testing in early twenties. If blood lipid levels are high then control it by exercise, proper diet and, if required, by medicines (statins).

Maintaining the blood pressure within normal range One must maintain blood pressure below 130/80mmHg to reduce this risk factor. Blood pressure can be controlled by doing regular aerobic exercise, by avoiding excessive consumption of salt and by avoiding stressful situations. Patients who don’t respond to lifestyle modification need medicines to control hypertension.

Diabetes control Diabetes carries very high risk of heart attack. Diet and exercise should be tried initially to control the blood sugar within normal range in diabetic patients. If this does not work, then go in for drug or insulin therapy. The HbA1C level should be in normal range in diabetic patients to prevent heart attacks.

Dr Sandeep Gore is Head of Emergency Medicine, Fortis Hospital, Mulund

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