Heart attacks

The medical term for a heart attack is myocardial infarction (pro -nounced 'myo-car-dee-al in-fark-shun'). The heart muscle is the myocardium; infarct means death - thus, death of heart muscle. Some people also use the term 'coronary' because the cause is a block of a coronary artery.

Every 30 seconds someone dies from coronary artery disease. It is the single most important cause of death for men and women. Coronary artery disease kills more people than all the cancers put together.

Will I be able to avoid a heart attack?

There is no guarantee (never say never!) but your risks can be lessened by heeding the following advice.

• Do not smoke (not one cigarette, not at all).

• Avoid passive smoking (sit in non-smoking areas; if your family smokes, send them outside to do so).

• Watch your blood pressure (know your reading).

• Know your cholesterol level and keep it low by diet, and medication if necessary (this is very important).

• Eat plenty of fresh fruit and vegetables.

• Keep your weight down and take plenty of exercise.

• Enjoy alcohol in moderation.

Just as you service your car - service your body

Can you tell me what causes a heart attack?

Heart attack occurs when an area of heart muscle is deprived of blood because of a blockage in a coronary artery. As the muscle no longer has oxygen to feed it, it begins to die, chemicals build up and pain is felt. The cause is usually a clot forming on an area of narrowing in an artery (see Chapter 2).

I have recently heard that heart attacks can be caused by exhaust pollution. Is this true?

Recently, a statistical link has been reported between car exhaust pollution and heart attacks, with those most at risk being pedestrians, cyclists and drivers. Links like this have been shown before (for example, in railwaymen in fume-filled tunnels) but no medical proof exists that it causes a heart attack, and there could be other interpretations of the association. An association does not mean a cause, and most links like this raise more questions than are resolved. It is of course interesting, but there is little we can do about it other than change our travel methods on a large scale.

SYMPTOMS

What are the symptoms of a heart attack?

Almost always there is chest pain. It usually builds up to become . severe. It lasts longer than half an hour and, unless treated,

Figure 4.1 Site and radiation of heart pain.

may go on for 4-6 hours or more. The pain is most often across your chest and feels like a weight or a tightness. Some people describe it with a clenched fist as if the pressure or squeezing of the pain resembles the clenching of the fist. The pain is rarely sharp like a knife and cannot be pointed to by one finger as it is spread across the chest. The pain comes from the same place, even if you change your position from standing to sitting or lying down (see Figure 4.1).

You may also get pain down your arms, usually the inside, to your wrists. The left arm is more often affected than the right. It can go to your jaw, throat, back or stomach. The pain may be severe, causing sweating, and be associated with feeling sick (nausea) or vomiting. So, get help fast if you have:

• a heavy feeling - a feeling like a weight or pressure, or a squeezing feeling like a band in the chest - that lasts longer than 20 minutes and builds up (heart attack pain usually builds up rather than being at its worst when it starts);

• pain from your chest, going to your neck, jaw or arms (left more common than right) and lasting longer than 20 minutes;

• pain (or discomfort) along with nausea, sweating, feeling faint or short of breath.

Are there any warning signs that might point to an impending heart attack?

Many people complain of 'indigestion' for some days or weeks beforehand. What they have been experiencing is angina. It is quite common for people who have had a heart attack to say that they have been very tired in the previous 3-6 months. Some complain of breathlessness (the tightness across the chest has a breathless feeling about it) and dropping off to sleep watching TV. Others have noticed an increased tendency to snore and irritability: feeling 'out of sorts', 'just not themselves'.

A new warning sign is that of men complaining of difficulty getting an erection. The blood vessels to the penis do not function properly and can reflect problems with the blood vessels to the heart. Erection problems in men are caused by smoking, raised cholesterol, blood pressure or diabetes - exactly the same as for the coronary arteries! Play safe and go to the doctor. If you are worried about a friend or relative, do not take no for an answer - get them to see a doctor. If you think it is a heart attack, do not delay: for every 1 hour's delay, one life in every hundred will be lost - dial the emergency services (999 in the UK).

I know that I get angina and have learnt to recognise the symptoms. How will I recognise the difference between the pain of angina and that of a heart attack?

Angina is the result of a temporary shortage of oxygen available to the heart muscle and is usually caused by exercise (such as walking up a hill) or strong emotion, especially anger (see Chapter 3). The pain is most often a tightness or a weight on your chest that may spread to your neck or arms. Anginal pain passes off when you stop or reduce exercise or when you take a nitrate tablet or spray. It does not last longer than half an hour.

The cause of angina is narrowing of the coronary arteries. Think of the artery as a three-lane motorway and angina as the result of two lanes being coned off. All the traffic will get through if people travel slow enough but, at high speeds, three lanes will only go into one if someone stops to give way. If no one gives way there will be a crash blocking the third lane. This is what happens in a heart attack. A clot forms on the narrowed part to block the artery totally. Narrow coronary arteries are often described as being hardened or furred-up.

My brother has had a heart attack - according to the hospital. He says that he did not feel it happening. I thought a heart attack was painful.

Some heart attacks can be so minor that they are barely noticed, but others can be more severe. The severity depends on which part of the artery is affected. If you look at the diagram of the heart in Chapter 1 (Figure 1.1), you will see that there are two main arteries shown - the right and left. The left divides into two main trunks. These branch again and again into smaller branches or tubes (vessels), supplying blood to all of the heart muscle. A blockage in one of the tiny vessels means that only a very small part of the heart is deprived of blood. A blockage in a larger branch affects a much larger area of heart muscle. Because the blood can no longer get through and feed the heart and remove waste from the muscle, chemicals build up to produce pain, as if the heart had been bruised.