TZ is a 60-year old manager with a history of hypertension, diabetes mellitus, and obesity of over 10 years duration. He suddenly woke up at night with severe chest pain that radiated to his back. If he had not received adequate care in his hospital, he could have died. He had a heart attack.
A myocardial infarction (heart attack) results from a sudden interruption in the flow of blood to the heart. The suddenness of that interruption leads to the death of heart muscles or their valves. This disrupts the ability of the heart to pump blood to vital organs. If appropriate care is not received immediately, death may occur.
HOW DOES IT HAPPEN? This heart disease is usually due to narrowing of the blood vessels that supply the heart its own nutrients and oxygen. With aging and several risk factors (see below), the blood vessels to the heart gradually become narrowed to a stage where the heart’s capacity to carry out its function becomes compromised. An initial complaint by the individual is a form of chest pain brought on by moderate activity. The pain is usually relieved by rest. This relief usually makes people to ignore the pain. Other persons attribute the pain to other causes. Overlooking this pain is a very dangerous thing to do!
WHAT CONDITIONS INCREASE THE RISK OF A HEART ATTACK? Some risk factors can be modified or addressed. Others cannot.
Non-modifiable risk factors which cannot be addressed by anyone include
-Family history of heart attacks
Modifiable risk factors which can be addressed include
-Hypercholesterolemia (High blood cholesterol level)
-Obesity / Sedentary life style
-Obstructive sleep apnoea: A condition that typically manifests as occasional cessation of breath while asleep.
-Type A personality: A stress provoking personality in which the individual expresses impatience, hostility, unhealthy competition, perfectionism, et cetera, in different forms.
WHAT SHOULD AFFECTED INDIVIDUALS DO? Heart attacks are a big killer with long term implications for those who manage to survive the episode. Therefore, chest pain, especially a dull ache which comes on with exercise and is relieved by rest should not be ignored. The pain could be the warning sign of an impending heart attack. Urgent visit to the doctor with frank description of one’s complaints has saved many lives. The physician would be able to assess the risk factors. Certain investigations are requested to make a diagnosis. These investigations could be expensive especially for those without a health insurance. The importance, however, cannot be overemphasized. Necessary treatment is commenced. In addition, lifestyle adjustment, is recommended for the rest of the person’s life.
CAN HEART ATTACK BE PREVENTED? Yes!
As listed above, working on the modifiable risk factors is the best way to prevent heart attacks.
1. Hypertension causes a stiffening and hardening of blood vessels and also places a significant burden on the heart muscles to pump against resistance in the arteries. Medications to lower blood pressure to acceptable ranges are easily available.
2. Cigarette smoking is a major cause of hardening and narrowing of blood vessels to the heart. It significantly contributes to heart attacks. Smoking should be avoided because there is no safe smoking; not even a stick of cigarette.
3. Diabetes is a major killer of the heart and also contributes to the burden of heart attacks. In some cases, individuals with diabetes might not have the chest pain that warns of an impending heart attack. This is referred to as a silent heart attack! A good control of diabetes with regular check-ups is very important.
4. Obesity: An obese individual has extra weight to carry around, which translates to extra work for the heart to deal with. This also predisposes to more bad cholesterol in the body that tends to clog up the blood vessels of the heart. Adjustment of the diet plays a major role. Moderation in diet size, with preference for low fat, non-sugary, and less refined meals should be the core of eating habits. Regular and adequate exercises help control obesity.
5. Hypercholesterolemia is an accumulation of the bad cholesterol in the blood. While it is commoner in obese people, it often might be present in slim individuals. A blood test is the best way to know if this is a problem in one’s system. The use of blood fat lowering medication is essential.
6. Individuals with aggressive personalities need to undergo counselling sessions to overcome stressful situations.
Key Recommendation: An annual check of one’s health status helps to identity the risks of heart attack early.
Dr Femi Afolayan obtained his medical degree at the University of Ilorin, Nigeria. He had a stint in internal medicine residency programme at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi state and later National Hospital, Abuja before he relocated to Australia and started out in emergency medicine training as a registrar for 2 years and later a fellowship program in internal medicine about 3 years ago. He is currently a senior registrar in acute care and intensive medicine, general medicine, and geriatrics. He is also an honorary lecturer with the medical school, Deakin University, Geelong, Australia. He enjoys teaching, cooking and playing video games. He can be reached on email@example.com.