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Heart Attack: Causes, Symptoms, and Prevention

Cardiovascular disease in Nepal

Posted on : September 29, 2020 by Clinic One on Diseases in Nepal


Medically termed as “Myocardial Infarction”, a heart attack is a serious medical condition whereby blood to the heart muscles is blocked generally due to the clot.

Consequently, heart muscles start to die if not well attended promptly.

While it is unwise to predict the outcome of any heart attack, sometimes people come out of it fine without much damage to the heart, this is what is commonly called a mild heart attack.


Causes of Heart Attack

A heart attack is usually caused as a result of coronary heart disease / ischemic heart disease.

This is a condition where a fatty substance (cholesterol) or plaques builds up inside the coronary arteries, narrowing the arteries and thereby blocking the blood flow to heart muscles. 

These plaques can sometimes rupture the blood vessel and spillover cholesterol and other substances into the bloodstream consequently forming a clot at the site of the rupture.

If the clot is large enough, it can block the blood flow through the arteries and to the heart muscles, limiting the supply of oxygen, a medical condition known as “Ischemia”.

relation between cholesterol level & heart problems

This is primarily the cause of a heart attack where there is partial or complete blockage of coronary arteries.

This process of a buildup of plaques inside the coronary arteries is medically termed as atherosclerosis.

And this occurs over many years due to the result of unhealthy lifestyle habits such as drinking, smoking, lack of regular exercise, some medical conditions such as high blood pressure, cholesterol, etc.

It also has been noted that medications to treat pain for certain health conditions such as “arthritis” that uses cox2-inhibitors also increases the likelihood of having heart attacks.

This is because these medications block the cox2 enzyme that is expressed at the site of inflammation to reduce pain.

But the complication arises because cox2 inhibitors in these medications also inhibit the cox1 enzyme that thins the blood in the vessels leading to a blood clot and hence increasing the chances of a heart attack.

Heart With Muscle Damage and a Blocked Artery
Figure 1: Overview of the process of a heart attack: Adapted from NIH (National Institute of Health) website


Prevalence Of Heart Attack in Nepal and Worldwide

According to the WHO report published in 2018, the number of deaths due to coronary heart disease in Nepal was estimated to be 34,167 which is equivalent to 20.53% of total deaths in the country.

Moreover, the age-adjusted death rate is 184.95 per 1,00,000 people which ranks Nepal, 38th country in the world to have the highest death rate due to coronary heart disease. 

Similarly, according to WHO newsroom, the number of global fatalities is equivalent to 17.9 million people in 2016 due to cardiovascular disease (CVD) among which 85% are due to heart attacks and strokes.

This represents 31% of all global deaths and ranks (CVD) as the leading cause of death worldwide.

Moreover, over three-quarters of these deaths due to (CVD) takes place in low and middle-income countries.



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These statistics speak loud and clear about the overwhelming prevalence of heart disease in the national and global scene.

And since much of the fatalities are associated with heart attacks and strokes, any signs and symptoms associated with it must not be ignored.


Types of Heart attack

Heart attacks can be classified on three types namely ST-elevation myocardial infarction or (STEMI), non-ST-elevation myocardial infarction, or (STEMI) and coronary spasms/unstable angina.

They are classified based on the degree of blockage of the coronary artery which consequently limits the heart muscles of vital oxygen and nutrients.


STEMI and NSTEMI

Complete blockage of coronary arteries results in serious heart attack as termed as ST-elevation myocardial infarction or (STEMI) while partial blockage can cause mild heart attacks, medically termed as non-ST elevation myocardial infarction (NSTEMI).

STEMI can have fatal consequences or can pose serious damage to the heart while NSTEMI may not be lethal.


Coronary spasms 

In rare circumstances, spasms can also cause a heart attack by shutting down the blood flow to the heart muscles.

These are usually seen in smokers and peoples who abuse drugs such as cocaine.

Although it is commonly termed as a “silent heart attack” and hence, as the name implies, it is unlikely of permanent damage to the heart, nevertheless, it can be a warning sign for any future serious heart attacks.


Who is at Most Risk of Heart Attack?

Some risk factors that contribute to having a heart attack do so by building up fatty deposits inside the arteries, thereby narrowing them and eventually increasing the risk of having a heart attack over time.

These risk factors are listed below.

Age – The general statistics portrays that men of 45 years and older and women of 55 years and older are more at risk of having a heart attack.

Tobacco – Smokers and people who are constantly exposed to second-hand smoke are more likely to have a heart attack in the future.

High blood Pressure – High blood pressure eventually has a damaging effect on the arteries especially in addition to other conditions such as obesity, cholesterol, diabetes increases the likelihood of having a heart attack.

High blood cholesterol and triglycerides – Increased level of low-density cholesterol (LDL) or bad cholesterol effect on narrowing down the arteries thereby increasing the likelihood of having a heart attack.

Similarly, an increased level of triglycerides or blood fat also substantially increases the risk.

Obesity – Being overweight in addition to having medical conditions as listed above such as high blood pressure, increased cholesterol, and triglyceride levels are likely to be risk factors.

Diabetes – Increase in blood sugar level primarily due to not producing hormone insulin by the pancreas or due to not responding to the hormone by our body may increase the risk of a heart attack.

Family history – Having a history of heart disease in the family also increases the likelihood of having a heart attack it influences the genetics of the person.

Sedentary lifestyle- Not having enough exercise increases obesity and blood cholesterol levels both of which are the risk factors for heart attack. Hence regular exercise is a must for good heart health.

Drug use- Use of stimulant drugs such as cocaine and amphetamines increases the chances of spasms in the coronary artery and thereby increases the risk factor for heart attack.

Stress- Responding to stress that brings shock in the consciousness of an individual can also increase the chances of a heart attack.


Symptoms Of Heart Attack

Before we discuss more common signs and symptoms for heart attack, it must be noted that not all peoples have the same signs and symptoms and its severity vary.

In other words, some people may have severe chest pain while some may have mild pain and some may not even have any signs at all.

But more signs and symptoms people have and earlier they have is a prominent indication of a future heart attack so that they have time to prepare. Some common signs and symptoms may be.

  • Pain, pressure or tightness in the chest area (angina) or heartburn
  • Nausea, indigestion, or abdominal pain
  • Shortness of breath
  • Cold sweat
  • Weakness and dizziness
  • Indigestion
  • Anxiety or feeling of doom

Although chest pain is the most common and telltale sign of a heart attack it can radiate up to the chin through the shoulders.

And this may differ in the case of men and women and the difference is mainly based on how the pain radiates.


Symptoms of Heart Attack in Men

Chest pain in men may radiate to the left arm or shoulder up to the chin and jaw.


Symptoms of Heart Attack in Women

Pain can be more difficult to analyze or describe and may radiate to either side of shoulders, arms or chin, jaw, and even to the upper back or abdomen.

Moreover, it must also be noted that not all heart attack symptoms are severe chest pain as depicted in movies.

Thus some signs and symptoms can be less dramatic and silent such as shortness of breath, cold sweat, weakness, and dizziness.

These are termed as silent symptoms but can be equally dangerous because it goes un-noticed thereby inflicting much damage. 

Additionally, much of the signs and symptoms of panic attacks are similar to heart attacks thus leading people confused.

But anxiety associated with the heart attack is usually accompanied by chest pain or pressure which can radiate up to the shoulders, chin, and jaw. 


When to see a Cardiologist / Heart Doctor?

If you are having any of the above-mentioned signs and symptoms, then it is vitally important for you to see a doctor immediately because sometimes it’s too late even to arrive at the hospital.

disease in nepal, heart disease

As the statistics suggest almost half of the patient fails to get to the medical attention or arrive at the hospital and pass during the 1st hour of their first symptoms.


What are the complications of a Heart attack?

As in the case of signs and symptoms, similar is the case of complications arising from a heart attack which is to say that it varies a lot between individuals.

Variations are based on their severity and modality. Some common complications that may arise are discussed below.


1. Arrhythmias

This a condition that develops an irregular heart rhythm because of the damage to the heart muscles.

Eventually, these damaged heart muscles disrupt electrical signals sent by the nervous system that controls the rhythm thus leading to one of either form of arrhythmias as discussed below.

2. Tachycardia

Increased heartbeat rate than normal.

Bradycardia- Decreased heartbeat rate than normal

Or heartbeat rate can just be irregular 

Usually, medications are used as the treatment but some chronic cases may require the implant of pacemakers into the chest to regulate the rhythm.

Heart Failure: If the heart attack was severe it can lead to serious damage to heart muscles leading to heart failure. This is a condition where your heart is unable to pump blood around other parts of the body.

Heart Rupture: This the most serious complication of heart attack where muscles, valves, or walls of the heart splits apart. This occurs in almost 10% of the cases of heart attack and almost half of the peoples with heart rupture have fatal consequences within 5 days of the rupture. Generally, surgery is done to repair the damage.


Diagnosis of Heart Attack

The diagnosis of a heart attack starts with regular physical examination and verbal questioning of your signs and symptoms. This is because only then your doctor may decide on further evaluations and tests such as required.

ECG (Electrocardiogram)This is almost the first diagnostic test done to confirm that you are having a heart attack. In this test, a machine reads your nerve impulses passing through your heart. Since a damaged heart usually has irregular or abnormal impulses sent to your heart, this can be analyzed by a tour doctor and inform you if you just had an attack or you are having one.

Blood Tests- After an attack certain proteins from your heart may leak into the bloodstream. Thus this can be tested in the lab and analyzed by your doctor to inform you if you just had or having a heart attack.

Chest X-raysDoctors can usually analyze an X-ray image to check for your heart size and also look for any fluid on your lungs and say much about your heart condition.

Echocardiogram This is a technique where ultra-sound is used to create the image of a heart in motion. This is primarily done to check if your heart is pumping blood through the valves and chambers of your heart.

Coronary catheterization (angiogram)- This is a technique where a long, thin tube called a catheter is used to inject a dye into the arteries of your heart to see the area of blockage. Usually, the tube is inserted from an artery in your legs or groin into the arteries of your heart. After the insertion and release of the dye, X-rays are taken to reveal the area of blockage.

Cardiac city scan or MRI- These tests are done to create the image of your heart and chest in an extensive depth to reveal the condition of your heart. The difference here is that a Cardiac city scan uses X-rays while MRIs use magnetic fields and radio waves to come to an image. These teats are usually done to access the extent of damage to your heart from a heart attack.


Treatment and Procedures

There are some preliminary treatments that your doctor can embark on if you are a suspect of a heart attack such as

  • Use of aspirin to prevent clotting of your blood
  • Use of nitroglycerine to enhance the blood flow 
  • Oxygen therapy

These procedures drastically increase the survival rate of the patient. This is because almost half of the people that meet with fatal consequences die within an hour of their first symptoms and before arriving at the hospital.

Now when you are out of danger, or with mild cases of heart attack doctors may use some medications such as 

  • Clot busters – To reduce blood clots that are clogging your arteries
  • Blood pressure medications- To control blood pressure
  • Blood thinners– To enhance blood flow and remove a clot
  • Statins- To reduce bad cholesterol (LDL) levels 

But if your doctor suspects of any surgical process to be needed, you may be advised to have 

1) Coronary artery bypass or grafting: Procedure where the artery from elsewhere from your body will be attached into your heart at the site of the blocked coronary artery so that blood flow can be rerouted to your heart.

2) Stent: This is a technique that uses a narrow, flexible tube at the site of the blocked artery to enhance the blood flow. This will push the plaques, substance that blocks the blood flow into the walls of the arteries.


Preventive measures of Heart Attack

There are basically few basic lifestyle changes that can drastically reduce the likelihood of having a heart attack and these are

  • Keeping up a regular exercise schedule such as brisk walking, jogging, cycling, or swimming
  • Keeping up to a heart-healthy diet such as green and fresh vegetables and fruits, whole grain cereals, fish, nuts, beans, lentils, and olive oil
  • Avoiding red meat, processed food, and drinks with added sugar
  • Quitting unhealthy habits such as smoking, drinking, and drinking
  • Having ample rest particularly sleeping 7-9 hours a day
  • Reducing stress levels of any kind
  • Taking medications of blood pressure and cholesterol regularly
  • Getting regular checkups done for your heart and blood


What to do if someone in front of you is having a heart attack?

If someone in front of you is having a heart attack, that involves chest pain which is for more than 15 minutes, there are few things one can do to prevent the extensive damage until the patient gets any medical attention and help from a medical professional.

  1. Seek professional medical help: It is important to rush the patient to the hospital renowned for heart health care.
  2. Ingestion of aspirin- This will help minimize the blood clots triggered by plaque ruptures thereby increasing the rate of survival. Exception: Unless you are allergic to aspirin.
  3. Ingestion of nitroglycerine: If you previously have had a heart attack and had been prescribed nitroglycerine by your doctor, it is wise to take nitroglycerine as prescribed by your doctor.
    These are the class of medications known as vasodilators that relaxes your blood vessels so that your heart does not have to work extra hard and thereby cures angina.
  4. Begin CPR (Cardio-pulmonary Resuscitation) if the person is unconscious

This will be vital for the patient for his survival when given by someone trained to give it. But if not, you can always do the chest compression for up to 100-120 compressions per minute. This will also be very vital for the survival of the patient until they receive professional medical help.

References:
Cleveland Clinic (2020) What is a mild heart attack? Health Essentials
Health direct (2018), Complications of a heart attack
Honor Health, Heart attack symptoms and warning signs
HSE (Our Health Services) (2011), Heart Attack, Article
James Roland (2020) Types of heart attacks: What you should know, Health line journal
Mayo Clinic, Heart Attack, Signs, Symptoms, causes, risk factors, diagnosis, and first Aid 
Medicine Plus (2017), Nitroglycerine sublingual, why is this medicine prescribed?
News Medical Life Sciences (2006) Why COX-2 inhibitors such as Vioxx can cause heart attack and strokes
NIH (National Institute of Health), Heart Attack, Article
Penn Medicine, 4 silent heart attack signs
UPMC (2018), Heart and Vascular Institute, Is this an anxiety attack or heart attack? How to know
World Life Expectancy, World Health Rankings, Coronary Heart Disease in Nepal
World Health Organization (WHO) (2017), Cardio-Vascular Disease, Newsroom, Factsheets


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