Heart Attack Warning Signs
By Dr. Sattar Abbasi
Professor of Clinical Medicine
University of California, Los Angeles

In my last article, I mentioned the key elements for the prevention of heart disease and stroke. These may be summarized under the A-B-C-D-E's of prevention:
A: Aspirin, low dose, especially for higher risk individuals.
B: Blood pressure control, closer to 120/80.
C: Cholesterol at optimum level (both good HDL and bad LDL cholesterol).
D: Diet and diabetes management.
E: Exercise, minimum of 30 minutes a day, five days a week.
It has been estimated that by following the above guidelines, one may be able to prevent heart attacks and strokes by close to 80%. But if one is unlucky and develops heart disease, what are the symptoms, which could alert us to seek immediate help?
When coronary arteries gradually narrow so that not enough blood is going to the heart muscle, the patient gets what is called effort angina. This is classically felt as mid chest pressure or discomfort, which may radiate to the left or right arm, and is often associated with shortness of breath. The chest discomfort occurs during exertion or emotion, and is quickly relieved by rest. A diagnosis of effort angina can be confirmed by an exercise test, such as a treadmill test, and medical management is often sufficient to halt further progression. Angina, which occurs at rest or nocturnally, waking the patient from sleep, is more serious and needs urgent attention. It generally requires cardiac catheterization and angiography to confirm the blockage, and may need a stent to keep the artery open.
Heart attack occurs when there is a complete blockage of one or more of the major coronary arteries. It often happens fairly suddenly, and may not be preceded by exertional angina. That is because the fatty, atheromatous plaque inside the artery suddenly ruptures, followed by blood clot, which completely blocks the artery. If this clot can be dissolved by clot dissolving medicines (thrombolytics), and/or a stent is placed in the artery to keep the artery open, within 90 minutes of the heart attack, very little or no damage of the heart muscle may occur. If there is a delay in opening the artery, there may be a considerable amount of damage or death. Unfortunately, one-third of the patients with heart attack die suddenly. However, even in these patients there is often milder symptoms hours or days preceding the full-blown heart attack.

Heart Attack Warning Signs
Some heart attacks are sudden and intense (movie heart attack) where no one doubts what is happening. But most heart attacks start slowly with mild pain or discomfort. Often people affected are not sure what is wrong, and wait too long before getting help. Here are the signs that can signal a heart attack is happening:
?Chest Discomfort: Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, or fullness.
?Discomfort in Other Areas of the Upper Body: Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
?Shortness of Breath: With or without chest discomfort.
?Other Signs: Other signs may include breaking out in a cold sweat, nausea, or lightheadedness.
As with men, women's most common heart attack symptom is chest pain or discomfort, but women are somewhat more likely than men to experience some of the other less common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.
If you experience the above symptoms, immediately call 911. Do not waste time to call your friends or family, and never drive yourself to an emergency room. Time is critical to save your lifeThe statistics of heart disease are alarming. Annually, 1,000,000 people in the United States will have a heart attack. One-third will die suddenly, and the rest may end up with significant damage to the heart muscle compromising their lifestyle. What a pity that most of this could be prevented or at least postponed with the tools of prevention we have available today. Even if a heart attack does occur, immediate help can save lives. Remember, South Asians have the highest risk of heart disease in the world. Young or old, we are all at risk, which should be taken seriously.
(Dr. Abbasi can be reached at: asabbasi@cox.net)



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