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
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
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.
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,
?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: firstname.lastname@example.org)