Heart attack: Prevention and management
Nowadays overall prevalence of heart disease is 3-5% in rural areas and 7-10% in urban populations. In our country, heart diseases occurs 5-10 years earlier and affect age group of 35-65 years.
The WHO estimates that more than 75% of premature heart diseases are preventable. Exercise is universally recognised as having a positive impact on keeping one’s heart healthy. But, one has to know the difference in exercise and exertion. This is to enforce on those who say, ‘we are working throughout the day’. Diet which is low in sugars and saturated fats, high in vegetables, fruits and whole grains has been shown to lower blood pressure and bad cholesterol that are independent risk factors for heart disease.
Alcohol intake, even for moderate drinkers, should be reduced. As per ESC guidelines, there is no safe level of alcohol intake.
Some psychosocial factors, such as depression and anxiety, lack of social support, social isolation, and stressful conditions at work, independently influence the occurrence of heart disease.
High-risk individuals should be motivated to:
Quit or reduce tobacco consumption
Opt for healthy food choices, and reduce salt intake
Become physically active Reduce their BMI (to less than 25kg/m2) and waist-hip ratio (to less than 0.8 in women and 0.9 in men)
Lower their blood pressure (<140/90 mmHg); blood cholesterol (<5 mmol/l or 190 mg/dl); and LDLcholesterol (<3.0 mmol/l or 115 mg/dl)
Control glycaemia, especially in diabetics
Women have an advantage of about 10 years over men at the first manifestation but lose this advantage if they smoke, have diabetes, or had premature menopause.
Patients of heart attack can have chest pain which is in upper part of chest, behind the chest bone spreading towards neck and jaw, below the chest bone going to left arm, upper part of tummy, neck and jaw, left shoulder going down both arms and in between the shoulder blades. One has to notice the character of pain which is squeezing, burning, constricting, or heaviness. This pain comes on exertion, excitement, stress, and cold meals. There can also be difficulty in breathing or shortness of breath, and sweating. Patient may feel weak, light-headed, or dizzy.
Acute Coronary Syndrome (ACS)/ heart attack results from either temporary or permanent blockage of coronary arteries, and includes unstable angina (temporary obstruction without cell death), acute myocardial infarction (obstruction, leading to cell death), and sudden cardiac death.
Ischemic changes are apparent at the time of presentation in only 20% to 30% of patients having acute heart attack. Conversely, 5% to 10% of patients with heart attack have normal findings on ECG at presentation. So any one having risk factors, pain typical suggestive of heart disease should reach nearby health center where facilities for ECG , Troponin I, 2D echo are available. In case it is a heart attack, PCI is the best mode of treatment.
The author of this article is Dr Viveka Kumar.