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Men are more susceptible to heart attacks than women, and need to be extra vigilant for tell-tale signs. Image Credit: Shutterstock

Dubai: Heart attacks are on the rise worldwide. According to the American College of Cardiology, about one-third of the total deaths in the adult population around the world occur due to heart disease. In the UAE, data for incidence of Cardio Vascular Disease (CVD) clearly shows residents here face an early onset of CVD, at least 10 years earlier than the world average. This data comes from evidence-based data provided by two leading heart registries — the Gulf Race Registry 2009 and the Cleveland Heart Clinic registry 2019. According to Dr VJ Sebastian, Consultant cardiologist at the Prime Health care group, in the UAE, as per the Ministry of Health and Prevention statistics, about one-third of the fatalities in the adult population can be attributed to CVD.

But what exactly is a heart attack and how do I know if I am having one? Am I more prone to it because of my age or ethnic background? Here’s a look at what causes a heart attack and how you can identify one.

What has age got to do with it?

Suchitra Bajpai Chaudhary, Senior Reporter

Traditionally, heart disease occurs in people around the ages of 65 and above. This was what cardiologists thought until a decade ago as they attributed heart attacks to changes in the arteries and blood vessels of the heart with age. However, as the UAE registries and worldwide data indicate, heart attacks are occurring at a far younger age.

What’s a heart attack?
The heart muscle requires oxygen to stay alive. Lack of oxygen will kill its tissues. A heart attack, or myocardial infarction (MI), occurs when part of the heart muscle is destroyed or damaged due to lack of oxygen.
Coronary arteries bring oxygen-laden blood to the heart muscle. The blood flow is severely reduced or cut off completely when the arteries are narrowed from a build-up of fat, cholesterol, calcium, proteins, inflammatory cells and other substances, which together are called plaque. It is a slow process, known as atherosclerosis.

What are the other causes besides blockage?
A coronary artery can sometimes temporarily contract or go into spasm (the reasons are unclear). That will narrow the artery, affecting the blood flow to the heart muscle.
A rare cause is a spontaneous tearing of the coronary artery wall (spontaneous coronary artery dissection).

Dr Sebastian says: “Instead of patients being in their fifties, a majority of heart patients in my clinic are in their thirties and forties. In fact, my youngest heart attack patient is only 21 years old and he suffered a heart attack because of his smoking habits. He had to undergo angiography and angioplasty for an arterial blockage and has a stent in one artery now. So the situation is really alarming.”

It is not just age; men have a natural propensity to heart disease. According to the Harvard Men’s Health Watch (HMHW), men are more susceptible to heart attacks than women, and need to be extra vigilant for tell-tale signs. The publication pointed out that about 10 per cent of all heart attacks occur in men before the age of 45 and nearly 80 per cent of these attacks happen due to Coronary Artery Disease (CAD), which occurs due to the collection of high cholesterol in the main arteries of the heart, forming a plaque.

Are certain races more susceptible to heart disease?

Statistical evidence clearly shows that cultural habits, demographics and genetics have a huge part to play in early onset of heart disease. Among races, Asians and Afro Americans have higher susceptibility for early onset of CVD leading to cardiac episodes earlier in their lives.

Dr VJ Sebastian

Dr Sebastian explained: “Asians are more susceptible to heart attacks and heart disease because genetically the arteries are narrower than those of other races. Besides this, most Asian cultures have a greater tendency towards leading a sedentary lifestyle and are not mindful of nutrition. Now as many generations among Indian and other South Asian families have seen heart disease, CVD is also attributed to a hereditary history of heart disease in the family.”

Graphic angioplasty heart attack
Image Credit: Graphic News

The other big factor for CVD and heart attacks among Asians is the habit of smoking, incidence of diabetes and the existence of high levels of stress.

Dr Sebastian added that in the UAE one could see a reflection of the same phenomenon at a microcosmic level, amongst the expatriates from South Asia here. “In the UAE we see a higher incidence of heart disease among South Asians particularly Indians. I have patients’ relatives often coming in to tell me that the patient who had a heart attack was facing high stress, chasing huge targets in office, suffered job insecurity or actually lost his job, days before the heart attack. It is such patients who follow unhealthy diets, are habitual smokers and face high stress, that suffer from early cardiac episodes. India is literally the head quarters for Type II diabetes as well as high stress which is the main trigger for heart attacks.”

Heart attack and cardiac arrest: What’s the difference?
The terms are generally used interchangeably, but actually they are two different events.
A heart attack is when blood flow to the heart is blocked. It’s a blood circulation problem, to quote the American Health Association.
A sudden cardiac arrest (SCA) occurs when the heart malfunctions and suddenly stops beating. The American Health Association calls it an electrical problem, caused by irregular heart rhythms called arrhythmias.
Death occurs within minutes after the heart stops.
A heart attack can cause a cardiac arrest.

Why do heart attacks happen?

The heart is the most sophisticated pumping device that pumps oxygenated blood to the body. There are several reasons for early incidence of CVD, say doctors. Smoking, eating unhealthy food that is rich in saturated fats, the early onset of high cholesterol, hypertension and above all these factors, existence of high stress in one’s life, are some of the factors that trigger the formation of plaques in the arteries. Plaques are deposits of excess cholesterol mixed with calcium and fibrous tissue. While small deposits may not pose a big problem, over time the deposits increase, and constrain blood supply in major coronary arteries. When a plaque that may be clogging one of the major coronary arteries bursts, it causes a blood clot that may restrict supply of blood to the heart, resulting in a heart attack.

Graphic athletes heart attack
Image Credit: Graphic News

Reaching hospital in time can save your heart muscle

Many people often dismiss a sudden pain or discomfort as being indigestion and miss out reaching the hospital in time. The symptoms can be so mild that they go unnoticed, that is why it is very important to catch coronary heart disease at an early stage and this is done through regular screenings. For people who have a family history of heart disease, it is important to start screening at an earlier age, say heart specialists. If one can identify the nearest hospital and reach the Emergency Room (ER) in time, the cardiologists today can intervene to prevent major damage to the heart muscle. Earlier it was thought that good rest with a combination of medicines would help conserve the heart. Now cardiac surgeons immediately look to do an angiography, and bust the clot to save the heart muscle. Time saves heart muscle, is what all cardiologists believe in.

Am I having a heart attack?

If you have not had the time to undergo screening and happen to undergo a heart attack, how are you likely to know what is happening to you?

Dr Rajiv Lochan

Dr Rajiv Lochan, Director of Cardiology and Heart Attack Centre at Al Zahra Hospital Dubai, explained: “When someone undergoes a heart attack, some of the most common symptoms they experience include pressure, tightness, pain, or a squeezing or aching sensation in the chest or arms that may spread to the neck, jaw or back.”

These symptoms can further be accompanied by nausea, indigestion, heartburn or abdominal pain, shortness of breath, cold sweat, fatigue, lightheadedness or sudden dizziness.

What are the common symptoms of a heart attack?
Symptoms and its severity can vary. Some people can have severe pain, while others will have only mild discomfort. In some cases, there may not be pain at all. For some others, symptoms may not manifest.
The common signs and symptoms include:
• Pressure, heaviness, or pain in the chest, arm, or below the breastbone
• Pain or tightness radiating to the back, jaw, throat, or arm
• Nausea, indigestion, heartburn or abdominal pain
• Sweating, nausea, vomiting
• Extreme weakness or fatigue, anxiety
• Shortness of breath
• Rapid or irregular heartbeats
• Cold sweat
• Lightheadedness or dizziness

Is it heart attack or panic attack?

Symptoms of a panic attack and a heart attack are similar. “Recently during the pandemic, with elevated levels of anxiety, we see many people coming in panic attacks that somewhat mimic heart attacks,” explained Dr Behrad Elahi, Specialist Interventional Cardiology at the Al Zahra Hospital Dubai Heart Attack Centre.

Dr Behrad Elahi

However, Dr Elahi advised it was better to come to the ER if one suspected heart attack as it was advisable to be cautious. “In some people, having a heart attack could trigger a sense of panic, while panic attacks are not a known trigger for heart attacks. However, both may have a stress connection and often have similar symptoms.” Reaching the hospital in time is the key to letting the heart specialists know the nature of the episode one is having as timely medical intervention ensures a good survival rate for patients.

Prevention is better than cure

“80 per cent of untimely heart attacks can be avoided,” said Dr Elahi, pointing out that adopting a healthier lifestyle was the key to it. The best option is for people to adopt a healthy diet and regular physical activity. Further cutting out the use of tobacco products, being vigilant about controlling comorbidities such as blood pressure, high cholesterol and high blood sugar or diabetes were very important in averting any episode of a heart attack, he explained.

Major causes that can trigger a heart attack
• Obesity
• Poor diet and lack of exercise
• Type 2 diabetes
• High blood pressure
• High cholesterol
• Smoking
• Family history of cardiovascular disease

Major lifestyle changes can prevent early incidence of heart disease

Even if one has a family history of heart disease, what can truly avert CVD is following a healthy lifestyle, say doctors. “One must be consistent with physical exercise of at least one hour a day. Maintain your body weight at an ideal level in proportion to the height, cut down on oily and fatty food, have sufficient portions of fresh fruits and vegetables in daily meals. In addition to this, it is recommended one should stop consumption of tobacco in any form, cut out on alcohol, undergo regular full body check-ups and keep the tendency of developing Type II diabetes, hypertension and high cholesterol, under control with proper medical intervention. These factors can greatly help towards reducing the risk of CVD,” said Dr Sebastian.

First person account

I have rushed to the Emergency four times

Shyam A. Krishna, Senior Associate Editor

I have had four heart attacks. At least, that’s what I thought. Each time the ECG and blood test told a different story. There’s no heart attack. Must be heartburn, the doctors at the Emergency ward told me.

In between the four visits to the hospitals, I have had chest pains on numerous occasions. I have lost count of them. But each time a couple of antacid tablets would help.

Yes, I’ve consulted Dr. Google many times. It only served to magnify my fears. I seemed to have every symptom described there.

Then there are the videos on heart attacks and heart health that tend to flood my WhatApp groups. A particular one by Dr Devi Prasad Shetty, a cardiac surgeon in Bangalore, caught my attention. What Dr Shetty said was very enlightening.

Read more

One question was: How do you distinguish between a heart attack and heartburn (caused by stomach acidity or acid reflux)? It’s very difficult even for doctors, he said, adding some symptoms are identical.

So what do you do? The prudent thing would be to rush to a hospital. A hospital, not a clinic, since many clinics won’t be equipped to deal with such an emergency. A clinic is an option only when access to a hospital is difficult.

I harp on this because I lost a friend who decided to drop into a clinic for chest pain. The doctor could not find any anomaly in the heart rate but advised him to go to a hospital, which he didn’t. He must have thought, “Why should I go to a hospital when the doctor didn’t find anything wrong”? He ignored the doctor’s advice. And paid the price around six hours later. He suffered a cardiac arrest, and no one was home.

So I take chest pains very seriously. Sometimes my left hand hurts, the pain seeps up the arm. That’s when I rush to the Emergency. It turned out to be a false alarm four times. Each time, it was a huge relief.

I have had heartburn for a very long. My bloated stomach is a source of mirth to my wife and daughter. I’m aware of acid reflux and its symptoms, but the risk of a heart attack is always at the back of my mind.

I’m Indian, which puts me in a high-risk category. And therapy for my lymphoma included a cocktail of medications, any one of which could increase the chances of a heart attack. This is my fear. The doctors didn’t say it.

When the next chest pain refuses to go away, you will find me in an Emergency ward with ECG electrodes stuck to my chest. I’m serious: cross my heart.

Know the medical terms of a heart attack

The following are the different medical terms for a heart attack, described by the American Heart Association:

Acute coronary syndrome (ACS): This is an umbrella term to refer to situations when the blood supply to the heart muscle is blocked suddenly.

STEMI: ST-elevation myocardial infarction is caused by a complete blockage in a coronary artery.

NSTEMI: A non-ST-elevated myocardial infarction is one in which an artery is partially blocked and severely reduces blood flow.

Myocardial infarction (MI): It’s the medical term for a heart attack. “Myo” means muscle, “cardial” refers to the heart, and “infarction” is death or destruction of tissue due to lack of blood supply.

Coronary thrombosis: Formation of a clot in an artery that supply blood to the heart muscle.

Coronary occlusion: An obstruction of a coronary artery that results in lack of blood flow to a part of the heart muscle. It is a cause of heart attack.