Heart attacks, the biggest killer in South Africa

According to Frikkie Gous, spokesperson of Lifemed Ambulance Services, a heart attack is the death of heart muscle due to the complete blockage of a diseased coronary artery due to a blood clot and the most common cause is coronary artery disease (Cad).

“Several factors increase the likelihood of a heart attack, the most important of which are family history of heart disease, high cholesterol, diabetes, smoking, obesity and uncontrolled hypertension. Before a heart attack occurs, there may be warning signs in the form of angina,” said Gous.

Trials monitoring the outcome of hospitalised heart attack patients have shown a mortality rate of up to 10% within the first 30 days after an attack and those patients with known risk factors must have them controlled to prevent another heart attack and disease progression, said Gous.

What causes it?

Cad is by far the commonest cause, said Gous.

Cad causes arteries to become narrowed, usually as a result of fatty cholesterol deposits (plaque) in the arterial wall, which bulge inwards and partly obstruct the flow of blood. The tip of this bulging cholesterol plaque can become eroded. The body attempts to seal this tip off by depositing blood platelets, forming a clot. As this clot increases in size, the artery becomes critically narrowed, or even totally blocked.

“When blood-flow to the heart muscle is obstructed in this way, chest pain (angina) occurs. If the blood-flow is totally cut off, the heart muscle actually dies, and this is called a heart attack, or acute myocardial infarct (Ami),” said Gous.

Associated risk factors

Several factors increase the likelihood of Ami, the most important of which are:

– Family history of heart disease

– High cholesterol

– Diabetes

– Smoking

– Obesity

– Uncontrolled hypertension

According to Gous, it is impossible to eliminate family history, but all of the other factors can be controlled to minimise the risk of Ami. The more abnormal the blood pressure, weight, blood sugar, cholesterol and smoking habits, the higher the risk of Ami.

Symptoms and signs

“Before a heart attack occurs, there may be warning signs in the form of angina. This is central chest discomfort or pain, usually of a crushing, heavy nature, which is brought on by exertion and is relieved by rest or sublingual nitrates,” said Gous.

This pain is usually due to a partly-obstructed coronary artery. If this anginal pain is not relieved by the usual measures, the pain may signal that the artery has reached critical or total occlusion, and that the patient is having an Ami.

The symptoms of a heart attack include the following:

– Chest pain that is crushing or squeezing, or a feeling of a heavy weight on the chest, a tight band around the chest or a dull ache in the middle of the chest

– Shortness of breath

– Nausea or vomiting

– Pain which radiates from the chest to the neck, jaw, or one or both arms

– Dizziness or light-headedness

– Increased perspiration

– Fast or irregular pulse

– Sudden urge to have a bowel action

Prevention

According to Gous, those patients with known risk factors must obviously have them controlled to prevent another Ami and disease progression.

However, bearing in mind that many patients have no warning signs, such as angina, it makes sense for everybody to modify lifestyle factors to minimise the risk of Ami and sudden cardiac death. The following lifestyle modifications have proven beneficial:

– Stop smoking. The more cigarettes you smoke, the higher the risk of heart disease.

– Maintain a normal body weight and body-mass index (BMI).

– Avoid foods that contain saturated fat and cholesterol. Limit fat to 30% of your daily energy intake by balancing occasional high-fat foods with low-fat choices, such as fruit, vegetables, legumes and grain products.

– Control high blood pressure. Even small elevations in blood pressure above 140/90mmHg can double the risk of cardiovascular disease.

– Exercise. Focus on aerobic activities such as brisk walking, swimming, jogging or cycling. Gradually work up to exercising 30 to 45 minutes at least three times a week.

– Control cholesterol levels. Medication may be needed to achieve target levels, especially when other risk factors are present.

When to call for help

“If you are experiencing symptoms of a heart attack, call Life Med immediately on 0861-086-911. Emergency treatment can prevent damage to the heart muscle and death,” said Gous.

A chest pain that occurs with exertion, stress or after eating a large meal, and which goes away with rest, may be a heart attack or angina (pain caused when the heart muscle receives inadequate oxygen). Such pain is a warning sign of ischaemic heart disease (blockages of blood vessels in the heart, which limits the oxygen supply).

Enrol in a first aid class and learn how to do CPR – this can save someone’s life.