Singer KK’s demise, reportedly from a heart attack, or what is known in medical terms as myocardial infarction (MI), at the age of 53 years has left the nation in shock. Yet he seemed fit and fine performing on stage. But with a majority of Indians not knowing that they are hypertensive and prone to strokes, it is important to know about warning signs, symptoms and preventive treatments.
What happens during a MI and what are some aggravating factors?
MI, commonly known as a heart attack, is caused by decreased or complete stop of blood flow to a portion of the heart muscles (myocardium), located in the middle layer of the heart wall. These heart muscles are responsible for keeping the heart pumping blood to the rest of the body. When the coronary artery, which supplies oxygen-rich blood to the heart muscles, is obstructed, the heart muscles see a cut-off in oxygenated blood supply and prolonged deprivation of this oxygen-rich blood can result in cell death in the heart muscles or damage to the heart muscles. Interventional cardiologist Dr Sameer Dani, who has nearly three decades of experience and is CEO of Apollo CVHF Heart Institute in Ahmedabad, says that the most common reason for this is arterial occlusion, or blockage of the artery. “When we are born, our arteries are very smooth and elastic, resulting in very good blood flow. Over time, small deposition of cholesterol happens on the inner surface of arteries. The rate of this cholesterol deposition depends on a range of factors but the major triggers are age, chronic health conditions and co-morbidities like diabetes, cholesterol, high blood pressure, smoking or tobacco use, stress, a sedentary lifestyle and genetics. Due to continuous cholesterol deposition in the arterial walls, a crack appears in the inner lining of the heart muscle causing the blood to clot. The moment this obstructs the artery, it leads to a sudden heart attack. So, though the causative process of a heart attack is gradual, the heart attack itself happens suddenly.” Heart attacks manifest through some level of bodily discomfort, such as chest pain or discomfort, which can radiate out to the neck, jaw, shoulder or arm.
How much does family history predispose you to a heart attack?
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Dr Dani says that the risk of a heart attack in an individual with a family history can be brought down significantly if the individual mitigates other risk factors like controlling diabetes, cholesterol levels, giving up tobacco and maintaining an active lifestyle with a balanced diet replete with fruits and vegetables. Yet, such an individual’s predisposition to a heart attack will never see better odds than an individual with no risk factor and no family history. “Family history is an important risk factor which has equivalence of two other risk factors (say the risk of a heart attack in an individual without a family history of heart attacks but who has high cholesterol and leads a sedentary lifestyle),” says Dr Dani.
With limited knowledge on specific hereditary genetic predisposition , Dr Dani thus recommends that individuals with a family history of heart attacks must start early with periodic health check-ups, say from the age of 20-25 years, and begin taking care of the other risk factors from an early age.
Are all heart attacks MI?
Dr Dani says that while all heart attacks are basically MI, there are some other sub-sets. One is sudden cardiac death or sudden cardiac arrest. “Sudden cardiac arrest happens 80-90 per cent of the time due to a heart attack, but in about 15-20 per cent of the cases, it happens without a heart attack or stoppage of heart function. This explains the death of some athletes. This happens because the heart suddenly becomes irregular in pumping blood — either because the heart muscles have become thick and need more blood supply or there is electrical instability in some part of the heart muscles. So despite a good blood supply, there is some fault in the electrical conduction in the muscles,” says Dr Dani. An example in the recent past is that of Danish footballer Christian Eriksen, who suffered a sudden cardiac arrest on field during a Euro Cup match with Finland, the phenomenon akin to overheating of a system, in lay terms. As Dr Dani explains, even drug overdose, especially cocaine, kills you in two ways — one, sudden spasms in the artery which in turn result in reduction of blood supply, despite there being no arterial blockage, or electrical instability resulting in either very fast heart rate or very slow heart rate, ultimately leading to a stop in heart activity.
Why are silent heart attacks and why do some people survive heart attacks and some others don’t?
A person can also suffer a “silent” heart attack, leaving it undetected at the time of the occurrence of the event as there is no manifestation of usual symptoms and is only detected in the form of unusual heart activity reported in electrocardiograms (ECGs). “This happens when the arteries are narrowing very slowly and more commonly seen in diabetics, but it can happen to anybody,” says Dr Dani.
He adds that the chances of survival after a heart attack depend on a couple of factors. “One, if there is very large heart muscle damage, which is dependent on which artery is blocked, the chances of death are high. Second is, if you have an active lifestyle, you are more likely to survive a heart attack,” says Dr Dani.
Preventive cardiology checklist – What do you need to look out for:
— Ensure regular exercise and eat fruits and vegetables
— Get a full cardiac check-up done annually as Indians are genetically predisposed to coronary artery disease
— Know and monitor your numbers periodically — blood sugar level, cholesterol level, blood pressure etc — and keep them in check
— Eliminate stress
— Cardiac imaging if you are in high-risk group