John, a 52-year-old male, was riding his horse on the weekend when he suddenly collapsed and fell off his horse due to a heart attack. Passers-by performed CPR until the paramedics arrived. The paramedics continued CPR before rushing John to hospital. John was lucky to have survived. At the hospital he told his doctor that he was feeling unwell that morning, describing chest heaviness and pain in his left arm. John did not think it had anything to do with his heart. He simply assumed that he pulled a muscle over the weekend and so ignored his symptoms and went riding.

According to the Heart Foundation, each year, around 54,000 Australians suffer a heart attack. It is important to recognise the warning signs of a heart attack and seek medical help immediately. The faster you get emergency treatment for a heart attack, the less damage to your heart and the greater the chances of survival.

What is a heart attack?

A heart attack occurs when one of the coronary arteries that provide vital blood supply to the heart becomes blocked.

It usually happens due to build up of fatty deposits, also called plaque, in the artery wall, causing the artery to narrow. The plaque limits blood flow and the delivery of oxygen to the part of the heart served by that artery.

About three of every four heart attacks occur because of plaque rupture - Once a plaque ruptures, a blood clot can form which can block your artery completely, depriving the heart of blood and oxygen. When this happens, a portion of the heart muscle dies. 

This whole process of rupture and the formation of a clot can happen in minutes.

 

Why do people get a heart attack?

There is no single cause for a heart attack. However, research has identified risk factors that increase your chance of developing it. Some risk factors are not in our control, but others are very much dependant on our lifestyle and can be modified.

Risk factors that you cannot change

• Age. The risk of heart attack increases with age. Heart attacks are more likely to occur in men age 45 or older and women age 55 or older than in younger men and women.

• Family history of heart attack. You may be at increased risk if your father or brother was under the age of 55 when they were diagnosed with heart disease, or your mother or sister was under the age of 65 when they were diagnosed with heart disease.
• Gender. At a younger age, men are at higher risk of heart attacks. Women’s risk grows after menopause.

Risk factors that you can change

• Stop smoking and avoid second-hand smoke. 
   
• Manage you blood cholesterol and triglyceride levels.
   
• Manage your blood pressure.
   
• Be physically active.
   
• Maintain a healthy weight.
  ​
• Manage your diabetes.

Other risk factors

• Reduce stress
• Eat a healthy diet
• Reduce alcohol consumption

Heart attack warning signs

• Chest discomfort. Most heart attacks involve discomfort in the centre of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, heaviness, tightness, fullness, or pain. Some people describe it as the feeling of a “truck on the chest” or “elephant on the chest”.
• Pain or discomfort in other areas of the upper body. The pain can appear in one or both arms, the back, neck, jaw or stomach; “ a knife on the back of the skull”, “arms feel like bowling bowls”
• Shortness of breath. “Breathing through a straw”
• Cold sweat.
• Nausea or vomiting.
• Light-headedness or dizziness.

Symptoms usually occur suddenly and last for at least 10 minutes.

Women and heart attacks

Jane, a 37-year-old woman, was experiencing anxiety and heavy breathing while having a heated argument with her 19-year-old son. Her husband wanted to call and ambulance, but Jane refused, thinking she was having a panic attack. When the symptoms worsened her husband eventually called an ambulance, only to find out that Jane was having a heart attack. It is a common misconception that men are at a higher risk of heart attack than women.

Indeed, until menopause, women have far fewer heart attacks than men. However, after menopause, the protective effects of oestrogen diminish and women catch-up.

In fact, Heart disease is the leading cause of death for women worldwide, and women are three times more likely to die of a heart attack than of breast cancer. 

Women tend to have different symptoms or warning signs than men, and are more likely than men to be misdiagnosed. While most men complain of the ‘classic’ chest pain, some women may also experience chest pain, but are far more likely to have subtler symptoms that may even begin three or four weeks before a heart attack. Warning signs include:

• Unusual fatigue
• Shortness of breath or sweating 
• Pain in the neck, back or jaw
• Nausea/vomiting

The bottom line

Heat attack is a life-and-death emergency. Learn the warning signs and act fast; but remember, not all people who have heart attacks have the same symptoms or the same severity of symptoms. Some people may not even have any major symptoms at all. If you think you are having a heart attack, even if you are not sure it is a heart attack, call Triple Zero (000) right away in order to reduce the damage to your heart muscle and increase your chance of survival. 

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References

American Heart Association 2016. What a heart attack or stroke can feel like.  Available at: https://news.heart.org/what-a-heart-attack-or-stroke-can-feel-like/

British Heart Foundation. Heart Attack - Symptoms – Prevention. Available at: https://www.bhf.org.uk/heart-health/conditions/heart-attack

Cleveland Clinic 2017. Women or Men — Who Has a Higher Risk of Heart Attack? Available at: https://health.clevelandclinic.org/2017/02/women-men-higher-risk-heart-attack/

Mayo Clinic 2017. Heart attack. Available at: https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106

The Heart Foundation Anon, Heart disease in Australia |. Available at: https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia

The Heart Foundation. Heart attack risk factors. Available at: https://www.heartfoundation.org.au/your-heart/know-your-risks/heart-attack-risk-factors

The Heart Foundation. Heart attack symptoms. Available at: https://www.heartfoundation.org.au/your-heart/heart-attack-symptoms