Heart attack

Most people don’t know they have heart disease until they experience chest pain (angina) or a heart attack. Angina is one of the warning signs of a heart attack, which can occur hours, days, or weeks before an attack and should not be ignored. However, not all heart attacks begin with sudden, crushing chest pain. In fact, the symptoms of a heart attack vary from person to person. The other common symptoms of a heart attack include:

• Discomfort or pain in the left shoulder, arms, neck, jaw, or back
• Shortness of breath
• Sweating
• Nausea
• Lightheadedness
• Abnormal heartbeat
• Vomiting
• Unusual tiredness

If you or anyone experiences chest pain or discomfort, or other symptoms of a heart attack, rush to a hospital immediately. Consult a doctor even if you feel mild pain or discomfort in the chest, as it might indicate that your heart is in trouble and needs help.

To differentiate between chest pain due to gastric issues and a heart attack, watch a video by our expert.

A heart attack occurs when there is a sudden and complete or partial blockage of the artery that supplies blood to the heart. Typically, coronary artery disease is the underlying cause, where the coronary artery (the blood vessel supplying blood to the heart) is blocked. The longer the blockage remains untreated, the greater the damage to the heart muscle. If blood flow is not restored promptly, it can lead to permanent damage to the heart muscle. Some common causes of a heart attack or myocardial infarction include:

• Coronary artery disease
• Coronary artery embolism
• Atherosclerosis
• Hypoxia (low level of oxygen in the body)
• Drug abuse
• Cocaine-induced ischemia

Why are people suffering from a heart attack at a young age? Cardiologist answers. Click to watch!

Age and family history are key non-modifiable factors that can increase the risk of heart attack. However, there are certain modifiable causes of heart attack that can help you prevent and lower your risk if known.

Some of the modifiable risk factors for a heart attack include:

• High Blood Pressure: High blood pressure puts excess strain on the blood vessels, which over time causes constriction of the blood vessels. This impacts blood flow to the heart and increases the risk of heart attacks. The damage is exacerbated by the buildup of fat, cholesterol, and other substances in the coronary arteries.
• Diabetes: If your blood glucose levels are not under control, it can cause inflammation of the blood vessels, further affecting blood flow. Over time, sluggish blood flow can damage the heart muscle and increase the risk of a heart attack.
• Cholesterol: Excess cholesterol deposited in the arteries that supply blood to the heart is concerning. This can block blood flow either partially or completely, resulting in a heart attack.
• Smoking: Smoking introduces harmful chemicals that can cause inflammation of the blood vessels, leading to the accumulation of substances like cholesterol and calcium. These deposits can block blood flow to the heart and cause a heart attack.
• Excessive Alcohol: Excessive alcohol consumption can lead to dehydration, impacting blood flow to the heart and other organs. Additionally, it can cause inflammation in blood vessels, promoting the deposition of cholesterol and calcium, which increases the risk of a heart attack.
• Stress: Chronic stress leads to the secretion of cortisol, which can significantly disrupt hormonal balance and result in excess cholesterol production, potentially causing a heart attack.
• Lack of Exercise: A sedentary lifestyle can lead to overweight and obesity, increasing the risk of lifestyle diseases such as diabetes and hypertension, both of which are known risk factors for a heart attack.

If you experience pain in the chest or discomfort, your doctor might advise some blood and imaging tests to determine the underlying cause.

A. Lab tests

Some of the commonly advised lab tests include:

• Lipid Profile Test: This is a group of blood tests that detects the levels of different types of lipids in the blood. Lipids are fatty substances that play an important role in several body functions. They serve as structural components of cells and act as a source and mode of energy storage for the body. It typically measures the levels of total cholesterol, High-Density Lipoprotein (HDL) cholesterol, Low-Density Lipoprotein (LDL) cholesterol, and triglycerides. Other results that may be reported include Very-Low-Density Lipoprotein (VLDL) cholesterol, non-HDL cholesterol, and total cholesterol to HDL cholesterol ratio.
• C-reactive protein (CRP) test: C-reactive Protein (CRP) is a protein secreted by the liver in response to inflammation caused by injury, infection, or other factors. The C-reactive protein (Quantitative) test measures the levels of CRP in the blood to determine the presence of inflammation or infection and to monitor treatment.
• Cardiac troponins (I and T): Troponins are proteins found in the heart muscles and skeletal muscle fibers. They help regulate muscular contraction. This test measures the level of cardiac-specific troponin in the blood, aiding in the diagnosis of heart injury or damage.
• Creatine kinase (CK): Also known as Total CK, Creatine Phosphokinase, and CPK test, this test is performed to detect and monitor damage to muscle. It is also used to diagnose conditions associated with muscle damage and to detect possible heart attacks. A more specific test, Creatine Kinase-MB (CKMB), measures the enzyme CK MB, primarily found in heart muscle cells, but also present in skeletal muscles in lesser amounts.
• Myoglobin: This assay is useful for assessing muscle damage from any cause. Elevated myoglobin levels are observed in cases of acute muscle injury, resuscitation, myopathies, shock, and strenuous physical activity.

B. Imaging & other tests

In addition to blood work, other tests that can assist in diagnosing myocardial infarction or a blockage in the heart include:

• Electrocardiogram (EKG / ECG): This resting 12-lead ECG test is the first-line diagnostic tool for acute coronary syndrome (ACS). It should be obtained within 10 minutes of the patient’s arrival in the emergency department. Acute MI is often associated with dynamic changes in the ECG waveform. Serial ECG monitoring can provide important diagnostic clues if the initial EKG is non-diagnostic.
• Holter monitoring or ambulatory ECG: A Holter monitor is a small, wearable device that tracks your heart rhythm. This monitoring is used to diagnose intermittent cardiac arrhythmias.
• Echocardiography: A cardiac echo is used to identify abnormalities in the heart's structure and function.
• Stress test: This test measures the performance of the heart during exercise of gradually increasing intensity on a treadmill.
• Carotid ultrasound: A carotid ultrasound detects narrowing or stenosis of the carotid arteries, which is a major risk factor for stroke.
• Tilt table test: This test records your blood pressure, heart rhythm, and heart rate on a beat-by-beat basis.
• MRI of the heart: A heart MRI (magnetic resonance imaging) uses magnets and radio waves to create an image of your heart and nearby blood vessels.
• Cardiac CT: The Computed Tomography (CT) scan of the heart creates a detailed three-dimensional image of the heart and coronary blood vessels, helping to assess their condition and understand blood flow.
• Coronary angiography: A coronary angiogram is a procedure that uses X-ray imaging to check the heart's blood vessels.
• Cardiac catheterization: Cardiac catheterization (cardiac cath or heart cath) is a procedure to examine the heart's functioning. A thin, hollow tube called a catheter is inserted into a large blood vessel leading to the heart to determine the origin of disease affecting the heart muscle, valves, or coronary arteries.
• Radionuclide ventriculography or radionuclide angiography (MUGA Scan): This test gathers images of the heart throughout its pumping cycle and is also referred to as a MUGA scan (multigated acquisition scan) or blood pool scan.
• Transesophageal echocardiography (TEE): TEE produces pictures of the heart using high-frequency sound waves (ultrasound) to create detailed images of the heart and surrounding arteries.

C. Nuclear heart scans

Similar to angiography, these scans use a radioactive dye injected into your blood. They differ from an angiogram by employing computer-enhanced methods like computed tomography (CT) or positron emission tomography (PET) scans.

• Positron emission tomography (PET) scan: This test uses radioactive dyes to produce images of the heart, differentiating between healthy and damaged heart muscles.
• Single photon emission computed tomography (SPECT): A SPECT scan uses radioactive tracers injected into the blood to produce images of the heart and assess blood flow.
• Myocardial perfusion imaging (MPI) test: This test shows how well blood flows through your heart muscle and identifies areas that aren’t receiving enough blood.

1. Do not ignore symptoms of heart disease: The most common symptom is chest pain (angina) that originates in the center of the chest, behind the breastbone, and is typical of a heart attack. Chest pain occurring after walking a distance that was not previously experienced can also indicate a heart attack. Other common symptoms include shortness of breath, sweating, and pain or discomfort in the jaw, arms, and shoulder. If you experience any of these symptoms, it is recommended to immediately go to a hospital or consult a doctor at the earliest.
2. Go for regular health check-ups: Diabetes, high blood pressure, and high cholesterol are key factors that increase the risk of heart disease. Therefore, individuals with high blood glucose, high blood pressure, and high cholesterol should undergo regular health check-ups annually. The frequency of health check-ups should increase with age and for those with a family history of heart disease. Ideally, it is advisable to get a heart check-up after age 45, but due to rising incidences in younger individuals (above 30 years), even young adults should get a health check-up every year.
3. Do not self-medicate: Taking painkillers at home is a common practice; however, frequent use can lead to health complications and side effects. Long-term opioid therapy has been reported to increase the risk of cardiovascular diseases, particularly myocardial infarction. Self-medication without consulting a doctor is not recommended, as it may lead to harmful side effects. Your doctor will evaluate the pros and cons of medication based on your overall health and condition. Therefore, think carefully before taking any medication without informing your doctor.
4. Maintain a good relationship with your family doctor: A significant reason patients fail to consult their doctor is the lack of a good relationship with their family physician. Many individuals do not feel comfortable discussing everyday health issues with their doctor, which they may consider trivial. It is important to be open with your family physician and discuss your health in detail, as they can guide you in the right direction.
5. Exercise is key to keeping your heart healthy: Many people have tight schedules that make it difficult to find time for exercise. While health consciousness is on the rise, regular exercise can still be challenging. If you are at risk of heart disease or wish to maintain heart health, ensure you lead an active lifestyle. This does not mean exercising every day; rather, aim to work out or walk daily. Walking for 30 to 45 minutes five days a week or achieving 10,000 steps a day can help maintain health.
6. Diet for a healthy heart: A healthy diet rich in vitamins, minerals, proteins, fiber, and healthy fats can help keep your heart in good condition.
   • Whole grains: Whole grains, vegetables, and fruits are excellent natural sources of fiber. They contain soluble fibers and phytosterols that decrease fat and sugar absorption in the small intestine and help lower triglyceride levels in the blood. Good sources include oats, barley, legumes, and psyllium husks.
   • Fruits: Fruits and vegetables are high in antioxidants that protect circulating cholesterol from oxidation, which can generate free radicals that negatively affect overall health and increase blood cholesterol levels. Incorporate more vegetables like cauliflower, broccoli, and celery, as well as potatoes with skin.
   • Fish: According to the American Heart Association, consuming two servings of fatty fish per week is beneficial for heart health. Include fatty fish rich in omega-3 fats, such as salmon, herring, sardines, mackerel, and tuna, to improve triglyceride levels and control cholesterol.
   • Garlic: Garlic has been shown to lower triglyceride levels and total cholesterol levels. It also helps regulate glucose homeostasis and insulin secretion, aiding in blood glucose control.
   • Nuts: Nuts are excellent sources of fiber, omega-3 fatty acids, and unsaturated fats, which are all heart-healthy nutrients. As plant-based sources, they are rich in beneficial fats, sterols, and nutrients.
   If you have suffered a heart attack or undergone heart surgery, strict dietary control is essential. Here is a sample Indian diet chart for heart patients by an expert nutritionist.

Depending on the condition and the extent of the block, your doctor might advise medications or recommend surgery.

A. Medications

Heart attack treatment involves a variety of drugs. Your doctor will recommend the best combination of heart attack medications for your situation. Some of the common drugs include:

1. Thrombolytic drugs - Thrombolytic or clot-busting medications are intravenous (IV) medications that cause blood clots to break down and dissolve. These medications are usually used only within the first 12 hours after a heart attack. Examples include:
   • Streptokinase
   • Alteplase
   • Urokinase
2. Anticoagulants - Anticoagulants, commonly known as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time. Examples include:
   • Apixaban
   • Dabigatran
   • Heparin
   • Rivaroxaban
   • Warfarin
3. Antiplatelet agents - Antiplatelet agents reduce the ability of platelets to stick together (platelet aggregation) and inhibit the formation of blood clots. Examples include:
   • Aspirin
   • Clopidogrel
   • Prasugrel
   • Ticagrelor
4. Angiotensin-converting enzyme (ACE) inhibitors - These inhibit the angiotensin-converting enzyme, regulating salt and water retention in the body, lowering blood pressure by relaxing blood vessels. Examples include:
   • Fosinopril
   • Captopril
   • Enalapril
   • Ramipril
   • Lisinopril
   • Benazepril
5. Angiotensin receptor blockers (ARBs) - If you are unable to tolerate ACE inhibitors, ARBs are used to block angiotensin-II from binding to its receptor, helping to reduce blood pressure. Examples include:
   • Telmisartan
   • Losartan
   • Valsartan
   • Irbesartan
   • Fimasartan
   • Olmesartan
6. Beta blockers - Beta-blockers are recommended for patients with left ventricular ejection fraction (LVEF) less than 40% if no other contraindications are present. Examples include:
   • Atenolol
   • Metoprolol
   • Propranolol
   • Oxprenolol
   • Labetalol
7. Combined alpha and beta blockers - This medication helps lower blood pressure by slowing heart rate and reducing nerve impulses that tighten blood vessels. Examples include:
   • Carvedilol
   • Labetalol
8. Calcium channel blockers - These block the entry of calcium into blood vessels, causing dilation and helping to decrease blood pressure. Examples include:
   • Amlodipine
   • Nifedipine
   • Clevidipine
   • Verapamil
   • Diltiazem
9. Statins (cholesterol-lowering agents) - Statins work by reducing “bad” cholesterol (LDL) and raising “good” cholesterol (HDL) levels. Examples include:
   • Atorvastatin
   • Lovastatin
   • Rosuvastatin
10. Diuretics - Diuretics like hydrochlorothiazide eliminate excess salt and water, decreasing calcium excretion. Examples include:
    • Hydrochlorothiazide
    • Chlorthalidone
    • Furosemide
    • Triamterene
    • Amiloride
11. Vasodilators - Vasodilators help lower blood pressure by widening blood vessels. Examples include:
    • Hydralazine
    • Minoxidil
    • Nitroglycerin

B. Surgery

1. Percutaneous coronary intervention - Also known as coronary angioplasty, this nonsurgical procedure improves blood flow to the heart using a catheter-based device. It often involves the placement of a stent to keep the artery open.
2. Bypass surgery - A surgeon takes a section of healthy blood vessels and attaches them above and below the blocked artery, redirecting blood flow around the narrowed part.
3. Atherectomy - Similar to angioplasty, this procedure uses a catheter with a rotating shaver to cut away plaque from the artery.
4. Implantable medical devices - These include:
   • Pacemaker - A battery-operated device that helps the heart beat in a regular pattern.
   • Implantable cardioverter defibrillator (ICD) - A device placed in the chest to detect and stop abnormal heartbeats, delivering electric shocks to restore normal rhythm.
   • Ventricular assist devices (VAD) - An implantable pump that helps pump blood from the heart's ventricles to the rest of the body.
5. Other surgeries - These include:
   • Cardiomyoplasty - An experimental procedure using healthy skeletal muscles to support the failing heart.
   • Radiofrequency ablation - A catheter guided to the heart to create scars that block abnormal electrical signals.
   • Transmyocardial revascularization (TMR) - A laser creates channels in the heart’s pumping chamber.
   • Heart transplant - Replacing a diseased heart with a donated healthy heart.

What should you do when you suspect that you or anyone in your family is having a heart attack? The first thing to do is seek medical help immediately. In the absence of medical aid, the following tips may help you:

1. Know the symptoms
   At times, chest pain is absent in certain cases of a heart attack, known as a ‘Silent Heart Attack’. In this case, pay attention to associated symptoms such as long deep breathing, dizziness, nausea, anxiety, or a panic attack. You might be able to identify a heart attack just because of the vague discomfort that you are experiencing.
2. Act fast
   Most attacks are not very rapid and provide enough time to act. Therefore, it is essential to have complete knowledge about a heart attack and the ability to act quickly. People often confuse a heart attack with other conditions like indigestion, flu, or panic attacks. However, if you are unsure of what exactly is happening, it is best to seek help immediately.
3. Know which medicine to take
   Take an aspirin if you feel you are having a heart attack. Most people feel better after chewing an aspirin tablet at the onset of a heart attack. However, aspirin may be harmful to some individuals. Therefore, consult your physician in advance about the most appropriate medication for you in case of a heart attack.
4. Seek immediate help
   Shout for help immediately. Do not hesitate to ask someone to call for medical assistance. If immediate help cannot be attained, request someone nearby or a friend to take you to the nearest hospital. During this time, any activity will cause more harm to the already damaged heart muscles. Stop whatever you are doing and sit or lie down calmly while asking to be taken to a hospital. Do not travel alone or drive yourself to a clinic or hospital.

In addition to taking medications as recommended by your doctor, consider the following to keep your heart healthy:

1. Incorporate more fiber in your diet
   Include foods such as whole wheat grains, cereals, peas, pulses, fruits like oranges, pears, melons, and vegetables such as carrots and broccoli. There is more fiber in a single fruit than in a glass of fruit juice made from 3-4 whole fruits.
2. Limit fruits, especially if you are diabetic
   Choose whole fruits and vegetables to increase your fiber and nutrient intake. However, limit fruit consumption, especially for diabetics. Incorporate berries, oranges, sweet limes, apples, and pears, which contain less sugar and more fiber.
3. Salads are a must in every meal
   Vegetables are a great source of nutrients, and including raw vegetables in the form of salad is a healthy idea. One large bowl of salad containing vegetables and sprouts is essential for a complete meal. Sprouts are rich in proteins and fiber, so aim for two servings per day.
4. Add fenugreek (methi) seeds to your food
   Fenugreek is a rich source of soluble fiber and contains active compounds that reduce cholesterol and benefit heart health. If you have diabetes along with heart problems, incorporating methi in the form of raw seeds in curries, dal, or curd can help maintain heart health.
5. Restrict intake of salt
   For healthy individuals, the daily recommended salt intake is 5-6 grams. However, if you have a history of heart disease or have undergone heart surgery, limit your daily salt intake to 2 grams, approximately half a teaspoon.
6. Choose cooking oils wisely
   Opt for oils that are high in essential fatty acids, such as monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA). Oils like groundnut oil, sunflower oil, safflower oil, mustard oil, and sesame oil are good for the heart. It is beneficial to use different oils each month for added health benefits.
7. Keep a tab on the amount of cooking oil
   Regardless of the cooking oil used, monitor the amount consumed. It should not exceed 15 ml per day, which is about three teaspoons. You can also incorporate ghee, ensuring the total does not exceed the daily limit of 15 ml. For example, instead of three teaspoons of oil, you could use one teaspoon of ghee and two teaspoons of oil.
8. Follow portion control
   Spread your food intake throughout the day and eat in limited amounts. Consuming three full-course meals can put pressure on the stomach and other organs, including the heart. It is advisable to have six small meals daily or two meals with breaks, such as breakfast, a mid-morning snack, a mid-afternoon snack, and an evening snack. Dinner should consist of light, easy-to-digest foods. Avoid heavy and gas-forming foods like beans and cauliflower at dinner time.
9. Nuts are good for the heart
   Nuts are a rich source of omega-3 fatty acids, which are essential for maintaining heart health. They help regulate blood pressure, lower triglyceride levels, reduce cholesterol, decrease inflammation, and prevent heart disease. Almonds are rich in MUFA, while walnuts are high in PUFA, both of which are beneficial for heart health.
10. Snack wisely
    Choose light snacks such as boiled corn, puffed rice (kurmura), sprouts chaat, vegetable chaat, or boiled corn chaat. Avoid packaged foods, as they are not suitable for heart patients. Freshly cooked homemade food is the best option. Consume fruits as a mid-morning snack and avoid them after lunch and dinner.

Is it angina, heartburn, or heart attack? Know the difference!

If left ignored or unattended, myocardial infarction can cause severe damage to the heart. Some of the health complications that may result due to a heart attack include:

• Angina
• Arrhythmias
• Cardiogenic shock
• Cardiac failure
• Cardiac rupture
• Myocardial dysfunction
• Peripheral embolism
• Pericarditis
• Pericardial effusion

There are no studies highlighting the significance of Ayurveda or homeopathy remedies for heart attacks. However, certain lifestyle modifications and yoga asanas are known to improve heart health.

Yoga Asanas for a Healthy Heart

Cardio and weight training work to elevate your heart rate and build muscle mass. However, yoga, as a complementary practice, can assist in preventing or managing heart disease. A combination of adequate weight training, aerobics, and yoga can significantly enhance heart health.

Yoga Asanas that Can Help Maintain Your Heart Health Include:

• Padangusthasana (Big Toe Pose): Known to effectively stretch all the muscles in the body, this asana stimulates the abdominal organs and heart while also slowing down the heart rate.
• Janu Sirsasana A: This asana stretches the entire back of the body. With the heart brought closer to gravity, the heart rate becomes slower and calmer. It is also known to calm the mind and relax all major organs of the body.
• Utthita Hastapadasana (Extended Hands and Feet Pose): This pose focuses on breathing and posture, helping to calm the mind. It lowers the heart rate, promotes blood circulation, and improves the overall functioning of the heart.
• Setu Bandha Sarvangasana (Bridge Pose): This pose facilitates deep breathing, opens up the chest, and improves blood flow to the chest region. It also enhances blood circulation to the heart and helps control blood pressure.

On average, about a fourth of heart attack victims who survived the first year are likely to experience another within the next four to six years.

Some easy, yet consistently effective steps to prevent a second heart attack and lead a healthy lifestyle include:

• Follow a healthy and balanced diet: Simple dietary modifications such as reducing the intake of cholesterol-rich foods, especially trans fats and saturated fats, added sugars, salt, and caffeine can improve overall well-being. Instead, increase the intake of fresh fruits, vegetables, legumes, and beans. Supplementing the diet with Omega-3 fatty acids can also be beneficial for metabolism. Want a personalized diet plan? Get in touch with our expert. Consult a Nutritionist!
• Daily exercise and walking: A regular and mild exercise routine boosts body metabolism, maintains a healthy heart, and enhances overall mood.
• Quit smoking and drinking: Smoking is known to severely damage the normal rhythm of the heart and its arteries. Reducing smoking can lower the risk of a second heart attack by about 50%. Moderate alcohol consumption poses no threat; however, exceeding the recommended limits may raise blood pressure and increase the chances of a heart attack.
• Regular health checkups: Adhere to the prescribed medications after the first heart attack. Timely check-ups and follow-ups are equally important. Do not stop or alter medications without your doctor’s advice.
• Lead a healthy psychosocial life: Socialize, discuss your problems with trusted individuals, ensure adequate sleep, consult professionals if needed, limit emotional involvement, and consider joining a laughter club. These activities can contribute to a stress-free and happy life.