Focus on: Heart attacks

Martyn Thomas

Every five minutes, someone in the UK has a heart attack. Doireann Maddock talks to Dr Martyn Thomas, Director of Cardiovascular Services at St Thomas’ Hospital in London, about the causes, symptoms and effects.

A heart attack occurs when part of the heart muscle suddenly loses its blood supply. Every five minutes, it happens to someone in the UK. There are currently 1.35 million people in the UK who have survived one.

What is a heart attack?

Coronary heart disease (CHD) causes most heart attacks. CHD is a condition where the inside of one or more of the coronary arteries becomes narrowed because fatty deposits called atheroma have built up within the artery walls. The fatty area of atheroma in the artery wall is called a plaque, and if that ruptures, a blood clot forms to try to repair the damaged artery wall. The blood clot can block (fully or partially) the coronary artery, causing part of the heart muscle to be starved of blood. This is what we call a heart attack.

Do the symptoms differ for men and women?

Heart attack symptoms can vary hugely between individuals but, in general, symptoms are the same for men and women. What may differ is the doctor’s perception of the patient. We know that CHD in women is under-treated compared with men, and doctors need to be educated to tackle this.

Typical symptoms of heart attack can include pain or discomfort in the chest that doesn’t go away; it may spread to the arms, neck, jaw, back or stomach; and, as well as pain or discomfort, you may get light-headedness, dizziness, shortness of breath, nausea or vomiting.

It is possible to have a heart attack without experiencing ‘classic’ chest pain

It is possible to have a heart attack without experiencing ‘classic’ chest pain, though. This is more common in people with diabetes, because a consequence of the condition can be nerve damage, which can affect how you feel pain.

The important thing is to call 999 immediately if you think you or someone else is having a heart attack. Too many people risk their lives by waiting too long to call for an ambulance.

What needs to be done if you have a heart attack?

Rapid treatment is essential, and the aim is to restore blood flow to the damaged part of the heart muscle as soon as possible. This helps to limit the amount of damage to the heart. Many people will have either a treatment called primary angioplasty, which is a procedure to reopen the blocked coronary artery, or thrombolysis, which means giving a ‘clotbusting’ medicine to dissolve the blood clot that is blocking the artery.

What to do if you think someone is having a heart attack

Send someone to call 999 for an ambulance immediately.

If you are alone, go and call 999 immediately and then come straight back to the person.

Get the person to sit in a comfortable position, stay with them and keep them calm.

If the person is not allergic to aspirin, give them an adult aspirin tablet (300mg) to chew if there is one easily available. If you don’t have an aspirin to hand, or if you don’t know if the person is allergic to them, just get the person to stay resting until the ambulance arrives.

Has treatment changed over the years?

There have been huge changes since I first started out. When I was a junior doctor in the 1980s, if a patient had a heart attack they would be given painkillers and would be put to bed – that was the only treatment.

Back then, about 25 per cent of people who suffered a heart attack died during the event. When thrombolysis and aspirin were introduced, that just about halved mortality rates, bringing them down to about 12 per cent. More recently, the development of primary angioplasty has reduced mortality rates even further and, assuming that this treatment is administered quickly, there is now about a 2–4 per cent chance of dying during a heart attack.

How important is medication after a heart attack?

Medication is very important and people who’ve had a heart attack need to take some medicines from each of these four groups: aspirin, beta blockers, either ACE inhibitors or angiotensin receptor blockers and statins. You need to keep taking these medicines after you leave hospital, and continue with most of them for the rest of your life.

The main reasons for taking the medicines are to help prevent another heart attack, treat angina and help strengthen the pumping action of your heart and reduce the risk of heart failure.

Medication can also help to reduce risk factors for CHD, such as high blood pressure and high blood cholesterol levels. The general mantra that we have around cholesterol is that whatever your level was when you had the heart attack, it is too high for you, regardless of the number. So it’s important to take your lipid-lowering medication, for example statins, to help with this.

What about cardiac rehabilitation?

Cardiac rehabilitation is one of the most important parts of the entire treatment pathway of a heart attack.

It can reduce the risk of dying after a heart attack and helps to reduce some of the risk factors for CHD. It also aims to help you recover and get back to as full a life as possible. Episodes of low mood can be common following a heart attack – cardiac rehab and meeting up with others who’ve been through a similar experience can also help with this.

Read our feature about cardiac rehab

What’s the long-term impact of having a heart attack?

If you have chest pain, the most important thing to do is call 999 and get to a hospital as soon as possible, then your chances of survival are very good

Many people assume that if you have a heart attack, you will die, and I think that is so wrong. If you have chest pain, the most important thing to do is call 999 and get to a hospital as soon as possible, then your chances of survival are very good.

More people than ever are surviving heart attacks and many people still have a good quality of life and health afterwards. If a heart attack causes a significant amount of heart muscle damage (this can happen if help is not sought quickly) then the pumping action of the heart can be affected and the person can develop heart failure. This can cause symptoms such as breathlessness, tiredness and swollen ankles. Unfortunately, the muscle damage cannot be reversed but with the right treatment and good management of symptoms, it’s possible to lead a full life.

Why did you choose to work in this area?

There’s a lot of satisfaction because you can make a real difference. For example, when a patient comes in with a blocked artery and you do a primary angioplasty, it’s very rewarding to perform the procedure, resolve the blockage and see the blood flowing to the heart muscle again. You can see that it makes a huge impact on people’s lives.

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