By Dr David Delvin

Do you know what a heart attack actually is?

Most people don't - which is surprising, in view of the fact that the commonest way of departing this life is a heart attack!

And rather worryingly, most people have no real idea of how to prevent such attacks. But they can be prevented - provided you take action decisively enough, and early enough. In this month's article, I want to explain to you what the phrase 'heart attack' means - and show you how to do your best to avoid having one.

THIS HISTORY OF HEART ATTACKS

Now, you might think that heart attacks have been around forever. They haven't.

When you do think that the first-ever heart attack was reported in a medical journal? 1,000 years ago? 50 years ago? 200 years ago?

All wrong. It was actually in 1910. That's right - heart attacks were unknown until the early part of the 20th century. Yet within a few generations, they'd become the leading cause of death in most Western countries - including Britain.

As you'll readily appreciate, this strongly suggests that somewhere about the beginning of the last century, Man started doing something badly wrong healthwise! Or perhaps I should say 'Western Man' - because the incredible rise in occurrence of heart attacks during the 20th century did not occur in less well-off countries. It only happened in well-off places like Britain, America, Germany and Australia.

I well remember that when I used to practice medicine in one of Britain's less well-off former colonies, heart attacks were almost unknown there. So clearly, the inhabitants were doing something right- and we were doing it all wrong!

So what is it that we do in Britain which makes us so frightening liable to heart trouble? We'll look at this in more detail in a moment, but basically it comes down to:

· Smoking

· Eating far too much Animal Fat

· Not getting enough exercise

Click here to go back to the top of the page.

SO WHAT ACTUALLY IS A HEART ATTACK?

Right, so what does this phrase 'heart attack' actually mean?

It's like this. Your heart is a lump of muscle - which contracts about 72 times every minute. To keep going, it needs a constant supply of blood. If that blod supply is cut off, part of the heart muscle will die! That's a heart attack.

But what stops the blood supply to the heart?

Well, the blood gets into your heart through some quite narrow tubes, called 'the coronary arteries'. They're thinner than a ballpoint pen. So you can see that they could easily get blocked.

And if one of them gets blocked …. Bang! You've got a heart attack.

But should they get blocked? And why does it happen hundred of times a day to people in Britain (particularly people in the 50-plus age group)?

Well, the coronary arteries get blocked by 'fatty' deposits. The sad fact in that is the UK, nearly all of us adults have these fatty deposits! Almost incredibly, they start building up from about the age of 18. And if they get big enough (or if a clot forms on them) they will block the artery. Result: heart attack.

Click here to go back to the top of the page.

WHAT'S A CORONARY THROMBOSIS? AND WHAT'S AN INFARCT?

Unfortunately, doctors have a bad habit of making things sound complicated! So they use various terms, which just mean 'heart attack' - but which can confuse the public.

So if you hear any of these expressions, they all just mean ' heart attack':

· CORONARY THROMBOSIS
· A CORONARY
· MYOCARDIAL INFARCT
· MYOCARDIAL INFARCTION
· M.I.

Click here to go back to the top of the page.

WHAT ARE THE SYMPTOMS OF A HEART ATTACK?

Before I go on to describe the symptoms, can I just warn you that a lot of people think they're having a heart attack - when they're not. This is particularly common in young folk - especially if they've had too much to drink, or are having a panic attack!

But a person who is really having a heart attack usually experiences a crushing pain in the centre of his/her chest. It generally makes you feel pretty awful - and you may well collapse or have a lie down.

A word of reassurance: many pains in the chest are not heart attacks. Much of the time, a chest pain turns out to be due to something trivial.

But … and this is terribly important … if you're over 40 and you get a SEVERE or PROLONGED (i.e., more than 20 minutes) pain in your chest, it is always better to go straight to the hospital. (If you are a smoker, a heart attack is particularly likely.)

Do NOT hang around! You need an examination and an ECG (the electrical test on the heart). If necessary, dial 999. The Ambulance Control people will assess your situation by phone - and ensure you get the best possible medical care.

It's not usually worth starting off by ringing your GP - as this merely adds a delay to the process.

Click here to go back to the top of the page.

PREVENTION OF HEART ATTACKS

With tens of thousands of heart attacks occurring every month in Britain, it's obvious that they can't all be prevented. However, you can take certain steps to help protect yourself. These are:

· DON'T SMOKE. Heart attacks are far, far commoner in smokers. Smoking is one of the big reasons for the increase in heart attacks over the last 90 years. Nearly everyone who has a heart attack at an early age is a smoker.

· CUT DOWN ON SATURATED FATS. 'Saturated' fats - which are mostly animal fats - form far too large a part of the Western diet. They cause those fatty deposits in your coronary arteries. So they seem to be the main reason why heart attacks are so common in the West - yet so rare in poorer countries.

· GET a reasonable amount of exercise. Regular exercise cuts the risk of heart attacks. It doesn't have to be a lot; experts say that 20 minutes, three times a week is probably enough.

· HAVE YOUR BLOOD PRESSURE CHECKED OCCASIONALLY. High blood pressure - about which I wrote last month - is often a factor in causing heart attacks. So anybody aged over 50 should get theirs checked from time to time.

· DON'T LET YOUR CHOLESTEROL GET TOO HIGH. Cholesterol is a type of fat in the blood. If it is too high, you're more likely to get big, fatty deposits in your coronary arteries. So keeping it within normal limits is a good idea. In America, people over about 35 tend to have their cholesterol checked rather frequently. The current view in this country is that you needn't have it done regularly unless there's some compelling reason - like a family history of early heart attacks.

· WATCH YOUR WEIGHT. Those who are badly overweight are more liable to heart trouble. So keep an eye on your poundage!

Click here to go back to the top of the page.

AND … WHAT'S ANGINA?

Finally, a word about ANGINA

Angina is a type of pain caused by the same sort of heart trouble that causes heart attacks. It's caused by a partial blockage of a coronary artery. Instead of causing a heart attack, this partial blockage causes severe pain, occurring during exertion. 

Typically, the pain may come on while a person is walking up hill - or even climbing up stairs. Very characteristically, it runs from the chest area DOWN THE LEFT ARM.

Angina needs early treatment by a doctor. Fortunately, there are now various drugs, which can open up the narrowed coronary artery. Generally, people take these before any exertion. There's also the possibility of curing the condition by having a 'Coronary By-Pass' op - which (as the name implies) by-passes the partial obstruction. And these days, it's sometimes possible to put a 'STENT' - which a sort of dilator of widening device - into the artery.

As you can imagine, you also need to follow such commonsense measures as giving up smoking and keeping your weight down …

Click here to go back to the top of the page.


1. HEART QUESTIONS.

Q. I had a BUPA check-up - a sort of 'M O T' - recently, and was found to be in A1 condition. Does this mean that I can assume I'm safe against the possibility of heart attacks for the rest of my life?

A. No, not at all. The brutal fact is that ANY of us could die of a heart attack at any time. That includes both you and me! Furthermore, the risk of a heart attack in the second half of life is so high that EVERYONE should take the commonsense measures which I've mentioned above.

Q. My wife seems to have some sort of theory that WOMEN are immune to heart attacks. Is this true?

A. Far from it, sir. It's true that up to the age of their menopause, women are much less likely to get heart attacks than men. But AFTER the menopause, the risk of heart attack in women rises steeply. Eventually, it becomes about the same as men's. It's thought that the reason why women get less heart attacks BEFORE the change is the fact that their hormones give them protection. And it is likely that the female hormones in 'HRT' help to continue that protection in to the 50s and 60s.

Q. My daughter is on the Pill. Does that increase the risk of heart attacks?

A. Yes, it does slightly. But provided she doesn't SMOKE (and has no other risk factors), then the danger is fairly remote.

Q. I'm 53. I had a brother who had a fatal heart attack at 54. Also, two of my uncles died young from heart trouble. Should I be worried?

A. Well, you certainly must get yourself checked out - because it's perfectly possible that you family has a gene for HIGH CHOLESTEROL, which is a common cause of early heart attacks in closely-related people. So you need to ask you GP to give you the once over, to check your blood pressure, and (above all) to do your cholesterol test. He'll also have some questions for you about lifestyle and exercise.

Q. I'm 57, and my blood pressure is 145 over 100. Does this put me at risk of a heart attack?

A. Well, that's not too bad a reading at your age - though it would be nice if it were a wee bit lower. You really need to have several readings done over a period of time to establish a true level. Also, please see last month's article on blood pressure.

Click here to go back to the top of the page.

2. NON HEART Q & As:

Q. I'm 75. Do you think I'm too old to have my tonsils out? You see, I get a lot of sore throats. 

A. I'm very doubtful whether a tonsillectomy would help you at age 75, sir. Be guided by your own doc. But bear in mind that the operation is no fun at all. It hurts!

Q. I have been diabetic since I was 50, and now I have a continuously sore foreskin. Why?

A. This is common in diabetics, and is usually due to the constant passing of SUGAR over the years. You may need to have a circumcision done. Sorry!

Q. I went on 'Hormone Replacement Therapy' when I was 50, and am now approaching my 60th birthday. Does this mean I must STOP it?

A. Not at all, ma'am. Many ladies - particularly in the USA - go on taking it till far into their 70s.

Q. I lost my potency just after my 65th birthday. I'd like to try Viagra, but have heard it has side effects.

A. The chief possible side effects are very mild, sir: flushing; headache; nose congestion; indigestion; and dizziness on jumping out of bed too quickly. A few men get temporary discoloration of vision. But there have been some worries about Viagra and the HEART. For this reason, you must not take it unless you've had a chat with a doctor, and a check-up. Please do NOT buy it off the Internet, as some folk do!

Q. I am 74. Would just TWO cigarettes a day really harm me now?

A. I can't honestly say that they would, ma'am - but just a few more than that could be harmful to your health. So take it easy!

Click here to go back to the top of the page.