Everything you need to know about Heart Disease

As you are all well aware, across the globe and exclusively in our Indian Subcontinent, cardiovascular disorders in the form of Heart attack (AMI) & Heart Failure(HF) are burgeoning by several folds of deaths in human kingdom is related to either Acute MI, that means out of 10 deaths, 6 deaths are related to cardiovascular disorders in the form of Acute Coronary Syndrome, Heart failure & Heart stroke. Unfortunately 1 out of every 3rd person suffering from Hypertension & Diabetics in our country. That’s why India became Diabetic & Cardiovascular diseases capital. There are two peaks of incidents of heart attacks in our country, the peak between 30-45 years (young) & another peak after 60 years (old).

Principle reasons for Heart Stroke in young between 30-45 years are:

Sedentary lifestyle (Obesity & lack of physical activity)

Excessive consumption of high calories through foods & beverages. example: Pizzas, burgers & fried vegetarian & non vegetarian food and foods with high TFA( Trans Fatty acids).

• Insulin Dependent Diabetes Mellitus
• Excessive tobacco addiction
• Genetic reasons
• Environmental pollution
• Undue mental stress and suffering
• Night shift & stress related jobs
• Dyslipidemia
• Hyperhomocysteinemia and
• Hyperuricemia

Principle reasons behind Heart Attack( Acute MI) in Middle aged/ Elderly people above 45 years are:

• Age factor
• More chances in men and women
• Hypertension
• Diabetes mellitus
• In women after Menopause
• Dyslipidemia
• Obesity & physical inactivity and
• Chronic Kidney Disease (CKD)

Heart Attack (Acute Myocardial Infarction): Heart attacks are generally of 2 categories.

Silent Heart Attack (or) Silent MI

A heart attack does not always have obvious symptoms, such as pain in your chest, shortness of breath and cold sweats. In fact, a heart attack can actually happen without a person knowing it. It is called a silent heart attack or medically referred to as silent ischemia (lack of oxygen) to the heart muscle. This is generally seen in diabetic patients and heavy smokers, here even the ECG looks normal, But cardiac enzymes like Trop –T/ Trop-I/ CK MB are positive.

At times, patients under this category die before reaching the hospital. As patient himself misleads on his own, because he/she lacks significant and regular heart attack symptoms. Some people later recall their silent heart attack was mistaken for indigestion, nausea, muscle pain or a bad case of the flu.

Having a silent heart attack puts you at a greater risk of having another heart attack, which could be fatal. Having another heart attack also increases your risk of complications, such as heart failure.

MANIFEST Heart Attack

In this category of Heart attack, patient will experience the general symptoms like chest pain, breathing difficulty (SOB), Palpitation, Diaphoresis (sweating), giddiness, vomiting etc,. Some patients may have abdominal burning discomfort & sometimes loose motions, and they converts into Heart attack. Sometimes the heart attack is often mistaken as gastric problem and food poison, because they will be symptoms causes to Heart attack. Sometimes patients with cough and mild shortness of breath are diagnosed having upper/ lower respiratory tract infections. Some patients may present with giddiness with transient loss of consciousness due to nonsustained ventricular tachy arrhythmias in Anterior wall MI may often mistaken as CVA / TIA( Brain Stroke).

Some patients may have throat pain and jaw discomfort due to predominantly radiating pain from chest & therefore often mislead as ENT problems. Therefore the dictum is – pain anywhere from head to abdominal area should be evaluated for cardiac disease.

If you wonder if you’ve had a silent heart attack or MANIFEST heart attack, talk to your doctor. A review of your symptoms, health history and a physical exam can help your doctor decide if more tests are necessary.

How to recognise Acute MI/Heart Attack

BASIC TESTS

1ST TEST –  EKG/ECG( Electrocardiogram)

Unfortunately, reliable only in 60% of cases, but in 40% cases ECG looks normal & hence misplaced as normal.  But we must not treat this as normal case, we need to check with the second level of testing. Here If ECG is positive, then we call it as ST Elevation MI (STEMI).

2ND TEST – 2D ECHO

Even in 2D ECHO test we will not get complete accurate results for all the cases. Unfortunately, it is normal in 10% of the cases. If this is misleading as normal, please check with the Cardiac Biomarkers test.

3rd Test – CARDIAC BIOMARKERS

Here check for the levels in testing Troponin T(TROP -T) or troponin I(TROP – I) or Creatine Kinase Muscle/Brain(CK-MB). If these levels are positive, then there is high suspension of the heart attack. If ECG looks normal and patient gets results in Cardiac Biomarkers test, then this heart attack is named as Non ST Elevation MI (NON STEMI). This means Heart Stroke with Normal EKG.

4th Test – ANGIOGRAPHY/ANGIOGRAM/Coronary Angiography (CAG)

Angiography is the final test for more specific investigation and confirmation. Angiogram gives us the information about the diagnosis as well as prognosis & guides to future management. As is gives further information about the severity of blocks, number of blocks, location of blocks, out come of patient & need for PTCA (angioplasty stenting) management or CABG (Coronary Artery Bypass Grafting) management or Medical management.

NOTE: TMT must be avoided in those patients with high suspension of Acute MI, despite the negative results in ECG, 2D ECHO & positive Cardiac Biomarkers. Conclusively Heart attack is life threatening, the only early suspension is key and institution of appropriate therapy. Either Thrombolytic therapy or PTCA(Percutaneous transluminal coronary angioplasty) is paramount to mitigate the mobility and mortality.

Dr Y P Raju
Consultant Cardiologist,
OMNI Hospitals – Kothapet