Heart Attack Warning Signs and What to Do First

A heart attack happens when a clot blocks one of the arteries feeding your heart muscle. That muscle starts dying within minutes. This is an emergency. Call 1122 or go straight to DHQ Hospital Abbottabad Emergency. Do not wait to see whether the pain settles. Every minute of delay costs heart muscle.

What should you do right now if you think it is a heart attack?

Stop what you are doing, sit down, and call 1122 for a Rescue 1122 ambulance. If someone is with you and can drive, go straight to DHQ Hospital Abbottabad Emergency. Do not wait to see whether the pain passes. Do not book a clinic appointment for the morning. Treatment works best in the first hour, and that hour started when the pain did.

While you wait for help:

• Sit or half-lie in whatever position makes breathing easiest.
• Unlock the door so rescuers can reach you quickly.
• Do not drive yourself, climb stairs, eat or smoke.
• If the emergency responder tells you to and you are not allergic, chew one plain aspirin. Aspirin thins the blood and can limit the clot.
• If someone collapses and is not breathing normally, start chest compressions and keep going until help arrives.

The American Heart Association (AHA) advises calling emergency services rather than travelling alone, because treatment can begin on the way.

What are the symptoms of a heart attack?

The commonest symptom is pressure or heaviness in the centre of the chest lasting more than a few minutes. It can travel into the arms, the jaw, the neck or the back. Cold sweat and breathlessness usually come with it, along with an unsettled feeling that something is badly wrong.

Patients in Abbottabad describe it in many ways:

• A weight or heavy pressure sitting on the chest
• Pain spreading to the left arm, both arms, the jaw or the back
• Cold, clammy sweat
• Breathlessness
• Nausea or vomiting
• Sudden weakness, dizziness or fainting
• Restlessness and a sense of dread, what patients often call dil ghabrana

Not everyone gets the classic picture. The table below sets the typical symptoms against the atypical ones that show up more often in women, older adults and people with diabetes.

The AHA notes that women are more likely than men to arrive with breathlessness, nausea and back or jaw pain. Diabetes blunts pain nerves, so a person with diabetes may have a silent heart attack with almost no pain. If the symptoms worry you, treat them as an emergency.

What causes a heart attack, and who gets one earlier in Pakistan?

Most heart attacks start when a fatty deposit inside a coronary artery cracks open. A clot forms on the crack and shuts the artery down. The deposit itself takes years to build, out of high cholesterol, high blood pressure, diabetes and smoking. South Asians build it earlier than most.

The risk factors that matter most here:

• Smoking and naswar. Both damage artery walls and make clots more likely.
• Diabetes, which is common in Pakistani families and often undiagnosed. It usually arrives alongside high blood pressure and high cholesterol.
• High blood pressure that nobody has measured or treated for years.
• A diet heavy in ghee, salt and fried food, with little daily walking.
• Family history. A father or brother with heart disease before 55, or a mother or sister before 65, raises your own risk.
• Weight carried around the waist, even when the scales look normal.

The AHA reports that people of South Asian origin develop coronary artery disease earlier and more often than many other groups. A heart attack at 40 in Abbottabad is not the surprise it ought to be. Chest pain that comes on with effort and eases with rest may be angina, the stage before a heart attack, and it needs urgent assessment of its own.

When should you go to the Emergency?

Go now. Call 1122 or head for DHQ Hospital Abbottabad Emergency if chest pressure or pain lasts more than a few minutes, or if the pain comes with sweating, breathlessness, nausea, fainting, or spreads to the arm or jaw. Do not wait for morning and do not wait for a clinic appointment.

Treat these as emergencies too:

• Chest pain at rest in someone with known angina, particularly when the usual tablet under the tongue does not help.
• Sudden severe breathlessness with cold sweat, even without pain, especially in a person with diabetes.
• Collapse or fainting with chest discomfort.

You are not wasting anyone's time by coming in. An emergency visit that turns out to be acidity is a good night. A heart attack managed at home is not.

How is a heart attack diagnosed?

Diagnosis is quick. An ECG, which is a painless electrical tracing, is done within minutes of your arrival, along with a blood test called troponin that rises when heart muscle is injured. Between them they confirm most heart attacks fast, which is why reaching hospital early matters so much.

Once the emergency is stable, further tests map the damage and the blockages. Echocardiography shows how strongly the heart is pumping. Angiography shows exactly which artery is blocked and where. If the pain turns out not to be a heart attack, a structured chest pain evaluation works out the real cause. Dr. Muhammad Ali Khan, Consultant Cardiologist, assesses and follows up heart attack patients in Abbottabad after their emergency treatment at DHQ Hospital.

How is a heart attack treated?

The aim is to reopen the blocked artery as fast as possible. That is done with emergency angioplasty and stenting, a balloon and a small metal scaffold that hold the artery open, or with clot-dissolving (thrombolytic) medicine when angioplasty is not available quickly enough.

According to European Society of Cardiology (ESC) guidelines, long-term treatment after a heart attack usually includes:

• Antiplatelet medicines such as aspirin, to stop new clots forming.
• Statins, which lower cholesterol and steady the plaque.
• Beta-blockers, which reduce the heart's workload.
• Blood pressure medicines that also protect the heart muscle.
• Cardiac rehabilitation, a guided return to normal activity.

These are not a short course. Stopping them without medical advice is one of the commonest reasons people have a second heart attack.

How do you live after a heart attack?

Most people go back to work, to family life and to normal activity. Recovery does ask something of you, though. The muscle that survived needs protecting, and whatever caused the first attack has to be treated so that there is no second one.

What actually helps:

• Take every medicine, every day, including the days you feel completely well.
• Stop smoking and naswar. Nothing else you do will cut your risk as much.
• Walk daily, building up gradually as advised. Abbottabad's weather makes this easier than most places.
• Eat less ghee, less salt and less fried food. More vegetables, daal and fruit.
• Keep blood pressure, sugar and cholesterol checked and controlled.
• Come to follow-up visits so your heart function and medicines can be reviewed. Close family members share your risk, so a preventive risk assessment is worth arranging for them too.

Feeling low, frightened or on edge after a heart attack is common, and it is treatable. Say so at your follow-up. It is not a separate problem from your heart.