Heart Attack, also known as Myocardial Infarction (MI) or Coronary Thrombosis, is the result of a full blockage of an artery that supplies blood to a portion of the heart muscles. This happens when any of the coronary arteries or their branches are completely blocked. The cardiac muscles are completely devoid of blood and oxygen, which results in death. The severity of a heart attack is determined by how much of the heart muscle is affected. It is mild if just 5 to 10% of the body is affected, and the majority of patients survive. However, if the dead area of the cardiac muscles is greater than 30 to 40%, the attack is termed serious and, if not treated appropriately and promptly, might result in death.

Hypertension is another term for high blood pressure. (If your blood pressure is regularly over the usual range, you have high blood pressure.) The force of blood pushing against the walls of blood vessels is known as blood pressure. It’s expressed as two figures, for example, 122/78 mmHg. The highest number, systolic, represents the pressure in the heart when it beats. The bottom number, diastolic, represents the pressure in the heart when it is at rest. High blood pressure is defined as a BP that is continuously 140 systolic and/or 90 diastolic. No one knows for sure what causes the majority of high blood pressure situations. It is usually not curable, but it can be managed. It affects millions of Bangladeshis and Indians (1 in every 4 individuals), and many don’t even realize it. It’s risky to ignore high blood pressure. If you treat and control it, you can have a healthier life! High blood pressure frequently has no symptoms, which is why it is so dangerous. Make sure you get it checked on a regular basis and follow your doctor’s instructions. Who is most at risk?

• People with close blood relatives who have it
• People over 35
• Overweight people
• People who use too much salt
• People who use too much alcohol
• Women who take birth control pills
• People who aren’t active
• Pregnant women

How can I tell I have it?

You usually can’t tell! Many people have it and don’t know it.
The only way to know if your blood pressure is high is to get it checked regularly by your doctor.

What can untreated high blood pressure lead to?

• Stroke
• Heart attack
• Heart failure
• Kidney failure

What can I do about it?

• Lose weight if you are overweight.
• Eat a healthy diet that is low in salt and fat.
• Be more active.
• Take medicine the way your doctor tells you.
• Know what your blood pressure should be and work to keep it at that level.

How can medicine help?

• Some medicines help relax and open up your blood vessels so blood can flow through better.
• A diuretic can help your body from holding too much water and salt.

How can I learn more?

Talk to your doctor, nurse or health care professional. Or call your SAAOL Heart Center. If you have heart disease, members of your family also may be at higher risk. It’s very important for them to make changes now to lower their risk.

Angina is a type of chest pain that develops when your heart does not receive enough blood and oxygen. A buildup of cells, lipids, and cholesterol can obstruct the coronary arteries that feed blood to your heart over time. Plaque is the term for this accumulation. When one or more arteries become partially clogged, not enough blood can flow through, causing chest pain and discomfort. Angina is a symptom of heart disease and may not cause long-term harm to the heart. Angina occurs when a clogged artery prevents the heart from receiving adequate blood and oxygen. What does it feel like to have angina? Angina is usually only a few minutes long. Here’s how people say it feels:

• Chest feels tight or heavy.
• Hard to breathe.
• Pressure, squeezing or burning in chest.
• Discomfort may spread to arm, neck, jaw or back.
• Numbness or tingling in shoulders, arms or wrists.

When will I get angina? You may get angina when you:

• Climb stairs
• Carry groceries
• Feel angry or upset
• Work in very hot or cold weather
• Have sex
• Have emotional stress
• Exercise
• Combine any of these

What tests might I have?

• Blood tests
• Electrocardiogram (EKG or ECG)
• Treadmill exercise test
• CT Coronary Angiography or Scan – 128/64 slice
• Cardiac catheterization, which shows where the artery is blocked

How is angina treated? Your doctor may give you nitroglycerin, a medicine to relieve the discomfort. Nitroglycerin: Comes as tiny tablets you put under you tongue, and as spray, capsules, skin patches and ointment. Is safe and not habit-forming.

Be sure to ask you doctor, nurse or pharmacist about:

• What to do if you get angina
• How to use your nitroglycerin the right way

What can I do about angina? Don’t give into it! You can change your way of life and lower your chance of having angina attacks. A few simple steps can help you feel more comfortable every day. They are:

• Stop smoking.
• Eat healthy meals
• Control high blood pressure and blood cholesterol level
• Learn to relax and manage stress.
• Avoid extreme temperatures.
• Avoid strenuous activities.
• Call your doctor if your angina changes. For example, if you get angina while resting or if it ever gets worse.

What can I do about angina?

Talk to your doctor, nurse or health care professional. If you have heart disease, members of your family also may be at higher risk. It’s very important for them to make changes now to lower their risk.

The heart muscles die during a heart attack because they are deprived of blood flow. Because Cholesterol Blockages (which account for 70-80% of the cases) cannot be eliminated, blood clot clearance is the only way for patients to avoid losing their cardiac muscles.

The sole treatment options are an immediate injection of clot busters like Streptokinase or Urokinase (both of which are highly expensive shots) or a drip of Heparin. If they can break the clot (which normally closes 20-30% of the tube’s lumen), the heart muscles will be able to get some blood right away and survive. If given within one hour of the attack, these injections can reverse almost all of the heart attack’s damage. If given during the next five hours, it will still have some effect. However, these injections frequently fail to provide results. These medicines also have their side-effects like internal bleedings, cerebral hemorrhage, peptic ulcer bleeding and can be dangerous sometimes.

The injured portion of the heart puts a pressure on the heart muscles’ other active sections. And it’s critical to avoid any more heart attacks. After a heart attack, patients are encouraged to stay in the hospital for around seven days, with the first few days spent in the intensive care unit (ICCU) (Intensive Coronary Care Unit). It is possible to handle any emergency here.
Early mobilisation of heart attack patients, beginning on the fifth day, is the most recent therapeutic concept. Patients with heart disease were formerly restricted from moving for the next month or so. Now the dictum has changed, as with early movement (walks, exercises) the recovery has been found to be better.

The PET Scan is the most recent non-invasive diagnostic for determining the progression of coronary artery disease or the reversal of blockages. This experiment was used by Dr. Dean Ornish to demonstrate that the blockages in his patients’ coronary arteries had been reversed. Only a few facilities throughout the world offer this incredibly expensive and complex analysis. The patient is made to lie down on a table that is then inserted into the scanner, where sectional images of the heart are taken. A coloured graphical image of blood flow throughout the heart can also be provided, providing an exact picture of any obstructions. The PET Scan Machine costs around Rs.15 crores and is not as yet available in our country.

It’s not uncommon to come across heart patients with a normal ECG. It’s important to note that ECGs are taken while the heart is at rest, when it’s beating at its slowest pace. Patients can have a normal ECG even if they have 90% blockages. In such circumstances, the patient would also agree that there is no discomfort in the chest when they are at rest, and that the angina symptoms only appear when they increase their heart rate, such as by walking.
This is the situation in which a TMT test is required. The patients’ heart rates should be gradually increased, increasing the blood demand of the heart muscles. ECG records are taken at the same time. If there is a blockage of greater than 70%, the ECG will show alterations that are suggestive of Angina.

This exam, which uses a computerised equipment, requires patients to make physical effort. According to an established protocol known as the Bruce’s Protocol, the intensity of the exercise is gradually increased. The continuous ECG monitoring throughout the workout would reveal any blood and oxygen deficits in the cardiac muscles. The patient should stop exercising as soon as any ECG changes or symptoms of chest pain, discomfort, or shortness of breath arise.

Exercise Stress Test, Computerized Stress Test, or simply Stress Test are various terms used to describe the TMT test. This is the most simple, popular, and prevalent test used to detect the degree of heart disease in patients. This test, when performed at regular intervals, can reveal if the patient’s angina is improving or worsening.

When a patient can attain a specified heart rate without showing any ECG alterations, it is called a negative TMT or Stress Test. This is known as the target heart rate, and it is determined using the formula (Target Heart Rate = 220 – patient’s age). Though the TMT can be considered negative if the patient achieves this rate without causing any ECG alterations, it does not mean that the blockage is zero. It simply means that the person performing the test is likely to have a blockage of less than 70%.