What is a heart attack?
A heart attack is a condition where one or more of the coronary arteries are blocked.
These arteries running on the surface of the heart provide oxygen and nutrients to the heart muscles. Deprived of blood supply,
the muscle cells (termed myocytes) will die eventually if blood flow is not restored.
Someone experiencing a heart
attack will be unwell and usually complain of severe constricting chest pain associated with sweating, shortness of breath
and giddiness or feeling faint.
It is important to seek immediate medical advice if you think you are having a heart
attack. Modern treatment is aimed at restoring blood flow as soon as feasible either by infusion of clot-busting medicine
or by balloon inflation.
What risk factors are responsible for heart attack ?
The underlying problem responsible for heart attack is a disease process involving
the wall of these arteries (medically called atherosclerosis). Gradual deposition of cholesterol and calcium leads to progressive
narrowing of these arteries. There are five major risk factors;
· High blood pressure
· High cholesterol
· Family history of coronary heart disease
There are other additional
risk factors such as stress, lack of exercise and overweight. The more risk factors you have, the higher is your risk to have
coronary artery disease and heart attack.
Can you have coronary artery disease without knowing it?
Yes you can. The majority of patients with coronary artery disease will have chest
pain, especially during exertion. If you live a sedentary life with minimal or no exercise, you may not have any chest pain.
Some 5 to 10% of patients truly has no chest pain even with very bad disease. This is a dangerous situation.
not a bad idea to have a routine treadmill stress test after the age of 45 to detect coronary artery disease. Blockage in
the coronary artery may not manifest itself at rest.
What is the effect of smoking on the heart?
Smoking is a health hazard in many ways. It causes lung cancers and many other forms
of cancer. To the heart, smoking is a major risk factor for coronary artery disease. Smoking causes increases in heart rate
and high blood pressure. The internal lining of coronary arteries will be damaged and predisposes to further deposition of
cholesterol in its wall.
The risk is associated with the duration and quantity of cigarettes smoked.
I have high cholesterol level despite being thin and on a low
cholesterol diet. Why is this so ?
has no direct relation to body weight although the higher you weigh, the higher is the likelihood that your cholesterol level
will be high too.
Cholesterol in blood comes from two sources. Firstly, cholesterol is produced by your own liver as
cholesterol is an important component of cellular integrity and processes (making cell wall and hormones for example). Secondly
it comes from the foods that we eat. Cholesterol level can be high because of high liver production (inherited) or high cholesterol
intake or both.
If your cholesterol level is still high despite strict dietary control, it is most likely due to increased
liver production. Your doctor will prescribe you regular exercises and a drug called statin to lower the liver production
My doctor mentioned something about good and bad cholesterols.
I thought all cholesterols are bad.
Cholesterol is needed for normal function. It is the excess cholesterol that is detrimental.
are several subgroups of cholesterol, being divided by its size and components. The bad cholesterol (called LDL-cholesterol)
are bigger molecules that can be deposited in the wall of arteries and causes atherosclerosis, the cause of coronary artery
disease. The good cholesterol (called HDL-cholesterol) are smaller molecules that scavenge for bad cholesterol. Higher level
of good cholesterol will remove higher level of bad cholesterol from circulation.
Regular exercises and good dietary
control will increase the level of good cholesterol. Statin drugs will also raise good cholesterol level.
I am 45 years old and do not have any history of medical problems.
I rarely see a doctor. Can I assume that I have a healthy heart?
General rules apply - never assume. Some
risk factors may be present without you realizing it. High blood pressure and high cholesterol are largely silent, with no
signs. Similarly, narrowing and blockages in the arteries could be silent or not obvious at low level of activities.
is a wise investment to undergo at least some blood tests and a treadmill stress test routinely once a year once you go past
Can coronary artery disease be treated?
Yes, but as always, prevention is much
better. Depending on the severity of the narrowing and blockages, there are usually 3 modalities of treatment. Mild degree
of narrowing will usually treated with medications only. If the narrowing is more significant, a balloon angioplasty (doctors
call them PTCA) may be performed. For severe disease involving many coronary vessels, a bypass surgery will be required.
How often should I exercise to positively affect my health?
Any amount of exercise is good for health. If you are exercising for your heart, the traditional wisdom is to do it
at least three times per week, each session lasting 30 to 40 minutes. The best forms of exercise for the heart are brisk walking,
light jogging, swimming or cycling. These activities are called aerobic activities and are of moderate but constant intensity.
Source : Insititut Jantung