CONTENTS

V The heart 1
* Blood supply to the heart 2
V What is a heart attack? 3
V The kind of person most likely to have a heart attack? 3
V Can heart attacks be prevented totally? 4
V What are the risk factors for heart attack?
V How can the risk factors be controlled?
V What are the indications of a heart attack?
V What are the changes in a blood vessel leading to a heart attack?

V What steps should be taken during an attack?

V Why is it important to treat a heart attack as soon as possible?

V What is the treatment given for heart attack? 11

V What adjustments are required in a heart attack patient's lifestyle? 12

V What are the tests to evaluate Heart Function?
- -

V 6 ways to a healthy life

- --

V A little exercise does your heart good

 THE HEART
The heart is one of the most important
organs far the maintenance of one's life.
Situated in the middie of the chest, it is a
powerful pump, weighing about
300-350 grams, which drives blood around
the body carrying vital food and oxygen
(energy) to the tissues.
T k job of the heart is to pump blood
around two separate pathways in the body.
Through one pathway the heart pumps
btoud out into all the parts of the body
thereby delivering foad and oxygen to
them. The blood then r&urns to the heart
having had all the oxygen and food
absorbed by the body.
The heart also pumps the blood on its
second pathway to the lungs t~ replace the
oxygen. It is then returned to the heart
with its oxygen renewed.
Even when we sleep, the heart goes on
tirelessly pumping away, never stopping for
a moment, usually beating 70 times a
minute and much more when we are awake
and running around.
During our lifetime, the heart performs a
massive amount of work. In a life span of
say 75 years, the heart will have beaten
more than 3000 million times and pumped
over 200 million litres of blood. Not
surprisingly, the heart does fail eventually.
"Go t o your bosom,
Knock there and ask your heart
What it doth know."
- William Shakespeare,
 BLOOD SUPPLY TO THE HEART

The muscles of the heart themselves receive patient begins to experience the warning
blood from two arteries (right and left signs of an impending heart attack.
coronary artery). This is of utmost
importance because the heart works
continuously and requjres large amounts of
energy to sustain itself.
If due to any reason, the heart muscle d ~ e s
not get enough blood, then it will not be
able to beat well enough to cope with the
body's requirement of blood supply and the
person will start getting the symptoms of a
tiring heart.
These symptoms of a tiring heart are a
special 'Body Language' telling you that the
blood supply to the heart is seriously
reduced. At this stage, prompt medical
attention may prevent further
complications.
If a person does not recognise these
warning signs and seek medical attention at
once, then the Mood supply to the heart
soon gets further reduced and a t some time
there occurs a complete shutdown of the
blood supply to a part of the heart muscle.
The most common cause for decreased
blood supply to the heart muscle is
narrowing and blockage of the coronary
arteries.
The process of blockage of the coronary

sometimes reaches such an extent that the

 WHAT IS A HEART ATTACK?

i heart attack is known in medical terms as Myocardial infarction happens mainly

I "myocardial infarction". It is a sudden
~fe-endangeringoccurrence caused by the
:omplete stoppage of the blood supply to a
)art of the heart. This part of the heart
nuscle then dies and is replaced by dead tissue.
because of the slow. progressive,
irreversible blockage of the vessels
supplying blood to the heart (coronay
arteries).

THE KIND OF PERSON

MOST LIKELY TO HAVE A HEART ATTACK?

"The heart never grows better by age;

rather, worse, always harder."
- Lord Chestefield,

c. Smoker d. Overweight
 D CHOLESTEROL
t
tY HIGH
I
HIGH

HEART ATTACKS BE PREVENTED TOTALLY?

M Q W W I yno. But the risk can be of the risk factors and dutifully foilowing
d bgr p a q r prevention and control the advice of your Ductw.
 WHAT ARE THE RISK FACTORS
FOR HEART ATTACK?

CONTROLLABLEFACTORS
g. Sedentary life - People with sedentary
a. Smoking - It is directly related to the habits are three times more susceptible
number of cigarettes smoked daily. to heart attack. as compared to those
who are physically active.
b. Overwight - Obesity puts extra strain
on the heart and'also leads to high blood Uncontrollable factors
pressure, high blood cholesterol and a. Age - Increases with age
triglyceride levels and a tendency to b. Sex - More common in males
develop diabetes.
c. Heridity - More common in people
c. High blood pressure - In hypertensive with strong family history of premature
people the heart must work harder to heart attacks (before the age of 45
keep the blood moving from the heart to years)
the bodv tissues. This also increases the
wear and k a r of the arteries leading to
arterial hardening and thickening.
d. Diabetes - Due to high blood sugar
levels, the process of arterial hardening
and thickening is accelerated.
e. High levels of blood cholesterol and
triglycerides - Excess cholesterol and
triglycerides present in the blood are
deposited within the walk of the arteries
leading to their hardening and thickening.

f. Emotional stress and tension - When a

person is under stress, the blood
pressure and blood sugar levels shoot up,
which then strain the heart.
-SEX
FACTORS BEYOND OUR CONTROL
 CAN THE RISK FACTORS BE C ?

In patients who have been hospitalised

far heart attack, it has been noted that
the number and severitv of comolications
- -

masis h k k bp@das 8-causes are markedly reduced ii

-
accustomed to regular exercise than in
pmure level. patients who lead sedentary lives.
e. d - kguiar check-ups of blood your doctar is important to prevent
pressure and blood sugar levels and their damage to your heart.
proper control fdiowiog the advice of
WHAT ARE THE INDICATIONS OF A HEART ATTACK?
The characteristic feature is sudder! pain in the centre of the chest which may come
~getherwith shortness of breath, restlessness, nausea, vomiting and loss of consciousness.

What are the different types of chest pain

1. A central chest pressure ranging fr b. Pain radiatinq to the left arm, where it
mild to severe causing a feeling of may cause a sensation of weakness in
suffocation. the arm muscles.

- - -

c. Pain radiating upto the jaw and An upper abdominal discomfort which is
sometimes to the back normally mistaken for acidity or
indigestion.
 WHATARE THE CHANGES
IN A BLOOD VESSEL LEADING TO A HEART ATTACK?
I I

Blockage (atheroma)

Narrowing of the blood vessel

Wall of the blood vessel
 WHAT STEPS SHOULD BE TMEW
DURING AN ATTACK?
1ID
1. O not panic and do not allow others to panic. I I 2. Call for a Doctor immediately. II

3. Stay with the patient until the Doctor arrives.

5. If the patient has di.fficuIty in breathing, he may 6.Loosen any tight clothing on the patient and see
be more comfortable in a propped up position. that the room is airy and quiet. Do not allow
crowds in the room and do not permit any noise.

7. I f pwible give the patient a tabket of nitrate to 1 8.Do not allow the mtient to smoke. it will not t
be kept belaw the tongue ta alIeviate his
I help fo relieve hi; pain and discomfort
 WHY IS IT IMPORTANT TO TREAT A
HEART ATTACK AS SOON AS POSSIBLE?
4 heart attack can strike anyone and when
t occurs there is no time for delay. Most
wart: attack victims survive if they
recognise the early warning signals of heart
attack and seek medical attention at once. It
has now been well established that most
deaths associated with a heart attack occur
withm the Wrst hour after its onset and
that death usually is due to disturbance in
the hearth electkal activity.
I
4
WHAT IS THE TREATMENT GIVEN FOR
HEARTATTACK?
The patient should be immediately
transferred by ambulance to an ICCU.
In the ICCU the patient is continuously
monitored for changes in the blood
pressure, pulse and recurrence of chest
pain. During the very early stages of a
heart attack intravenous drugs may be
given to dissolve the clot in the coronary
arteries with rernarkabke success. Facilities
for DC shock and cardiac pacing are also
I
Therefore it is imperative that the patient
should be transferred immediately by
ambulance to an ICCU (Intensive Coronary
Care Unit) where prompt medical treatment
can be
available in the ICCU which can help to save
the patient's life.
After 'being stilbitized in the ICCU which
takes 3-5 days. the patient is shifted to the
wards where he is gradually mobilized and
then discharged after about 2 weeks and is
advised to take a months rest at home.
The stages in treatment are:
Medical : Drugs to control various risk
factors and to prevent further blockage and
narrowing of the coronary arteries.
Diagnostic :
Exercise stress test
The aim being to see during stress how the
heart responds by building up the required
amount of blood pressure and by
maintaining the regularity of the heart
beats.
If the heart is unable to cope with this
stress, it indicates that the heart is. weak
due to inadequate blood supply.
 WgvN
This is c b e to see t o what extent are the
car0m-y arteries blocked.
A n a s m tube is inserted via a blood vessel
in the kg and is pushed upto the heart and
into the qm$ng of the coronary artery.
Dye is then Injected vh the tube iirto the
coronary artery and serial filrn/video
recordings are takm of the flow of the dye
in these arteries. Hocks in these arteries
can be viwilised as areas where dye flow is
thin and minimum.
Surgical : Patients who do not respond to
canservative medical treatment or who are
young and want to pursue an active life:
have a choice of surgical procedures.
a. Coronary angioplasty - Where a balloon
is passed up to the site of obstruction
and is inflated to stretch out the
obstruction and thus re-establish blood
flow.
b Coronay artery bypass graft (CABG) -
In this procedure the obstructed segment
of the coronary artery is bypassed with
a piece of vein graft taken from the
patient's leg.
"Let my heart. be wise,
I t is the God3 best giff.*'
- Euripides.

WHAT ADJUSTMENTS ARE REQUIRED IN A

HEART ATTACK PATIENT'S LIFE ?STYLE?
The 'Road to Recovery' following a heart
attack is usually about 3 months, during g
which there is a gradual return to normal
activity. 4
Anyone who has suffered a heart attack has
an increased r i ~ kof suffering another one
in the following few years, and the second
heart attack usually has serious
complications which may lead to death. But
the chances of another attack can be
decreased and the quality of life improved,
by proper control of the risk factors
premt.
Controlling the risk diet, jular exercise and by medical
* If the patient is overweight he is advised treatment (drugs and/or insulin
to reduce weight and abstain from any injections).
forms of tobacco (cigar-s, bidis, pan * The patient is advised to take a low
and snuff). calorie, low salt, easily digestible diet, to
* B 1 d sugars a'nd blood fats (cholesterol be eaten in small amounts more
and trigiyerides) s h l d be narrnalised by frequently during the day.
Wcation
* It is of utmost importance that the
patient takes his medication on time
without skipping even a single dose (It is
also dangerous to take an extra dose).
Irregular medication can lead to serious
complications.
* It is advisable to the patient to keep a
boffle of nitrate Web handy at home as
well as a t the place of work for use in an
emergency.
Exercise programme
* In the ICCU absolute bed rest is essential
during the first 48 hours (to limit the
extent of damage to the heart muscle).
period of 2 weeks, during which he is
allowed to take short distance walks 3-4
times a day within the hospital premises.
Many hospitals a t the end of this period
conduct a 'limited exercise tolerance test'
(modified stress test) just prior to discharge
to help identi0 the high risk patient and to
formulate a specialised programme for
hidher physical activity.
Once the patient is at home, he/she may be
permitted short outdoor walks. in the early
mornings or late evenings.
It is n i t advisable for the patient to drive a
vehicle himself or to travel by air during
the first 3 months. Later, if his Doctor
permits, he may do so. Most airlines make
special arrangements for the transport of
the patient and for handling luggage a t the
airport if advance notice is given.
Sex and the heart patient

After this period the patient is allowed to

sit up for short periods of time and by
the 4th or 5th day he may be allowed t o
sit in a bedside chair and use a bedside
commode.
* After his transfer to the ward from the
ICCU, he is mobilised gradually over a
Sex. being one of life's survival instincts, is
one of nature's own way of alleviating
tension and stress.
Sex is often a taboo for a large majority of
heart attack patients.
About 6-8 weeks after an attack, the
patient may begin his normal sex life,
provided his heart holds sufficient reserves
(which can be assessed by an 'Exercise Stress
Test' conducted by the Doctor).
Patients who have had a large portion of
their heart muscle damaged due to the
attack and with consequent poor heart
function would necessarily have to avoid all
exertion (even sex) till they get better by
way of surgical treatment.
The precautions for safe sex are:
Persons employed in heavy manual work
need to take a t least 3 months lay off from
a. Avoid heavy meals and alcohol just work On rejoining they may need to
before sex. change to a lighter job.
b. All previous medication should have been
taken on time. Yoga and meditation
c. Keep a tablet of nitrate at hand. If chest
pain develops during or after sex. then
keep the tablet below the tongue to
alleviate the symptoms and immediately
contact the Doctor.
d. It is preferable to have sex in the
mornings or at such times when one is
fresh and not tired.
e. The patient should continue with the
routine exercise programme. This will
help improve higher exercise bearing
capacity.
Going back to work
The timing of return to work depends on
many factors, particularly the type of
employment.
Those witb sedentary occupations can often
return to work at the end of 2 months. In A sincere attempt to relax the mental
the bq~nning,they have to take things attitude towards life in general and to live a
easy, like working part time for a few more peaceful and active(not he&) life
weeks. avoiding rush hours while travelling along with meditation and yoga may help
and not entering into any arguments. tremendous~y.
Warning signs
If at any time the patient feels uneasy,
giddy, breathless, or gets chest pain, he
should stop whatever activity he is doing.
lie down immedia&ly in a comfortable
position, and if possible keep a tablet of
nitrate Maw his tongue and then send for
a Doctor immediately.
An overall outlook of optimism, positive
thinking and relaxed living would be
extremely helpful in improving the quality
of life.
WHAT ARE THE TESTS TO
EVALUATE HEART FUNCTIONS?
Test
a. Physical examinatnn
b. Chest X-Ray
c. ECG (Electrocardiogram)
d. Laboratory investigations CBC, ESR,
VDRL
BUN, Creatinine
FBS/PGBS/PLBS
Sr. Calcium, Sr.electrolytes
Sr. Cholesterolflriglycerides
e. Stress Test (Computerised Exercise
EGG)
f. 2D-echocardiographyff Colaur Doppler
ec hmrdiography
g. Stress Thallium Imaging
h. Gated Blood Pool Studies
i. Coronary angiography
It has now been medically proved that in
heart attack patients who take good care,
the blockage and narrowing of the coronary
arteries is actually reversed and slowly the
coronary arteries open up!
"A man 3 heart changes his
countenance,
eMer for good or for evil."
- The Bible
What the test heips to detect
- Heart failure
- Heart size and presence of heart failure
- Presence of a heart attack
- Strain on the heart
- Disturbances of the heart rate
- Position of the heart
- Presence and severity of infections
- Kidneys' excretory capacity
- Blood sugar levels
- Electrolyte disturbances
- Risk of atherosclerosis
- Changes in the heart when put under
strain
- Structural and functional abnormalities of
the heart
- Which area of the hearL gets less amount
of blood during exercise.
- The effectiveness of the pumping action
of the heart.
- The blockage and narrowing of the
coronary arteries.
 SIX WAYS OF KEEPING HEALTHY
By paying attention to each of the following six aspects of personal health care. you can
make an important start towards improving - or rnaintainin~vour individual levels of general
W "

health and physical fitness.

Eat WIWJ& Limit alcohol Don't smoke

Wree Regula~ly Waght-watch visit the doctor

A LITTLE EXERCISE
DOESYOURHEARTGOOD

Look afkr your HEART