When arteries become too narrow or a clot forms, it restricts blood flow to the heart; the heart muscle is deprived of oxygen and a heart attack occurs. The severity of the attack depends on the extent of the damage to the heart muscle.

What causes a heart attack?
Coronary artery disease (disease of the arteries leading to the heart) is the most common cause of heart attacks. Although a heart attack is often a sudden and dramatic event, it is the result of a gradual process over many years. The build up of fatty deposits in the walls of the arteries leading to the heart (this process is known as atherosclerosis) causes gradual narrowing of these arteries and can cause a total blockage of the artery and the blood flow to the heart muscle, causing a heart attack.

How is it diagnosed?
A heart attack is diagnosed through the symptoms experienced (see below) as well as by the results of blood tests and an ECG (electrocardiogram). The blood tests indicate levels of enzymes that are released into the bloodstream when the heart muscle is damaged and the ECG traces the electrical pattern of the heartbeat and can indicate areas of damage. These results determine the severity of the attack and degree of damage.

Many will not admit that they are in trouble or acknowledge that the symptoms they experience are serious. Recognising the warning signs and seeking medical treatment could save your life!

Having heart disease, a family history of heart disease or even one or two risk factors for the development of heart disease (high blood cholesterol, high blood pressure, being overweight, etc.) puts you at risk. It is important to know the “warning signs” of a heart attack or stroke so that you, a friend or a family member know when you are in trouble and what to do.

Watch out for the following, but be aware that symptoms do vary from person to person:         

• Heavy pressure, tightness, crushing pain or unusual discomfort in the centre of the chest.
• This may feel like indigestion, spread to shoulders, arms, neck or jaw and/or last for more than 15 minutes. It may stop or weaken and then return.
• Sweating, sickness, faintness or shortness of breath may be experienced
• There may be a rapid, weak pulse
• Sharp stabbing pain in the left side of the chest is usually NOT heart pain

What to do?

When these symptoms are experienced, it is important to act immediately. Call an ambulance, as medical help is most important in the first few hours after the attack. Rest quietly by sitting or lying down - sit up if breathless or lie flat if faint. CPR (cardiopulmonary resuscitation) may be necessary.

Angina occurs when the heart muscle does not get as much blood (and therefore as much oxygen) as it needs. This usually happens because one or more of the arteries that supply blood to the heart muscle is narrowed or blocked. Chest pain and discomfort are experienced.

A cardiac arrest occurs when the heart stops beating - the heart's rhythm may become chaotic, preventing it from pumping effectively or it may stop altogether. The person is usually unconscious, not breathing and his/her skin turns pale or blue. Without blood circulation, brain damage begins after about 4 minutes and death can occur after about 10 minutes.

Cardiac arrest may occur as a result of a heart attack, but those who suffer from a heart attack do not necessarily experience cardiac arrest or need CPR. Other common causes are electric shock, drowning, drug overdose, suffocation and trauma.
Someone who suffers a heart attack and goes into cardiac arrest requires skilled help immediately. Call an ambulance and start CPR. If you don't know CPR, open the airway and start rescue breathing.

The injured heart muscle starts to heal immediately after the attack and takes approximately 6 to 8 weeks. The final result is usually an area of strong scar tissue that, in most patients, does not affect the function of the heart or the way the person feels.

For the first few days after being released from hospital, resting is very important. Keep activity low - you may find that you are more tired than you expect.

With your doctor's approval and advice, begin light exercise as soon as possible. Start walking outside on a flat surface at a steady medium pace. Increase the length of your walk as you feel able. Each individual is different and you must progress at your own rate. Listen to your body. Don't overstress yourself. If you feel shortness of breath, dizziness, weakness, or chest pain, contact your doctor immediately. The best type of exercises at this stage are walking, cycling and swimming. Exercise need not be too vigorous to be beneficial; over time you should be aiming to do one of these at least most days of the week.

Some dietary tips for after the heart attack:

• Following a healthy balanced diet low in saturated fat is very important
• Changes in food consistency may be necessary so that the food can be eaten with more ease
• Avoid your stomach becoming distended by having too large meals
• Because you will be doing little exercise, you might develop constipation. Eat enough fibre rich foods and drink enough water (consult with your dietician for more specific guidelines)
• Avoid stimulants such as caffeine (coffee, tea, cola soft drinks and chocolate)
• Avoid alcohol at first
• Sufficient dietary intake is essential, but if the person is overweight, weight loss may be beneficial and a dietician should therefore be consulted

Heart disease is aggravated by poor lifestyle habits. Nothing is guaranteed, but preventative measures can be implemented to reduce the risk of suffering another heart attack:

• Do not smoke
• Reduce high blood cholesterol
• Control high blood pressure
• Eat a healthy balanced diet low in saturated fat
• Exercise regularly
• Maintain a healthy body weight
• Reduce stress

It is important for family, friends and close colleagues to know if you have heart disease and what to do if a heart attack occurs. Everyone can benefit from learning more about the warning signs of heart disease and CPR.

Frequently Asked Questions

When do I need to see my doctor again?
During the first week at home, your doctor advise you on this schedule

Will I need medication?

Most people will remain on their regular tablets to reduce the risk of another heart attack, but additional medication might be necessary.

Most people need 3 to 4 weeks after leaving the hospital to recover. If your job requires heavy manual work, you may need a longer recovery period.

When can I drive again?
You should not drive within the first 2 to 3 weeks after leaving the hospital. When resuming driving, avoid long journeys and heavy traffic.

There is no reason not to continue normal sexual activity after you have recovered from the heart attack.

And sport?

Sport is encouraged, as it provides both exercise and relaxation. Competitive sport should, however, be avoided until after the recovery period.

This is one in a series of brochures. For the full series and more heart smart information call the Heart Mark diet line on 0860 1 43278 (0860 1 HEART) or visit www.heartfoundation.co.za.

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