You are probably familiar with the 'Hollywood heart attack' – a grimacing man clutches his chest and then kneels over. As you no doubt know, life and death do not always happen the way they do in the movies. Doctors from National Heart Centre Singapore, a member of the SingHealth group, shares the warning signs of heart disease.

Tell-tale signs

In real life, attacks of the heart and brain do not announce themselves so dramatically. In fact, some warning signs of a heart attack and stroke are so easily dismissed or ignored that you might not even be aware that you, or a loved one, are in the throes of one until precious life-saving minutes are lost. If you, or someone you know, experience any of the tell-tale warning signs of a heart attack, sudden cardiac arrest or stroke, listed below, call an ambulance immediately. A life may depend on it.

Heart attack

During a heart attack (medically known as a myocardial infarction), blood flow to your heart gets cut off or blocked and the heart muscle starts to die. You would think that you would be aware of it when something like this was happening to you, but a third of all heart attack victims never experience that Hollywood-style, chest-clutching pain. Surprisingly, warning signs that your heart is in trouble can crop up days or even weeks before an actual attack. Since the red flags are easy to dismiss, it is important to be in tune with your body. A 'something's not right' feeling in your chest or stomach warrants a trip to the emergency room, as do these other heart attack symptoms:

1. Unusual fatigue
2. New, unexpected shortness of breath during everyday activities
3. Nausea or vomiting
4. Cold sweats
5. A persistent burning sensation in the upper abdomen (similar to indigestion)
6. Dizziness or fainting
7. Pain in the jaw, throat, back, shoulder or arm that does not go away

If you are having an attack, chewing an adult aspirin (or dissolve a crushed aspirin in water and drink it) can help restore blood flow until trained medical experts are able to administer clot-busting drugs. Heart surgery to improve the blood supply to the heart may eventually be needed.

Sudden cardiac arrest

It strikes out of the blue and the only warning signs may be:

• Feeling of dizziness
• Racing heart beat

Sometimes your heart's electrical system unexpectedly goes haywire, causing an arrhythmia called ventricular fibrillation that abruptly stops your heart from beating. With no blood or oxygen pumping through your system, you quickly lose consciousness and collapse. This is usually the first sign that someone is experiencing sudden cardiac arrest. As the name implies, the attack strikes out of the blue. The only warning signs may be a feeling of dizziness or a racing heart beat right before a bout.

Still, most victims never know it is coming. Sudden cardiac death is only minutes away unless a normal rhythm is restored to your heart immediately, via cardiopulmonary resuscitation (CPR) and/or a defibrillator, a device that delivers an electrical shock to your heart. Many places like airports and fitness facilities are equipped with automated electronic defibrillators or AEDs that are easy enough for just about anyone to use. These can be lifesavers until trained medical help arrives.

While sudden cardiac arrest is different from a heart attack (for one, the heart usually does not stop beating during a heart attack), a previous history of heart attacks is a major risk factor, and heart attacks can trigger sudden cardiac arrest. More than 80 per cent of those who experience sudden cardiac arrest have coronary artery disease or hardening of the arteries. The same factors that put you at risk of coronary artery disease – smoking, high blood pressure, high cholesterol, diabetes, sedentary lifestyle and obesity – also increase your chances of sudden cardiac arrest.

Stroke

If you suddenly find it hard to talk, move or focus, you may be having a stroke. Strokes occur when the blood supply flowing into your brain gets cut off either by a clot or a ruptured blood vessel. Within minutes, brain cells that control body functions like speech, vision and movement permanently die.

Recognising the warning signs is critical. Warning signs include:

1. Blurred vision and slurred speech
2. Excruciating headache or feeling dizzy and off balance
3. One side of your body may go numb or feel weak

Some stroke victims experience transient ischemic attacks (TIA) months or years prior to a full-blown stroke. These 'mini strokes' occur when blood flow to the brain is reduced but not fully blocked, causing mild stroke-like symptoms that leave no lasting damage. People who have experienced these warning strokes are 10 times more likely to some day have a full-blown stroke. Clot-busting drugs and blood thinners can help restore brain function, but only if treatment is given within three hours of a stroke.

Race against time

Time is the enemy for someone suffering from a heart attack, sudden cardiac arrest or stroke. The faster medical help is provided, the greater the chance of survival. The optimum time to get to a hospital if you are having a heart attack or stroke is within an hour of the start of symptoms. Yet studies show people wait up to seven hours before seeking care because they wrongly hope their symptoms will go away, or they are afraid they will look silly if they go to the hospital for something as 'minor' as gas or a headache.

With each untreated second, the heart muscle or brain cells are irreversibly damaged and lost. Always get medical help immediately if you or someone you know is experiencing any of the symptoms listed above. Do not call a friend or try to drive yourself to the hospital. Paramedics can begin treatment up to an hour sooner than if you arrive by car, and those precious minutes may mean the difference between life and death.

Ref: V10