Severe chest pain and a​ combination of the following symptoms can mean a person is having an acute heart attack (known medically as a myocardial infarction), shared Professor Marcus Ong, Senior Consultant, Department of Emergency Medicine, Singapore General Hospital (SGH), a member of the SingHealth​ group.

The severe chest pain experienced when a heart attack strikes is often likened to something very heavy pressing on the chest, and described as the worst pain suffered in a person's life.

Dos and don'ts during a heart attack (myocardial infarction)

Dos

  1. Call 995 for an ambulance.

  2. Paramedics are trained to stabilise the patient’s condition with medication, and the ambulance is equipped with a defibrillator to resuscitate the patient should the heart stop en route.

  3. Give clear instructions to the paramedics on finding the patient’s home, have someone wait at a visible location to guide the paramedics and hold the lift open if the patient lives in a high-rise building, so as to save time.

  4. Get ready the patient’s personal effects such as personal identification, medical benefit identification, insurance and other documents for admission.

  5. Have the patient seated in a location where he can be transferred easily to a stretcher.

  6. Give a clear account of what happened.

  7. Let the paramedics know about any drug allergies or past medical history

Don’ts

  1. Drive or take public transport to the hospital, even if the patient lives nearby. As the patient’s condition may deteriorate en route, it is safer to wait for an ambulance. Also, ambulances also get priority on arriving at A&E.

  2. Ignore the pain. The minutes and hours following a heart attack are crucial. The longer you wait, the more likely that permanent, irreversible heart damage will occur.

  3. Brush off the symptoms (this may sound similar to above but we're repeating this because it warrants attention). 
    It can be easy to look at someone and assume that their age or fitness level precludes them from suffering a heart attack. Never take a gamble on anyone’s health based on physical appearance.  Anyone can suffer a heart attack, and if the signs are present, 995 should be called immediately. 

Unsure how to identify a heart attack and what to do when it strikes? Watch this video!

 

Symptoms of a heart attack (myocardial infarction)

Some heart attacks are sudden and intense but many start slowly with mild pain or discomfort with one or more of these symptoms:

  1. Discomfort in the centre or left side of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain

  2. Prolonged chest pain (>30mins) that is not relieved with rest

  3. Chest pain or discomfort that spread to the neck, back or down to one or both arms

  4. Breathlessness, with or without chest discomfort

  5. Sweating

  6. Feeling faint and/or nausea

How a he​art attack occurs

  • Cholesterol in the bloodstream infiltrates the arterial wall.

  • The immune system dispatches white blood cells called macrophages to consume the cholesterol.

  • The bloated macrophages become foam cells.

  • Foam cells accumulate and become a major component of plaque.

  • To keep the arterial wall slick, smo​oth muscle cells form a hard fibrous surface called a cap.

  • Foam cells in the plaque secrete chemicals that weaken the cap.

  • If the cap cracks or tears, the soft, fatty inside is exposed.

  • Platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque.

  • A heart attack happens when a blood clot totally blocks the blood supply to the heart muscle.

When the pain strikes

Blockage of the artery deprives the heart muscle of blood and oxygen, causing injury to the heart. Irreversible death of the heart muscle occurs within 20 to 40 minutes, and it continues to die in the next six to eight hours. The dead heart muscle is eventually replaced by scar tissue.

Risk factors of heart attack (myocardial infarction)

Risk factors out of your control (non-modifiable risk factors)

  • Age
    Age increases a person’s susceptibility to heart disease. 

  • Gender 
    Men are three to five times more likely to have coronary heart disease than women. However, the risk for women increases after menopause. 

  • Ethnicity
    A Singapore study shows that the likelihood of coronary heart disease is highest amongst Indians. Compared with the Chinese, Indians are three times, and Malays are two times more likely to suffer from coronary heart disease.

  • Hereditary 
    You are likely to be at a higher risk of having heart disease if your immediate family members have a history of premature heart disease. 

  • Menopause
    The risk of heart attack in women increases after menopause. The risk of coronary heart disease in women increases to almost the same rate as for men approximately five to ten years after menopause.

Risk factors within your control (modifiable risk factors)

  • Stop smoking 
    Smokers face two to three times the risk of non-smokers for sudden cardiac death. Almost 40% of patients below the age of 65 who die of heart disease are smokers. Smoking also leads to stroke, high blood pressure (aldso known as hypertension), blood vessel disease, cancer and lung disease.

  • Keep blood pressure in check 
    High blood pressure is one of the major risk factors for coronary heart disease and cerebrovascular diseases, such as stroke. Left untreated, hypertension can also cause heart failure or lead to the rupture of blood vessels in the brain. If you are above the age of 40, check your blood pressure at least once a year, even if you do not have a history of high blood pressure.

  • Manage cholesterol levels 
    The goal is to keep your total cholesterol level as low as possible because any excess cholesterol in the blood may be deposited in the arteries. This build-up causes the arteries to harden and narrow, thus reducing or preventing blood flow to the heart, leading to a heart attack.

  • Avoid or manage diabetes 
    People with diabetes (type 2 diabetes mellitus) are two to four times more likely to develop coronary artery disease and stroke. This chronic illness is often associated with other cardiovascular risk factors, such as high blood pressure, increased total cholesterol and triglyceride levels, decreased HDL (‘good’ cholesterol levels) and obesity.

  • Avoid obesity 
    People who have excess body fat – especially located around the waist – are more prone to developing heart disease and stroke even if they have no other risk factors.

  • Avoid sedentary a lifestyle 
    An inactive lifestyle is a risk factor for coronary heart disease. Engaging in moderate intesity physical activities regularly helps prevent heart and blood vessel disease, whereby exercise may lead to improvements in other cardiovascular risk factors, such as weight loss, lower blood pressure, decreased stress, and improved cholesterol levels. 

  • Manage stress better 
    Prolonged stress may contribute to a heart attack. Emotional stress and tension also cause the body to produce adrenaline. This makes the heart pump faster and harder, which may cause the blood vessels to narrow.

Ref: G25 (ed)

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