It was a scene almost like what you see in the popular television drama series "ER"; where I was rushed into the A&E room by the ambulance. I caught a glimpse of myself through the glass panels lining the corridors, I looked pale but what really made me worried was this apprehensive feeling of what is yet to come and I remember distinctly having a very real fear that this was it for me, that I would die.

I remember a terrible tightness and I was holding on to my chest with both hands, accompanied by cold perspiration, unable to speak from shortness of breath. I felt terribly nauseous and vomited several times. The attending nurse was meanwhile administering oxygen and I could feel the needle as I was given an injection of morphine.

Now looking back and a warning to you the reader, this dramatic scenario may not always be presented where a heart attack is concerned. Pain is the cardinal symptom in most instances of heart attack, where it occurs in the middle of the chest behind the breast bone. Pain can also occur anywhere in the chest or trigger off at any particular part of the chest and spread to the left shoulder, jaw, neck or left arm. Some people experience a tingling sensation in the chest while others describe it as a ton of weight pressing on their chest - like what I felt in my case. Then there are others who would call it a sharp 'cutting' pain and there are also those patients who mistakenly think they are suffering gastric pain except that the pain spreads upwards into the chest.

All these varied presentations of heart attack therefore tend to mislead the patient. If a person is suspected of having a heart attack, it is best to call immediately for an ambulance, or better still; if a loved one is nearby, get them to take you straight to the nearest acute care hospital - it is crucial that you are brought to a hospital as soon as possible. I am thankful when I was incapacitated, that my friend had the presence of mind to arrange for the ambulance to send me to a hospital that had full facilities to treat heart attacks - another crucial factor. The chances of survival from a heart attack steadily diminish the longer you are kept away from adequate treatment.

Early warning symptoms and signs of a heart attack may be overlooked - like what happened to me. I had been on drugs intermittently for my blood pressure and the weeks prior to my encounter were possibly one of the more stressful periods of my life. Individuals who smoke, suffer from high blood pressure, diabetes, and high cholesterol or those persons who live with stress that they cannot cope with are particularly at risk. Obese individuals are also known to be more likely to suffer a heart attack

There are genetic factors too, like a family history of coronary artery disease or having traits common to certain racial groups like Indians for example and being male - the male population has been observed to get more heart attacks than the females. These are all known to be contributing factors.

Once we arrived at the hospital, I was wheeled into the cardiac suite and attended to by the resident doctor and a few nurses and given oxygen, pain killers as well as medication and sedatives - I was told, to help calm me. The cardiologist who was on duty arrived soon after and he was quick to administer clot-dissolving medication intravenously. By that time I was quite drowsy and I didn't even think of batting an eyelid when I saw the big intravenous needle.

Fortunately, the hospital that I was brought to had a full facility cardiac suite and it was in this intensive ward area that an emergency angiogram (special X-ray of heart and blood vessels, after injecting dye) was performed on me. Sure enough, the angiogram revealed the site of the clot and before I knew it, I was wheeled into the operating theatre where I was greeted by the anesthesiologist. It was only later, when I awoke from my unconscious state that I was told that a coronary artery bypass graft (CABG) had been performed on me - I had had an angioplasty performed two months earlier and my arteries had narrowed again. The significance of the operation and its ensuing events did not quite sink in as I recall only feeling a great sense of relief. I was relieved that I was looking at my wife who had been permitted to come into the intensive care ward to visit me.

WHAT HAPPENS TO THE HEART DURING A HEART ATTACK
The heart is composed of the heart muscle (myocardium) which contains four chambers and is actually a pump. The heart has its own blood supply via the coronary arteries which lie over the myocardium.

In a healthy person during exercise, the increased need for blood to the heart is brought by the coronary arteries which enlarge to bring in extra supply. When the coronary arteries are blocked by gradual deposition of fat (cholesterol), the arteries narrow and decrease blood supply to the heart muscles, causing pain on exertion. This is called angina and coronary artery disease (CAD) has set in.

The complete blockage of coronary artery usually due to blood clot, causes reduced blood supply and oxygen to the heart muscles and if the supply is not restored in about six hours, myocardial infarction (heart attack) occurs with death of the heart muscle as a result.

The blockage of the artery takes years but the clot formation may be sudden. Chest pain which is transient, often caused by physical or emotional stress, is due to increased work load or heat. Such pain will disappear with some rest or by taking certain medication to dilate the coronary arteries. This is a case of Angina Pectoris.

Any pain in the chest that is persistent even with medication must be considered a heart attack and immediate medical attention sought at a hospital. Much time can be wasted if the patient waits for a house call from his family doctor as time in such situations can be crucial, considering that about half the deaths from heart attack occur in the first few hours.

WARNING SIGNS OF A HEART ATTACK
Chest pain or pressure is a common symptom of a heart attack. Cardiac chest pain is often vague or dull and may be described as a pressure or band-like sensation, squeezing, heaviness or other discomfort.

Heart attacks frequently occur from early to late morning due to higher adrenalin levels released from the adrenal glands during the morning hours.

Increased adrenaline in the bloodstream can contribute to the abovementioned plaque rupture.

Approximately one quarter of all heart attacks are silent, without chest pain. In diabetics, the incidence of “silent” heart attacks may be much higher.

Heart attack victims may complain of:
* Chest pressure
* Sweating
* Jaw pain
* Heartburn and / or indigestion
* Arm pain (more commonly the left arm, but may be either)
* Upper back pain
* General malaise (vague feeling of illness)
* Nausea
* Shortness of breath

Early heart attack deaths can be avoided if a bystander starts CPR (cardiopulmonary resuscitation) within five minutes of the onset of ventricular fibrillation (a type of arrhythmia). CPR involves breathing for the victim and applying external chest compression to make the heart pump. When paramedics arrive, medications and/or electrical shock (cardioversion) to the heart can be administered to convert ventricular fibrillation to a normal heart rhythm. Therefore, prompt CPR and rapid paramedic response can improve the survival chances from a heart attack.

(This article first appeared in Parkway Medicine, April 2002)