Heart attack
A heart attack feels like severe angina pain lasting more than 30-40 minutes and is often associated with sweating, nausea, faintness and a feeling of being unwell. It is caused by a total blockage developing in one of the coronary arteries. The greater danger at this stage is the occurrence of a serious change in heart rhythm when the heart fibrillates. Ventricular fibrillation is the cause of cardiac arrest or sudden cardiac death.
What doctors can do
• Paramedic ambulances provide coronary care facilities at home.
• Drugs. Aspirin to reduce the clot formation and thrombolytic drugs which can dissolve the clot causing the heart attack. Sometimes other drugs are used to control pain, blood pressure or rhythm disturbances.
• Investigations. ECG, heart monitors are used to detect any abnormal rhythms and an echocardiogram can review the degree of heart damage. When indicated, an angiogram is arranged and this may be followed by angioplasty and stent or bypass surgery.
What you can do
Act immediately – this is not the time to have doubts or think it is a false alarm.
• Take one or two puffs of GTN spray every 5 minutes, sit quietly and try to relax.
• If the angina pain lasts more than 20-30 minutes, call an ambulance.
• Chew one aspirin tables (300mg).
• Chew a magnesium tablet (800mg) if you have one.
The most important thing is to get to a place where your heart rhythm can be monitored and treated if necessary – this means in an ambulance or a coronary care unti.
Thrombolytic drugs can actually reverse the damage caused by a heart attack, so the earlier this treatment is given, the less damage there is to the heart. So get to hospital as fast as possible, preferably by ambulance. Do not drive yourself!
After the heart attack
Usually a patient spends 4-5 days in hospital and then goes home. Convalescence is usually about 4-6 weeks to allow the heart to completely heal. Once the heart is healed the most important thing is to prevent another heart attack.
What doctors can do
• Drugs. Most patients are put on aspirin, a statin durg, to lower the cholesterol; a beta blocker, to reduce the work of the heart, and sometimes an ACE inhibitor.
• Investigations. An exercise ECG and an echocardiogram are usually organized after a few weeks and, depending upon the results and symptoms, an angiogram may be performed.
What you can do
• Exercise – gradually increase physical activity; walking is the best. Don’t overdo it and slow down if the exercise causes breathlessness or chest pain. Always warm up before doing more strenuous activity.
• Have a good night’s sleep and if necessary have an afternoon nap for the first few weeks. Learn how to relax or even meditate, and reduce the stresses in life.
• Diet is important. Don’t eat huge meals and don’t’ exercise after eating. Eat lots of fruit, vegetables, grains and fish. Limit the red meat, and use mainly monounsaturated oils and avoid saturated and trans fats.
Nutritional supplements
Although there are few trails on the use of supplements after a heart attack, the powerful data on the preventive benefits of supplements still apply.
• A good multivitamin and multimineral provides the heart tissue with all the nutrition for efficient repair and also will lower the homocysteine which is a strong heart risk factor. In areas where the selenium levels of the soil are low add selenium, 150ug/day.
• Calcium and magnesium, 800-1,000mg daily, help the heart function, enabling it to relax. Magnesium can also lower blood pressure and reduce rhythm abnormalities.
• Omega 3 fish oils – at least 1 gram daily, preferably 2-3 grams daily – are very important in reducing recurrences and also reducing the risk of serious rhythm abnormalities.
• Coenzyme Q10 is very important at this stage. It is essential for energy production within the cells, and the heat muscle usually has a very rich supply of CoQ10. The statin drugs (Zocor, Lipex, Lipitor), used in nearly all heart patients to lower cholesterol, also block the production of CoQ10. Many people suspect this could increase the risk of developing heart failure later in life. All people taking statin drugs should also be taking Coenzyme Q10 supplements.
