The phone call was put through to me at work. It was a footballing mate and patient.

“Crimmo, I’ve had this tight chest pain and I just feel crook. It’s probably only indigestion so I might just go home and have a lie down.”

No!!! Those words suddenly filled me with fear and dread. I bet similar words have been said or thought by many a bloke before, who then took that opportunity to lie down … except it was a very, very long lie down… and they never got up again!

Fortunately he was at work in the city, quite close to a big public hospital, and the urgency in my voice convinced him to get straight to casualty. Chest pain in blokes should never be passed off as trivial until fully medically assessed. If you can’t get to a doctor or a hospital straight away, then call the ambulance. Our wonderful ambos would much prefer to turn up to a false alarm rather than too late for a cardiac arrest. Time is of the essence.

What is a heart attack?
Heart disease is the biggest killer of men, and women for that matter. A heart attack occurs when the blood supply to the heart is suddenly interrupted. The heart itself is basically a glorified pump made up of muscle which pumps blood and oxygen out to all the vital organs that sustain our life – the brain, the kidneys, the liver, everything. It also collects all the used up blood minus its oxygen and pumps it to the lungs to get a fill-up of oxygen to be re-pumped out again to the rest of the body.

In order to do this, it requires its own blood supply and it gets this from two little (and I stress little) arteries that break off the main outflow artery, the Aorta, just after it leaves the heart. These important arteries, the Right and Left Coronary Arteries, snake back into the heart muscle to supply nourishment, particularly oxygen. It is these arteries or their tributaries that block up and cause a heart attack. If the heart muscle doesn’t get blood and oxygen, it dies and, depending on the area affected, the heart will stop pumping. The heart has its own electrical supply and power generators and if they are involved, it will be like flicking a light switch off. The heart will just stop.

What causes heart attacks?
The main problem is blockage of those small coronary arteries by a substance doctors call plaque. A big part of that plaque formation is the blood fat, cholesterol. But it is not the only risk factor. I reckon smoking is the most important risk factor as it causes damage to the delicate lining of the arteries and allows the cholesterol to get in to form the plaque.

Other risk factors include being male and having a strong family history of heart disease – both of which are both a bit difficult to change. But then there are the other modifiable risk factors such as being overweight, having high blood pressure or a high cholesterol level, being sedentary, eating a high animal fat based diet or developing diabetes. A new risk factor or marker of potential heart disease is erectile dysfunction. The arteries going to the penis are a bit smaller than the ones going to your heart so any plaque formation that can affect your coronary arteries will affect these a bit earlier and hence may be a warning of impending or silent heart disease. A bit like the canary in the mines but this time the budgie in the smugglers!

The blockage from the plaque occurs gradually over many years but often the final straw that breaks the camel’s back is that a blood clot forms on top of the plaque, completely blocking the artery. That is why one of the preventing measures recommended is for people prone to heart disease to take a daily dose of 100mg of aspirin to keep the blood thinner.

What are the symptoms?
Classically, heart pain is felt in the middle of the chest and may be felt in, or radiates to, the left arm or up into the jaw. It may even only be felt in the arm or jaw without any chest component. It is sometimes felt between the shoulder blades. The pain may be described as crushing, pressure or tightness. Breathing may be limited. There may be associated sweating and nausea and I have had some patients present with just this and no chest pain.

What to do?
You must seek medical assistance straight away as time is of the essence and that may mean calling the ambulance on 000. The damage to the heart muscle can be limited by the wonderful medical interventions that are now available in our hospitals. There are drugs which can thin the blood straight away and stents can be inserted to unblock the artery and re-establish blood flow and hence oxygen to the damaged area of heart muscle to aid repair. There is evidence that it is a good idea to take a soluble Aspirin straight away if you have access to it. The enteric coated Aspirins aren’t as good as the soluble or dissolvable varieties such as Disprin as the absorption is delayed to protect the stomach but that doesn’t matter in an emergency.

How can it be prevented?
Basically, by having a healthy lifestyle and getting regular check-ups. Don’t smoke or get assistance to quit. Avoid or learn to deal with stress as much as possible. Exercise and diet are extremely important.

Exercise: Exercise is important because it is both therapeutic and diagnostic. By therapeutic I mean that it is good for your heart in a lot of ways. It has been shown to directly increase the levels of HDL or good cholesterol in the blood which protects against heart disease. It helps to keep your blood pressure lower. It will assist to keep your weight down and lessen the likelihood of you developing diabetes in which heart disease is accelerated. Getting fit reduces your heart rate saving you many, many heart beats over your life time. By being diagnostic, I mean it will probably draw attention to possible heart disease at an earlier stage where simpler procedures such as stents will be possible rather than the more dangerous and involved procedures such as by-pass surgery.

If you don’t exercise, it is a bit like leaving your car in the garage. All sorts of things can be going wrong with it but you won’t know unless you take it out on the road.
Some useful exercise tips include:
– Less use of the car – walk or ride a bike ride to destinations.
– Get off public transport a stop or two early.
– Use of stairs rather than lifts or walk up escalators.
– Get rid of the remote control.
– Get the furthest car park space.

Diet: In order to prevent plaque developing in the arteries it is preferable to have less circulating cholesterol in your system as well as good levels of anti-oxidants that will prevent damage to the lining of the arteries. Thus you need to:
1. Reduce the intake of saturated fats. Saturated fat is a chemical term which roughly equates with fats that are found in animals – either the animal itself in the form of meat or what the animal excretes, such as dairy products or eggs. These fats are more likely to be damaging to your arteries as they can easily be oxidised, damaged and end up in your artery walls. In practice, to reduce your saturated fat intake you would have to:-
– Consume less meat overall but when you do choose leaner meat;
– Use low or non-fat dairy products (dairy products do not need to be excluded!);
– Consume chicken without the skin;
– Consume less fried, battered and crumbed food;
– Consume less fast or take-away foods;
– Use margarine (sparingly) instead of butter preferably;
– Grill, bake or microwave rather than fry food.

2. Reduce dietary cholesterol:
– Use low fat dairy products;
– Shellfish and organ meats are sources so be aware of this.

3. Be aware of the presence of trans-fatty acids (these are a form of damaging fats):
– Eat less meat if possible;
– Be aware of hidden fats in biscuits, cakes and pastries which may also contain trans-fatty acids.

4. Increase the intake of fish:
– Fish oil capsules may be an alternative.

5. Eat nuts high in omega 3 fatty acids such as almonds and walnuts.

6. Eat more fruit and vegetables.

7. Consume beans and lentils.

8. Eat cereals and grain foods such as bread (beware the volume because of weight issues) and include a source of soluble fibre such as oat bran.

9. Reduce your salt intake:
– Excessive salt intake is associated with high blood pressure or hypertension which may accelerate blockages of the coronary arteries and increase the risk of stroke.

10. Drink alcohol in moderation:
– No more than two to three drinks per day and have at least two to three alcohol free days (AFD’s) per week.

You’ll be happy to know that my mate and patient survived and didn’t have a heart attack but it was a salient reminder to take more heed of his body, look after it and get a regular check-up. I hope you all do the same.

Stay happy and healthy,
Dr Bernie Crimmins