Acute myocardial infarction, commonly known as heart attack, occurs when the heart is starved of oxygen because blood flow through one or more of the coronary arteries — a group of vessels that surround and supply the heart — is blocked. The lack of oxygen causes chest pain and results in irreversible damage, eventually leading to the death of heart muscle (called myocardium).
The most common cause of heart attack is coronary artery disease. The causes often are poor diet and physical inactivity, or medical conditions such as high blood cholesterol, high blood pressure, and diabetes.

Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack may be the first sign of an underlying disease.
Symptoms of a heart attack:
Pain or discomfort in the centre of the chest, and/or pain or discomfort in the arms, the left shoulder, elbows, jaw, or back.
In addition, the person may experience difficulty in breathing or shortness of breath; nausea or vomiting; light-headedness or faintness; a cold sweat; and turning pale. Women are more likely than men to have shortness of breath, nausea, vomiting, and back or jaw pain.
The most common symptom of a heart attack is sudden weakness in the face, arm, or leg, most often on one side of the body. Other symptoms include sudden onset of numbness in the face, arm, or leg, especially on one side of the body; confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness and/or loss of balance or coordination; severe headache with no known cause; and/or fainting or unconsciousness.
People experiencing these symptoms should seek medical care immediately.

Who is at risk?
The most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. The effects may show up as raised blood pressure, raised blood glucose, raised blood lipids, and obesity. These “intermediate risks factors” can be measured in primary care facilities and indicate an increased risk of heart attack, stroke, heart failure and other complications.
Cessation of tobacco use, reduction of salt in the diet, eating more fruit and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease. Health policies that create conducive environments for making healthy choices affordable and available are essential for motivating people to adopt and sustain healthy behaviours.

How to prevent it?
Give up smoking: A year after giving up, your risk of a heart attack falls to about half that of a smoker.
Get active: Do 50 minutes of moderate-intensity aerobic activity every week, like running, swimming or even dancing.
Manage your weight: Stick to a healthy, balanced diet low in fat and sugar, with plenty of fruit and vegetables.
Eat more fibre: Aim for at least 30g a day. High fibre foods include wholemeal bread, bran, oats, wholegrain cereals, potatoes with skins on, and fruits and vegetables.
Cut down on saturated fat: Eating foods high in saturated fat can increase the level of cholesterol in your blood, increasing your risk of heart disease.
Cut down on salt: Avoiding foods high in salt maintains healthy blood pressure.
Eat fish: Eat fish at least twice a week, including a portion of oily fish. Fish such as mackerel, sardines, fresh tuna and salmon are a source of omega-3 fats, which can help protect against heart disease.
Drink less alcohol: Although it may not feel like it, alcohol still contains calories. Try to keep to the recommended daily alcohol limits to reduce the risk of health problems.
Read the food label: When shopping, pay attention to the food labels for things like fat, salt and sugar content.

How to treat it?
If the patient is conscious, it is essential that they are moved to a comfortable position. Then loosen any tight clothings and ask them if they are a heart patient and are carrying Nitroglycerine tablets. These can be administered sublingually. However, they should not be given without medical supervision if there is no history of prior use.
Aspirin tablets should be chewed immediately.
If the person is unconscious, commence CPR if you are trained in the same. If there is AED [automatic defibrillator] available nearby, follow the instructions of device.
While performing CPR, push hard and fast on the person’s chest — about 100 compressions a minute. If you are trained in CPR, check the person’s airway and deliver rescue breaths after every 30 compressions.
Do not wait for an ambulance but instead try and take the patient to the nearest hospital with a cath lab and cardiology services as early as possible. Also, it’s prudent to inform the hospital about your arrival, in which case most hospitals have a system in place to directly transfer the patient to cath lab for immediate stenting.

The writer is an intern student at Adesh Institute of Medical Sciences, Bathinda, Punjab.

Danish Amin Mir