Heart Attack

Heart attack, or myocardial infarction, happens when a part of the heart muscle does not get enough blood due to a blocked artery caused by atherosclerosis. Part of the heart muscle dies in the process due to oxygen deprivation, giving rise to crushing chest pain.

According to the Singapore Myocardial Infarction Registry Report 2020, there were 11,631 heart attack cases(vs 7,344 in 2010), averaging 31 a day. Among them, 9.2% died within 30 days. The median age of a heart attack patient is 69.9 years old. The incidence rate of heart attack is higher for males, but the fatality rate due to heart attack is higher for females as females tend to be older when a heart attack occurs.

A heart attack is not the same as cardiac arrest, and the terms should not be used interchangeably.
According to the Singapore Myocardial Infarction Registry, chest pain and shortness of breath are the top two symptoms of heart attack that most patients encounter.

Symptoms

• Chest pain

  Continuous chest pain of at least 20 minutes is a typical symptom of a heart attack. Symptoms would be deemed atypical if the chest pain was of short duration and/or intermittent with each bout lasting less than 20 minutes.

  While chest pain is the most common symptom of a heart attack, this life-threatening event may present itself in diverse ways among different patients. For instance, in diabetic patients, heart attacks are generally silent without any accompanying chest pain.

• Shortness of breath

• Sweat

• Pain in the upper abdomen, back, shoulder, jaw

• Palpitations

• Giddiness

• A choking sensation

• Heartburn/indigestion

• Nausea

Caregivers and family members of cardiac patients should also be alert to a sudden and complete loss of responsiveness on the patient’s part as well as a cessation of signs of circulation, as these may likewise be warning signs of a heart attack.

Causes

The following factors may increase your risk.

• Age and sex
  • Man over 45 years old.
  • Woman over 50 years old, passed menopause or had ovaries removed.
• Family history
  • Your father or brother had a heart attack before age 55, or your mother or sister had one before age 65.
  • You have a close blood relative who had a heart attack.
• High blood pressure
  • Your blood pressure is 140/90 mmHg or higher, or you have been told that your blood pressure is too high.
  • The proportion of heart attack patients with hypertension rose from 71.9% in 2010 to 75.2% in 2020.
• High cholesterol
  • Your total cholesterol level is 200 mg/dl or higher.
  • Your HDL (“good”) cholesterol level is less than 40 mg/dl, or LDL (“bad”) cholesterol is more than or equal to 130 mg/dl.
  • The proportion of heart attack patients with high blood cholesterol rose from 67.6% in 2010 to 73.3% in 2020.
• Diabetes
  • Your fasting blood sugar level is 126mg/dl or higher, or you need medicine to control your blood sugar.
  • 51.5% of heart attack patients are diabetic.
• Physically inactive
  • You get less than a total of 30 minutes of physical activity on most days of the week.
• Overweight or obese
  • You are overweight by 9kg or more.
  • 60.1% of heart attack patients had moderate-to-high risk BMI.
• Smoke
  • You smoke or live or work with people who smoke every day.
• Excessive drinking
  • You take more than 2 drinks of alcohol almost every day.
• Medical history
  
  You have
  • Coronary heart disease
  • Atrial fibrillation
  • Carotid artery disease
  • Transient Ischaemic Attack
  • Disease of leg arteries
  • A high red blood cell count
  • Sickle cell anaemia
  • Previous episode of heart attack

What to do

Call 995 immediately!

Even if you are not sure if it is a heart attack, call 995. Every minute matters. It is best to call for medical help right away. Paramedics on emergency medical services can begin treatment as soon as they arrive.

Treatment

• Prevention of further clot formation with medication such as aspirin or other antiplatelet agents
• Pain relief with medication
• Re-opening of the blocked artery as soon as possible by either:
  • Infusion of drugs to dissolve the clot known as a fibrinolytic agent
  • Coronary angioplasty, which involves using a balloon to open the blocked artery
• Further investigations to look for complications of the heart and to assess and reduce the risk of another heart attack
• Long term medication and cardiac rehabilitation to control risk factors and prevent a recurrence

Prevention

Start by becoming aware of your risk factors, the personal characteristics and habits that may increase your chances of having a heart attack or stroke. Some you cannot change or control; some you can, by making a few changes in your habits or taking medicines as prescribed.

Take your first step to prevent heart disease!