Before listing the warning signals, let’s understand the difference between certain common terms, which are often used interchangeably but actually refer to different conditions and stages of malfunction of the heart. Dr Rajeev Menon, clinical director of the department of cardiology, AIG Hospitals, Hyderabad, explains these terms.
Dr Rajeev Menon. (By Arrangement)
“A commonly used term is angina ischemia, which is reduced blood supply to the heart due to narrowing of the blood vessels/arteries from fat deposition. At this stage, the heart muscle has not yet been damaged. It may get converted to a heart attack if there is sudden rupture of the cholesterol plaque, due to which the fat comes into the blood, which gets clotted, stopping blood supply to the heart from that vessel. In case of a heart attack, the patient must be brought to the hospital at the earliest, as a heart attack can lead to a cardiac arrest.
A cardiac arrest causes the patient to collapse. Their survival depends on the bystanders. They must immediately start cardiac massage or CPR (cardio-pulmonary resuscitation) after calling an ambulance, or else the patient may die.
Heart failure is a clinical diagnosis when the patient has symptoms such as swelling of feet, palpitations, breathlessness on exertion, cough while lying down, and distention of the abdomen. It means the heart muscle has become extremely weak and can’t contract the way it should.
Confusion in recognizing symptoms
Contrary to the usual belief, popularized by movies, chest pain does not always originate on the upper left side of the heart, nor is it always felt there.
Retrosternal chest pain (pain that develops behind the breast bone) is often mistaken as acid reflux because the symptoms are similar to gastric issues — chest discomfort, heaviness, burning sensation or heartburn. The patient usually takes antacids to ease the pain and discomfort. In such a scenario, whenever in doubt, treat it as cardiac pain rather than gastric pain and get tests and medical evaluation done.
Another challenge is silent ischemia for diabetic patients. Since the nerve endings in the heart of such patients are commonly damaged, they do not feel pain as non-diabetics do. So, they may be unaware of having suffered a heart attack. It can only be detected through an ECG or Echo-Cardiogram.
The third challenge is referred pain, which means the pain may not occur in the place of origin (the heart) but is felt in multiple other locations. The brain is not habituated to heart pain and therefore mistakes it, referring it to another site — behind the breast bone or centre of the chest, epigastrium (upper abdomen just above the stomach), left shoulder, neck, hands, back, jaw and teeth.
