Every year 10,000 Israelis have a heart attack – a frightening, shocking and of course also dangerous experience. Prof. Kobi Shaham, director of the cardiac intensive care unit at the Ichilov Hospital’s cardiology department, was a guest on the “Expert Clinic” podcast to explain what warning signs we must be aware of, and how heart attacks can be prevented.
And let’s start with the most important question – what does a heart attack feel like?
“When we experience a heart attack, it is caused by a sharp decrease in the blood supply in the coronary arteries that supply the blood and oxygen to the heart muscle. This is usually caused by a blood clot within atherosclerosis, which supplies the blood and oxygen to the heart,” Prof. Shaham explained, “as anywhere in the body, as soon as there is a decrease in blood and oxygen, we will feel a sharp pain, because the tissues experience a sudden lack of oxygen supply.”
The type of pain usually attributed to a heart attack is a pressing pain – a feeling of a load or a weight pressing in the center or left side of the chest, and this pain can radiate to the left hand. However, “we know today that there are different manifestations of the pain in different populations, and this classic manifestation does not have to be present in all populations,” explained Prof. Shaham.
For example, there is a significant difference in heart attack symptoms between men and women. “In men, they talk more about the classic occurrence of the pressing pain in the chest radiating to the left arm, in women the symptoms are less typical – pain in the upper abdomen, back pain, pain radiating to the jaws, a feeling of shortness of breath,” he said.
So when should you worry? According to Prof. Shaham, in any case a person experiences chest pain or unusual discomfort, which is not normally felt, and certainly, if it is accompanied by shortness of breath, sweating, nausea, or vomiting, and it does not go away – one should seek medical attention.
“As soon as the pain lasts for more than a few minutes and does not go away, we are talking about a time period of 5-10 minutes, if it lasts longer than that and does not go away or intensifies, you should seek medical attention as soon as possible.
In the event that a person experiences such an unusual or worrisome event, the recommendation is to call an ambulance first, since “people who experience a cardiac event, certainly a heart attack, are at increased risk of the appearance of fatal arrhythmias, which can lead to cardiac arrest, and only when the patient is taken to a hospital and connected to a monitor. Arrhythmia can be treated immediately by an electric shock, and avoid a situation where they deteriorate into a fatal arrhythmia.”
This recommendation is especially important since 50 percent of heart attack cases do not reach the hospital as it ends in fatal cardiac arrest.
Time is critical in the event of a heart attack for two separate reasons. “The more time passes that the heart does not receive oxygen – the greater the damage caused, and also the heart’s ability to recover from the damage caused, even when the best treatment is given by catheterization and drugs, decreases as we move away from the time when the event occurred,” explained Prof. Shaham.
“In addition, as more time passes and we do not treat, the risk of complications, such as the arrhythmia that causes ventricular fibrillation and cardiac arrest, also increases.”
“As more time passes and we do not treat, the risk of complications, such as the arrhythmia that causes ventricular fibrillation and cardiac arrest, also increases.”
Prof. Kobi Shaham
A heart attack comes as a complete surprise
Although most of us try to be connected to our health, heart-related health problems catch us off guard. “A lot of times it’s a surprise, the bulk of the patients who come to me didn’t think they’d find themselves in the hospital a few hours before,” Prof. Shaham said, adding that almost all people are caught by surprise, except for those with known heart disease who arrive earlier because they know how to recognize the symptoms.
The best treatment, Prof. Shaham explained, is prevention. “Know what the risk factors are, which significantly increase the risk of heart attacks,” with several of these factors being treatable.
A significant risk factor, for example, is excess lipids in the blood, which can be detected in a routine blood test. If this happens, it is important to treat it, usually by changing your diet or losing weight, and medication is often necessary as well. High blood pressure is also a significant risk factor. “Blood pressure, which we call the silent killer, is something that many times we don’t feel, and it builds up over years and may significantly increase the chance of a heart attack.”
Therefore, once a year it is very important to do a blood lipid test and at every visit to the doctor – a blood pressure measurement. From the age of 40, it is important to check fasting sugar once a year.
In addition, to protect the heart it is important to maintain a “healthy diet, stop smoking and regular and controlled physical activity – this does not have to be running, just walking for 30-40 minutes, 3-4 times a week,” Prof. Shaham said.
It is important to note, however, that even those who do sports and maintain a healthy diet may suffer a heart attack, since “heredity is an influential factor”, explained Prof. Shaham.
“This is one of the most important risk factors, those who have a first-degree family member – father, mother, brother – who had heart disease at a young age, this is perhaps one of the most significant risk factors for the appearance of a heart attack,” he said.
For these people, maintaining a healthy diet and exercise may not completely prevent a heart attack, but it will certainly delay it for several years and make the narrowing of the arteries less severe.
In conclusion, we will return to the question with which we opened. Heart attacks can have different symptoms, and in any case of an abnormal feeling, it is important to get tested.
“Some people arrive after a few days and we recognized late that they had a heart attack a few days ago,” said Prof. Shaham. “In general, anything that is unusual and different from what we know or pain that we have experienced in the past – we should not ignore it,” he said.
“As mature people, on the one hand, we know what pains we experienced during the flu, a toothache, or an upset stomach, but on the other hand, people have the desire to repress the situation and think. ‘It isn’t happening to me’ or ‘maybe it will go away.’ We sometimes see people who come many hours after the pain has appeared in the hope that it will go away,” he said, adding that there are many tragedies because of this desire to repress.
“Don’t wait, if you feel something unusual – come immediately for a medical examination.”
