Heart Attack

A heart attack, medically known as myocardial infarction, occurs when blood flow to the heart is limited. This is often caused by a build-up of fatty deposits (atherosclerosis). Even a partial blockage can lead to heart muscle damage and potentially life-threatening complications.

Heart Attacks in Singapore

Cardiovascular diseases account for 31.4% of all deaths in Singapore, making them a major health concern in the country. The Singapore Myocardial Infarction Registry Report in 2020 recorded 11,631 cases of heart attacks (averaging 31 cases per day), and 9.2% of those died within 30 days.

What Is a Silent Heart Attack?

A silent heart attack may occur without the typical symptoms associated with a heart attack, such as chest pain or pressure. Instead, it may present itself with subtle signs that could be mistaken for a less severe condition, such as heartburn, indigestion, or a strained chest muscle. In some cases, an individual may not be aware of having a heart attack until they receive a diagnosis weeks or months later.

Signs and Symptoms of a Heart Attack

Heart attack symptoms vary, ranging from mild to severe pain. Some occur suddenly, while others have warning signs days or weeks in advance. The following are common signs and symptoms of a heart attack:

Chest pain and discomfort
Pain that radiates to the arms, back, jaw, neck, or stomach
Shortness of breath
Cold sweat, nausea, dizziness, or light-headedness

Additionally, there are some atypical symptoms that women are more likely to experience, including:

Heartburn or indigestion
Extreme fatigue
Pressure in the upper back
Heart ‘flutters’

If you think you might be having a heart attack, call 995 immediately. Early treatment can significantly improve your chances of a full recovery. Even if you are not sure, it is always better to be safe and seek medical attention.

Causes of Heart Attack

The most common cause of a heart attack is the presence of a complete or partial blockage in one or more of the coronary arteries due to the build-up of fatty plaques in the arteries. If the plaques rupture, the resulting blood clots may block blood supply in the heart and may trigger a heart attack.

Other causes of heart attacks include:

Coronary Artery Spasm – This refers to the temporary tightening or contraction of the coronary arteries, which can restrict blood flow and cause a heart attack.
Spontaneous Coronary Artery Dissection – This occurs when a tear forms inside the coronary arteries, allowing blood to become trapped between the layers of the artery wall and causing it to protrude inward.
Anomalous Coronary Arteries – These are congenital defects in which the coronary arteries are positioned abnormally, leading to problems with blood circulation in the heart.
Takotsubo or Stress Cardiomyopathy – This condition is typically triggered by intense emotional or physical stress, which can result in rapid and reversive heart muscle weakness.
Coronary Artery Embolism – This happens when a blood clot or air bubble travels through the bloodstream and blocks one of the coronary arteries.
Electrolyte Imbalance – Severe electrolyte imbalances, particularly in potassium or magnesium levels, can disrupt the heart's electrical activity and lead to a heart attack.
Rare Medical Conditions – Certain rare medical conditions, such as blood clotting disorders or vascular conditions, may cause unusual narrowing and increase the risk of a heart attack.

Risk Factors for Heart Attack

Several factors can increase an individual's chances of developing a heart attack; some are preventable (modifiable), while others are beyond control (non-modifiable). Common risk factors include:

Age and Gender – The risk of heart attacks increases with age, for men after the age of 45 and for women after the age of 55 or after reaching menopause.
Family History – If a close relative, such as a parent or sibling, had a heart attack, particularly at a young age, it is more likely that an individual can develop one too.
Lifestyle – Lifestyle choices, such as smoking, alcohol consumption, lack of physical activity, and a high-fat diet, can increase the risk of having a heart attack.
Certain Health Conditions – Some health conditions can strain the heart and lead to heart attacks. These conditions include diabetes, obesity, high blood pressure (hypertension), high cholesterol or triglycerides, and a history of preeclampsia.

Complications of a Heart Attack

A heart attack can lead to several complications, some of which can be life-threatening. These include:

Heart Failure – This condition occurs when the heart is unable to pump enough blood, which can lead to sudden death.
Cardiogenic Shock – This is a more severe form of heart failure that requires prompt treatment.
Arrhythmias – These are irregular heartbeats that affect the flow of blood and oxygen to the heart.
Angina – This refers to the continued narrowing of coronary arteries after a heart attack, which can cause ongoing chest pain.
Heart Rupture – This occurs when the areas of the heart muscle that have been weakened by a heart attack rupture and cause heart failure or cardiogenic shock.

Diagnosing a Heart Attack

The diagnosis of a heart attack is based on your symptoms, medical history, physical examination, and diagnostic tests. These may include:

Electrocardiogram (ECG or EKG) – This test records the electrical activity of your heart to identify if an area of your heart has been damaged.
Imaging Tests – These might include coronary angiography, an X-ray imaging of the arteries to help identify blockages, and other imaging tests like an echocardiogram or an MRI to visualise the heart and assess damage.
Blood Tests – Heart proteins slowly leak into your blood after heart damage. A blood test can detect these substances and help diagnose a heart attack.

Treatment for Heart Attack

Heart attack treatment focuses on immediate action to restore blood flow, minimise damage, and manage symptoms. This may involve a combination of:

Heart Surgery

Coronary Artery Bypass Grafting (CABG), also known as heart bypass surgery, is a surgical procedure that improves blood flow to the heart muscle through grafting. This procedure attaches a healthy blood vessel from another part of the body to a blocked coronary artery. It creates a bypass around the blockage, allowing oxygen-rich blood to reach the heart muscle more effectively.

Balloon Angioplasty

Coronary angioplasty is a minimally invasive procedure that improves blood flow to the heart by widening narrowed or blocked coronary arteries. During the procedure, a thin catheter with a deflated balloon at its tip is inserted into a blood vessel and guided to the blockage. The balloon is inflated, compressing plaque buildup, and widening the artery. In most cases, a metal stent is deployed simultaneously to provide lasting support, preventing the artery from re-narrowing and maintaining normal blood flow.

A balloon angioplasty procedure is usually performed under local anaesthesia and may last anywhere from 30 minutes to two hours. Patients can be discharged the following day if no complications occur.

Medication

Clot-dissolving medications: Dissolve blood clots blocking the artery.
Anti-clotting medications: Prevent future clot formation.
Anti-arrhythmic medications: Restore normal heart rhythm.
Pain medications: Provide pain relief and reduce heart workload.

Additionally, adopting a healthy lifestyle through diet, exercise, and stress management is crucial for long-term heart health.

Recovery and Rehabilitation After a Heart Attack

Recovering from a heart attack involves both physical and emotional healing. The process can be challenging, but support can help you get back on track.

Physical and emotional recovery includes managing physical symptoms, improving strength and endurance, and dealing with emotions such as fear and depression.
Cardiac rehabilitation programmes offer education, counselling, and exercise training to help patients recover and reduce the risk of future heart problems.

Remember, recovery is a personal journey with varying timeframes and experiences. Celebrate your individual achievements and set realistic goals based on your specific circumstances.

Heart Attack Prevention Measures

To reduce the risk of future heart problems, lifestyle changes and following medical advice are crucial. These include:

Regular health checkups and follow-ups to help detect and manage heart disease early.
Quit smoking and adopt a healthy lifestyle by exercising regularly and maintaining a healthy weight through a balanced diet.
Manage existing health conditions like diabetes, high blood pressure, and high cholesterol.
Practice stress management with techniques like yoga and meditation.
Monitor risk factors like blood pressure, blood sugar, and cholesterol.
Take medications as prescribed by your doctor.

FAQs on Heart Attack

The extent of permanent damage to the heart muscle following a heart attack depends on the size of the area a blocked artery supplies, the site of the blockage, and the duration between the onset of the attack and medical intervention.

Mild heart attack symptoms may persist for only two to five minutes and then subside with rest. However, a severe heart attack involving complete blockage can last for more than 20 minutes to a few hours and require medical attention.

Recovery varies depending on the severity of the attack and the treatment used. Typically, patients can resume regular activities within a few weeks to two or three months after treatment. The doctor will recommend a cardiac rehabilitation programme to minimise the risk of a future attack.

If you suspect someone is having a heart attack,call the ambulance immediately. Inform the emergency responders of the patient's symptoms and how they began, so they can provide instructions while help is on the way.

In some cases, a heart attack can reduce the heart’s ability to pump oxygenated blood to organs and tissues in the body, including the brain. Without enough oxygen and other nutrients, the brain tissue may get damaged among some patients, which can affect memory.