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According to GUS data published before the coronavirus pandemic, the number of deaths caused by heart attacks in Poland is systematically decreasing. Over the past 20 years, it has decreased by 40 thousand. – up to 12 thousand annually. Despite this, heart attacks still affect us by 30 to 50 percent. more often than residents of other European Union countries, because we are not effective in combating risk factors. Meanwhile, a heart attack is a disease where time counts. Therefore, although the symptoms may confuse us, we must not delay the call to the emergency room.
- WHO research indicates that the health of the population is influenced by major lifestyle choices – and so is the case with a heart attack
- Dr. Michał Malinowski: – Symptoms of a heart attack can be so varied that it is difficult for a doctor to recognize it even sometimes
- 30 percent heart attacks are asymptomatic and painless – says Dr. Malinowski
- In the event of a heart attack, the time from the moment the patient passes the hospital door to the opening of the artery should not exceed one hour.
- You can find more such stories on the TvoiLokony home page
Monika Zieleniewska, MedTvoiLokony: Not so long ago more Poles died of heart attacks than of cancer. Now the situation has changed.
Dr. Michał Malinowski: This is because we treat heart attacks better and better. This is due to the interventional cardiology procedures performed in our company at the European level.
Specialists say that the risk of a heart attack depends on over 90 percent. on our way of life. What are the risk factors for this disease?
We started talking about risk factors in the 50s. The first major study was the Framingam study. Later, more appeared, and now we know that there are several hundred of these factors. They include those that we have influence on and non-modifiable factors, such as age or gender, because male gender is a risk factor. And genes, of course. If your parents had a heart attack, your grandparents suffered from heart disease, or died of some kind of heart disease, the likelihood that we too will develop coronary or cardiovascular disease increases.
Risk factors are common to heart attacks and other cardiovascular diseases, such as strokes and acute ischemia of the lower limbs – the equivalent of a heart attack, but in the legs. It can be assumed with high probability that if someone has atherosclerosis of the coronary arteries, he also has atherosclerosis in the legs, in the carotid arteries … It is a systemic disease.
The risk factors that we can influence are the so-called civilization factors, i.e.?
Let us remember that we have not changed since the times of primitive man. We are adapted to the lifestyle of the primitive man, and he dealt mainly with gathering, hunting from time to time. His diet consisted of lean meat, vegetables and fruit, and periods of fullness alternated with periods of hunger.
Later, the lifestyle of man changed radically. First, we don’t walk or run. We lead a sedentary lifestyle – we sit at home, in the car and at work. We’re out of traffic. Our diet has changed too. From time to time, lean meat has been replaced with farmed meat, which is full of various types of hormonal substances and antibiotics. We eat too little raw vegetables and fruits, and too many highly processed products. We also have an oversupply of salt in our diet. The amount of sodium chloride needed by the primitive man was contained in what he ate, and we, especially in Poland, like to add salt to the dishes.
How does salt harm us?
Blood pressure rises from excess salt in the diet, and the consumption of highly processed products can cause type 2 diabetes. Additionally, our diet is characterized by an excessive supply of energy, so we store it in adipose tissue, which in turn causes obesity – another risk factor.
We are also very stressed.
We certainly have more stress than the primitive man and we do not relieve them because we do not move. Our ways of relieving stress are mainly smoking and drinking too much alcohol. Depression has also been proven to be a risk factor for death in the event of a heart attack.
However, we live much longer than our ancestors.
Nature did not anticipate this. Primitive man, if he lived to be 40 years old, was already an old man. The modern 40-year-old is young. We live longer, and the compensatory mechanisms that work at a young age fail in old age. This further increases the potential for cardiovascular disease. There is a saying – a person is as old as his blood vessels.
Can you see it?
There are 40-year-olds who have not looked after themselves, have smoked cigarettes, have type 2 diabetes because of obesity, and their vessels are in a deplorable condition. There are also 80-year-olds whose coronary angiography shows no trace of atherosclerosis.
The WHO research shows that the health status of the population is to a small extent influenced by the state of health care in a given country – that is, a few percent, and genes – it’s about 10 percent. However, the main importance is the way of life.
So what tests can we do to find out if we’re at risk of a heart attack?
Anyone can measure and weigh themselves and then calculate their BMI or Body Mass Index. If it exceeds 25, we are overweight, if it exceeds 30 – obesity, and if it exceeds 35, we have pathological obesity. If your BMI is too high, you need to go on a diet.
You can also measure your blood pressure yourself. Normal values are up to 140/90, and in a young person the best value is 120/70. If the systolic blood pressure remains above 140, there is already an alarm signal. It is worth measuring the pressure systematically, it is also worth putting on a pressure recorder, come with an apparatus that measures pressure not only at rest. We will learn how our blood pressure is shaped during the day, what it looks like at night, when it should drop.
You also need to look at what we eat. How much vegetables, fats and sweets are in our diet.
- See also: Take care of your heart. Six practical tips
What about blood tests?
From laboratory tests, it is worth making a lipidogram and fasting glucose.
In the lipidogram, we check LDL, i.e. bad cholesterol. The norms are different, if the subject has had a heart attack, there is a tendency to reduce the LDL to the maximum, even below fifty-five. If he has not had a heart attack, LDL should be below 115, preferably below 100. Triglycerides below 150 mg / percent.
When your fasting glucose is above 100, you should do additional testing.
Irregularities detected early can be corrected. If we control hypertension, its negative effects may not occur at all, because atherosclerosis is accelerated by diabetes and hypertension. These two factors are compounded.
Medonet Market offers a package of 11 tests that will allow you to control the work of the heart and the functioning of the circulatory system. The tests can be performed at 500 points all over Poland.
But when does a heart attack occur, what are its symptoms?
They can be so varied that even a doctor sometimes finds it difficult to recognize. Many times it happened to me that the case did not look like a heart attack, but it turned out to be a heart attack and vice versa.
Can the sick person distinguish it on their own?
There are some common symptoms that indicate the likelihood of a heart attack. Most often it is chest pain, i.e. burning, pressure behind the breastbone, sometimes patients do not call it pain, they say it is discomfort. Sometimes the pain radiates to the back or to the hand. If it is radiating to the left arm, a light should light up in the head, indicating a coronary problem. Pain is often caused by exertion, for example when the patient is climbing stairs. This is because there is severe constriction in the artery, which is so tight that very little blood flows to the heart with exercise. At one point, the artery closes completely, causing a heart attack. It happens that the irrelevant atherosclerotic plaque becomes unstable and suddenly breaks, e.g. as a result of stress. Therefore, it may be the case that the patient suffered a heart attack, although he previously only had wall lesions without strictures. These are infarcts that are not preceded by stable coronary artery disease.
Further part under the video.
How to understand?
The patient feels well, functions normally and has no symptoms. If he had done a stress test, he would have been able to pass a heavy load because there is no ischemia. And after the test, even on the same day, he suddenly gets angry and gets severe pain in the chest that does not go away. This points to plaques, otherwise insignificant atherosclerotic lesions. The vessel wall is papered over with such atherosclerotic plaques. The patient lives normal until suddenly the plaque bursts and thrombosis occurs. This is what an acute heart attack looks like. If the symptoms are life-threatening, coronary angiography must be performed as soon as possible.
Coronary angiography, or interventional surgery?
There is a saying: time is a muscle. If we delay treatment, cells in the infarct area will die, scar tissue will form, symptoms of heart failure and even death will occur.
Heart attack mortality is decreasing. Before the aspirin era, that is before the 70s, in-hospital mortality was 50%. In the era of aspirin, it decreased to several dozen percent, then, when fibrinolysis started, to several percent. And when interventional treatment came in, the mortality rate of patients admitted to hospital with a heart attack remained below 5%. However, it should be remembered that the pre-hospital mortality, i.e. among patients who did not go to the hospital, is still 50%.
Are the symptoms of all heart attacks similar?
I have seen many heart attacks with unusual pains. These can be abdominal pain, especially in inferior wall infarction. And to make it even more complicated, the same pains characterize pancreatitis. Sometimes back pain resembles heart attacks. It happens that the heart beats unevenly or very quickly. The pressure may be abnormal, very low or very high. The patient may complain of very strong weakness. He may feel nauseous and may vomit. This is especially true for women, because in men the symptoms are more bookish.
And could there be no symptoms?
30 percent heart attacks are asymptomatic and painless. After some time, on the occasion of check-ups, the patient learns that he has suffered a heart attack.
- Editors recommend: Seven symptoms of a silent heart attack
When is this happening?
For example, in diabetics. In diabetes, nerve glycation occurs – neuropathy – and the patient simply does not feel pain. This is a similar mechanism to that of the diabetic foot.
What is decisive?
Chest pain and a general feeling of anxiety. Now paramedics have ECG machines and can send the test directly to one of the hemodynamic centers, and we, while on duty in such a center, can see the record and say if there are any obvious features of a heart attack thanks to teletransmission.
If they are, the patient is immediately brought to us, to the hemodynamics laboratory. There we put it on the table and we do the coronary angiography. The patient is immediately referred to us, skipping the diagnostic stage in the emergency room. The door to baloon time is specified, ie from the hospital door to the opening of the artery, and should not exceed an hour. There are places where it is several minutes. During this time, the patient arrives, someone registers him, puts him on the table, washes for the procedure, covers with drapes, prepares the puncture site, and then the doctor performs the puncture, usually through the hand, which reduces the risk of bleeding. Before we open the artery, we do a full coronary angiography to check the condition of the coronary vessels. This should all take us under an hour.
What if there are no obvious signs of a heart attack?
The patient goes to the HED, where he has tests, e.g. blood is taken to determine myocardial enzymes and cardiac troponins. They are normally found in the heart and trace amounts in peripheral blood. If they are normal, the test must be repeated after a few hours, because if the heart attack occurred half an hour earlier, the result will be correct, because the enzymes have not yet been released from the damaged heart. If they are elevated by many orders of magnitude, the situation is clear and coronary angiography must be done quickly.
Chest pain can also be a symptom of aortic dissection. A ruptured aortic dissecting aneurysm is something many ED doctors have slipped on. It is very easy to miss as the symptoms depend on where the fracture is. If it occurs at the level of the coronary arteries, we have symptoms of a heart attack, and doing the coronary angiography and the catheter can cause even more dissection of the aneurysm. I would also like to add that elevated levels of troponins are also noted in other life-threatening conditions – e.g. pulmonary embolism.
In order not to call the ambulance unnecessarily, let’s summarize what should worry us?
Chest pain that doesn’t go away after a few minutes and doesn’t depend on breathing. If we breathe in and after releasing it, the pain changes or changes after changing position – it is probably not a heart attack. If the pain persists, we feel anxious and the pressure is abnormal, don’t hesitate and call an ambulance.
The pandemic has made people fear contact with medicine.
The effect is that they do not attend planned coronary angiographs and elective procedures. Having chest pains, they are afraid to call an ambulance, they hope that they will withstand it. In the end, they come to us with heart attacks that are delayed, passed through, e.g. weekly. The pain is gone, because everything died at the site of the infarction, but there was shortness of breath due to heart failure. As time goes on, treatment becomes more difficult.
If the patient is immediately on the table, we can aspirate the thrombus, administer a drug that acts like a “mole” and insert the stent. After an hour, the sick person feels well. After a few days, he can go home, go back to work and, for example, shift two tons of coal.
However, if the same man with the same infarction comes to us after a week, he already has necrosis and blood clots in the vessels. It may turn out that we can’t help him anymore. The heart attack cannot be reversed. The patient may develop heart failure, which is potentially fatal. There is a risk of arrhythmia that requires very expensive treatment.
By not treating heart attacks, we also generate costs for the health care system, because patients take more medications, develop venous insufficiency, and valvular heart disease, and need to have special devices implanted, operated on valves, etc. There is a domino effect. If we do not break this vicious circle in time, we enter the course of treatment and the patient goes on a pension.
specialist in internal diseases, cardiologist, angiologist. I work as an interventional cardiologist in various heart attack centers, incl. at the Military Medical Institute in Warsaw.