Heart attack!

Chest pain can be a worrying symptom. Most chest pain is not from the heart and a good description helps your doctor to work out what is going on. People have heart pain when the heart muscle is short of oxygen. This occurs in two main situations. Angina is pain experienced when the blood flow to heart muscle, is insufficient to supply enough oxygen. Usually, the blood vessels (arteries) have been narrowed (or "furred up") over the years; occasionally the arteries go into spasm and narrow for a short period of time. Because the artery is not completely blocked there is usually enough blood getting through when the heart is not stressed, so there is no pain at rest. On exercising, eating a meal or going out in the cold weather, the heart has to pump harder to keep up with the body's demands for oxygen. At this point the narrowing in the artery becomes significant and the heart muscle cannot get enough blood to nourish it with oxygen. This hurts, and the pain is usually felt in the middle of the front of the chest (over the breast bone). Although the heart lies on the left side of the chest, heart pain caused by lack of oxygen is nearly always central and so left sided pain is not due to angina. Sometimes heart pain can spread into either arm, up to the jaw or down to the stomach. It can be mistaken for indigestion. The character of the pain is variously described as a tightness, constriction, unpleasant dull ache, or like a heavy weight. It is not sharp and stabbing in quality; this would indicate another cause. The other important point is that angina pain is commonly (though not exclusively) brought on by exercise. Angina pain stops when you rest. If you have chest tightness brought on by walking up a hill that goes away if you stop to rest, it may well be heart pain.

The second situation is when a small clot of blood completely blocks an artery supplying heart muscle. This causes a heart attack ("coronary"), or myocardial infarction in medical terms. When this occurs part of the heart muscle can get no oxygen at all and dies if not rescued quickly. The pain is like angina pain in nature but usually more severe and does not settle with rest. Because the pain is so bad, the patient is pale and sweaty and obviously unwell (although a bad attack of angina can also cause this). If doctors in hospital can start treatment with clot dissolving drugs quickly, the heart muscle may be rescued or the damage minimised. For this reason if you think you are having a heart attack you should waste no time in getting to a local hospital as fast as possible (dial 999 for an emergency ambulance and tell the operator you think you are having a heart attack); every second helps to save some heart muscle from damage. If you have some, take one aspirin tablet as this greatly helps minimise the damage to heart muscle from the blocked artery. Rapid treatment with aspirin and clot dissolving drugs saves lives.

How can you help prevent heart disease? Firstly, stop smoking. Secondly, stop others smoking. Smoking is the major avoidable cause of heart disease. It contributes to furring up of your arteries and reduces the oxygen carrying capacity of blood. Take regular exercise, preferably half an hour jogging or training (or its equivalent) three times each week. Exercise will make you feel better and increase the stamina and blood supply of the heart. Obviously if you have pre-existing heart disease discuss this with your doctor. If you are not sure of your exercise limits and for healthy but unfit people, start gently, perhaps with brisk walking and build up your tolerance to exercise. If exercise brings on chest pain, see your doctor. If your blood pressure has not been checked in the previous 3 years it might be an idea to see the nurse or doctor for a measurement. Modifying diet to reduce weight and decrease the cholesterol (fat) content of your blood is important too. For example, change your diet to include no more than 7oz (200g) of meat per day, eat fish and poultry in preference to red meat, eat lean meat only and remove the skin from poultry. Stick to a maximum of two eggs per week (including in cooking); eat low fat cheeses and cottage cheeses, drink skimmed or semi-skimmed milk. Use vegetable oil or soft margarine for cooking. Bread, cereals, pasta, potatoes and rice are OK. Avoid lard, butter, hard cheese, coconut oil and palm oil.

And remember, smokers die younger.