What is Acute Coronary Syndrome?

Acute coronary syndrome (ACS) refers to conditions where the blood supply to the heart muscle is suddenly blocked or severely reduced. It is a life threatening condition affecting millions of people every year and requires prompt diagnosis and care. Unstable angina and heart attack both are types of ACS.

Causes

The build-up of plaque in the arteries can block the blood flow to the heart. Plaque is a fatty substance made up of cholesterol, fat and other substances.

Gradual build-up of plaque can cause an artery to become very narrow and later completely blocked. The plaque can rupture suddenly leading to the formation of a blood clot that narrows or blocks the artery.

Symptoms

Some signs and symptoms of ACS include:

  • Chest pain or severe discomfort
  • Pain spreading from the chest to other parts of the body
  • Shortness of breath
  • Sudden, heavy sweating
  • Nausea
  • Fast or irregular heartbeat

Symptoms may vary depending on the patient’s age, sex and other medical conditions.

Risk factors

Certain risk factors increase the probability of developing ACS. People over the age of 45, those who are obese, and those who smoke are at risk.

Similarly, other conditions like high blood cholesterol, hypertension, diabetes and family history of heart disease also cause a risk of ACS.

Types of ACS

ACS includes three types of coronary artery disease that can damage heart tissue. These are:

  • Unstable angina: It comprises sudden and unexpected chest pain and is a warning sign of a heart attack.
  • NSTEMI: A Non-ST-elevation myocardial infarction (NSTEMI) is a heart attack in which the coronary arteries aren’t fully blocked.
  • STEMI: An ST-elevation myocardial infarction (STEMI) is a severe heart attack that occurs when the blood flow to the heart is fully blocked.

Diagnosis and Treatment

There are a number of tests that doctors may recommend to diagnose ACS including:

  • Electrocardiogram (ECG) – It measures the heart’s electrical activity.
  • Blood test – Blood tests such as troponin blood test can detect the cause of chest pain and the risk of a heart attack.
  • Echocardiogram – This test uses sound waves to detect if heart has been damaged or has any other problems.

Treatment for ACS may comprise medicines, surgery, or other procedures to treat the symptoms and restore blood flow to the heart. Doctors may prescribe different medicines such as aspirin, beta blockers, blood thinners, clot dissolving drugs, angiotensin converting enzyme (ACE) inhibitors, or nitroglycerin based on the patient’s condition.

Angioplasty procedure is performed to open a clogged artery using a long, thin tube known as catheter. Bypass surgery is performed to route the blood around the blocked artery.

Prevention

According to Dr Ramji Mehrotra, the risk of ACS can be reduced to a great extent by adopting a healthy lifestyle.

This includes consuming a balanced diet with plenty of whole grains, vegetables and fruits while limiting foods with high cholesterol and saturated fats. It is also important to maintain optimum weight by exercising regularly and avoiding smoking and tobacco in any form as it can damage the heart.

It is also advised to get regular preventive health screenings done and manage health conditions such as cholesterol, blood pressure and diabetes under control.

Women and Heart Disease

It is generally considered that heart disease affects men more than women. However, coronary heart disease is a leading cause of death for both men and women, though the symptoms may be different for both. According to research, cardiovascular disease accounts for 1 in every 3 deaths around the world.

Women and men experience heart disease differently due to the differences in the respective cardiovascular system. For example, women have smaller heart chambers and blood vessels than men. They have lesser number of red blood cells and cannot take in as much oxygen as men. Sudden drop in blood pressure and fainting are more likely in women.

Oestrogen and progesterone hormones are dominant in women, while in men it is the testosterone hormone. These also impact heart health differently.

Identification of heart disease in women

In women symptoms of cardiovascular disease are generally noticed much later than in men. The most common symptom is chest pain or angina which may feel like heaviness, pressure, aching, numbness, squeezing, etc. 

Other symptoms usually observed include fatigue, breathlessness, heart palpitations, nausea, sudden sweating, etc. Anxiety, loss of appetite, frequent indigestion, intense headache and discomfort in the jaws or teeth, are other warning signs of a possible heart attack.

Women are also at higher risk for having a silent heart attack, that is an attack without any visible symptoms.

Hence, it is very essential to get medical help whenever any unusual symptoms are noticed to prevent the chances of heart attack.

Risk factors for heart disease in women

While risk factors like high cholesterol and high blood pressure affect both men and women, women face certain unique risks that affect them more. These include the following:

  • Obesity: During menopause women face greater risk of obesity and gaining abdominal fat which puts them at higher risk of heart disease.
  • High cholesterol: In women aged 65 and above, low level of HDL or good cholesterol is closely linked with death, more than in men.
  • Diabetes: Women with diabetes have a much greater risk of developing cardiovascular disease than men with diabetes.
  • Hypertension: Hypertension or high blood pressure has been found to be linked more closely with heart attacks in women than in men.
  • Family history: Instances of early heart disease in the family cause greater risk to women than men.  

Reducing the risk of heart disease

According to Dr. Ramji Mehrotra, it is very important to adopt a healthy lifestyle in order to reduce the risk of heart disease. A healthy diet with whole grains, vegetables and fruits must be consumed. Saturated fats and high amounts of salt and sugar must be avoided to maintain good health.

Regular exercise is a must, especially for women who are overweight, in order to reduce the risk of heart disease. Stress must be kept under control with meditation and yoga, as high levels of stress have been found to cause microvascular disease.

In addition, other health conditions such as high blood pressure, diabetes and high cholesterol should be managed by regular consultations with the medical practitioners.

By following the above guidelines, heart disease can be prevented in women and they can lead healthy lives.

What is Coronary Artery Disease?

Coronary artery disease (CAD) or coronary heart disease is a common type of heart disease that occurs when the arteries become hardened and narrowed. This is caused due to the cholesterol and calcium deposit or plaque in the arteries.

Coronary artery disease begins due to a condition called atherosclerosis which occurs when cholesterol and calcium collects on the inner walls of the arteries. This build-up is known as plaque which can block blood flow due to the narrowing of the arteries. If the plaque bursts it can lead to a blood clot.

Symptoms of CAD

A patient having coronary artery disease can have chest pain, breathlessness, fatigue, nausea and due to the reduced blood flow to the heart. Chest discomfort or angina is accompanied by symptoms like numbness, heaviness, aching, squeezing, etc.

Complete blockage of blood flow can also lead to heart attack.

Risk Factors

In addition to high cholesterol, other causes of damage to coronary arteries include high blood pressure, diabetes, smoking, sedentary lifestyle, etc.

Obesity, stress, unhealthy diet, irregular sleep and alcohol usage are other risk factors for coronary artery disease.

Diagnosis of CAD

The doctor reviews the patient’s symptoms, risk factors and medical history before performing a physical examination. Diagnostic tests include:

  • Electrocardiograph test: This test can detect heart attack and heart rhythm issues by recording the heart’s electrical activity.
  • Exercise stress test: This is a treadmill test that can help suspect  coronary blockages
  • Pharmacologic stress test: This test can also help detect coronary blockages through medication given to increase heart rate. This is done in patients who cannot walk on treadmill.
  • Coronary calcium scan: This can identify the amount of calcium on the walls of the coronary arteries which can give an indication of atherosclerosis.
  • Echocardiogram: This test utilizes sound waves to measure the overall functioning of the heart.
  • Blood tests: These tests are done for factors affecting arteries like cholesterol, triglycerides, lipoprotein, glucose, etc.
  • Cardiac catheterization: In this test small tubes are inserted into the blood vessels to detect the presence of coronary artery disease and also evaluate the heart function.

Prevention of CAD

According to Dr. Ramji Mehrotra who is one of India’s leading cardiologist, coronary artery disease can be prevented by adopting a healthy lifestyle to improve heart health. These include stopping smoking and limiting alcohol use, consuming a heart-healthy diet, exercising and increasing activity levels, etc.

Blood pressure, diabetes and cholesterol should be controlled. Stress management is also essential to prevent coronary artery disease.

Heart Attacks Are Becoming Common In Young People

Heart attacks, which were once called “old man’s disease”, are now occurring more frequently in younger people including women. It is increasing in people in the 20’s to 40’s age group. Presently, 1 out of every 5 heart attack patients is under the age of 40 years.

Hence, it is very important to take the required steps to protect one’s health and prevent cardiovascular disease and heart attacks.

Causes for Early Heart Attack

There are several factors that lead to heart attacks in young people. Generally, a heart attack results from a combination of factors and not just any one factor.

  • Diabetes: Diabetes is a key risk factor that can lead to blockages in coronary arteries which can cause an early heart attack. Adults with diabetes are 2 to 4 times more likely to be affected by heart disease than those without diabetes. High blood sugar can damage the blood vessels and increase the build-up of fats in the arteries thereby causing atherosclerosis.
  • Hypertension: Another major risk factor for cardiovascular disease is hypertension or high blood pressure. The occurrence of hypertension is increasing at a faster rate in the younger population than in the older people.
  • Obesity: Being obese or overweight can also increase the risk of heart attack. Excess weight not only puts a lot of strain on the heart but can lead to other health complications like diabetes, hypertension and high cholesterol which affect heart health.
  • Stress and anxiety: Stress levels are increasing rapidly in today’s youth due to various reasons. Healthy ways of dealing with stress and anxiety such as proper sleep and relaxation of the mind are not being adopted. Chronic stress is not good for the body and can lead to hypertension and obesity which affect the heart health.
  • Sedentary lifestyle: Decreased physical activity coupled with a sedentary lifestyle also leads to an increase in cardiovascular diseases in young people. Sometimes too much of exercise is also not good for the heart. Excessive exercise, in cases where there is a per-existing un-diagnosed heart condition, can lead to a heart attack.
  • Unhealthy dietary habits: Unhealthy eating is on the rise among the young population.  Consumption of saturated and trans fats, found in deep-fried and oily foods, increases the risk of heart disease and other health problems. Taking a variety of health supplements without medical advice is also harmful and can lead to health issues.

Tips for Preventing Heart Attack in Young People

Dr. Ramji Mehrotra recommends that it is important to be physically active by exercising for at least 30 minutes every day. Cardio exercises such as brisk walking, jogging, cycling and swimming keep the heart in good shape. Yoga and meditation are also very helpful in reducing stress and anxiety levels.

Smoking as well as alcohol and tobacco consumption must be stopped completely. Salt intake must be reduced in the diet while nutritious food including fresh vegetables, fruit and whole grains must be consumed regularly.

If a person has high blood pressure, cholesterol or diabetes, it is essential to keep them under control by consulting a doctor regularly.

By adopting all the above suggestions, the incidence of heart attack in young people can be minimized, according to Dr. Mehrotra.

Effect of a Positive Mental State on Heart

Mental health is an important component of the overall health of an individual. It involves a combination of psychological, emotional, and social well-being. Benefits of good mental health include reduction in stress and anxiety, clearer thinking, improvement in moods and inner peace, reduced chances of depression, etc.

Relation between Mental Health and Heart

Research has shown that mental health is related to the health of the heart. According to Dr Ramji Mehrotra, cardiovascular health is negatively affected by negative psychological factors and mental health disorders, while positive attributes make a positive impact and can lower the risk of cardiovascular disease and death.

Negative psychological conditions like chronic stress, anxiety, and depression can cause harmful biological responses such as irregularities of heart rate, increased blood pressure, and reduced blood flow to the heart. Smoking, unhealthy diet, obesity, lower levels of physical activity, etc. all negatively impact psychological health apart from directly influencing the heart negatively which in turn is connected to heart disease. To improve mental and psychological health, stress reduction therapy, meditation and exercise are recommended.

On the other hand, people with positive psychological health are likely to have lower blood pressure and lower cholesterol. Consequently, they are at a lower risk of developing cardiovascular disease. Health behavior that is likely to increase positive psychological health includes consuming healthy food, physical activity, regular health screening, and check-ups, etc. apart from stress reduction therapy including meditation.

Adopting a Healthier Lifestyle for Healthy Mind and Heart

While the risk of developing cardiovascular and heart diseases is high if a person has a mental health condition, the positive news is that it can be reduced with appropriate changes to one’s lifestyle. These steps towards improving both the body and mind include:

  • Be physically active: Physical activity boosts mental health by releasing chemicals into the brain that reduces depression and anxiety. It also ensures better sleep, less stress, and higher energy levels, etc.
  • Consume a healthy balanced diet: Eating a balanced and healthy diet is essential for mental health along with physical health. A healthy diet controls not only weight but also BP and cholesterol levels which reduce the risk of heart disease.
  • Stop smoking: Though smokers may think that smoking reduces their stress, in reality it increases stress, tension, and anxiety. It also leads to a high risk of lung cancer and all other cancers as well as heart and circulatory diseases. Hence, it is essential to cut down on smoking and eventually stop it altogether. Infect tobacco in any form is injurious and should be avoided.
  • Reduce alcohol: Alcohol is a depressant and affects the mood and mental state of a person. People consuming large amounts of alcohol lose control of their feelings and can become angry, aggressive, anxious and depressed. It can also cause several other health issues.
  • Other activities: Mental health can also be improved by taking up several activities such as adopting spirituality and meditation, improving social relationships, expressing gratitude, practicing kindness, cultivating optimism, etc.

Conclusion

It has been observed that people with mental health issues like stress, anxiety, and depression may experience physiological effects like increased cardiac activity and reduced blood flow to the heart. This may lead to abnormal calcium build-up in the arteries and heart disease. Hence, it is very important to maintain positive mental health by adopting a healthy lifestyle with physical activity, proper diet, stress reducing activities, meditation, cultivating hobbies, feeling good and avoiding smoking, tobacco etc.

Dr. Mehrotra’ says that along with taking care of physical conditions such as blood pressure, diabetes, cholesterol levels, etc., the negative aspects of mental health must be monitored and addressed regularly to reduce the incidence of heart disease in patients.

Heart Attack, Cardiac Arrest, and Stroke Symptoms

The terms Heart Attack, Cardiac Arrest, and Stroke are often used interchangeably but they are not the same. They are three different problems with different causes and treatments. Heart attack and cardiac arrest are involved with the heart, while stroke is involved with the brain. When blood flow to the part of heart muscle stops due to complete blockage in the artery which supplies blood to that part of heart muscle, the muscle dies and this is called heart attack. Cardiac arrest happens when the heart suddenly stops beating. When the blood supply to the brain is interrupted stroke occurs.

Heart Attack

A blocked artery can prevent blood from reaching the heart. This can be due to the build-up of plaque in the arteries and causes a heart attack. The blocked artery must be reopened quickly to avoid permanent damage to the heart.

The heart attack symptoms may be immediate or may also start slowly and persist for a few days or weeks before the attack. The symptoms of the heart attack can be different in both men and women. The common heart attack symptoms in men include:

  • Uncomfortable pressure, squeezing, or pain in the centre of the chest
  • Discomfort in the arms, neck, jaw, back, or stomach.
  • Shortness of breath with discomfort in the chest
  • Cold sweat, nausea, or light headedness

In women, chest pain or discomfort is the most common symptom of a heart attack.  Other symptoms include shortness of breath, back or jaw pain, nausea, and vomiting.

Cardiac Arrest

Cardiac arrest is the abrupt loss of functioning of the heart. Unlike heart attack which is a circulation problem, cardiac arrest results from a problem with the heart’s electrical system which disrupts the heart’s pumping action and stops blood flow. A heart attack is a common cause of cardiac arrest, though most heart attacks do not lead to cardiac arrest.

Sudden cardiac arrest often occurs with no warning and can lead to sudden collapse, loss of consciousness, no breathing, and no pulse. Sometimes there are symptoms observed in advance such as shortness of breath, chest discomfort, palpitations, etc.

Cardiac arrest stops the heart from beating and causes the stoppage of blood and oxygen to the brain, lungs, and other organs. If not treated immediately, cardiac arrest can lead to brain damage and also death within a few minutes. However, according to leading cardiac surgeon Dr. Ramji Mehrotra, chances of survival can be as high as 90 percent if treatment is initiated immediately with CPR and a shock with a defibrillator to jump-start the heart after sudden cardiac arrest.

Stroke

Strokes also deals with blood flow, but are not in the heart. A stroke occurs when blood supply to the brain is reduced, thereby blocking oxygen and nutrients.  The two major types of strokes are Ischemic and Haemorrhagic. When a vessel supplying blood to the brain is obstructed or clots, ischemic stroke occurs. Almost 90 percent of all strokes are ischemic strokes. Haemorrhagic stroke is caused when a weakened blood vessel or small aneurysm in brain vessel ruptures and bleeds. Uncontrolled high BP is the most common cause of haemorrhagic stroke.

Symptoms of a stroke include severe headache, sudden numbness or weakness; paralysis, difficulty with speech, loss of balance, unconsciousness etc. Risk factors that can cause stroke include smoking, high BP, high blood cholesterol, obesity, and type 2 diabetes.

Almost 75 percent of all strokes occur in people over the age of 65.

Conclusion

Dr Ramji Mehrotra says that heart attack, cardiac arrest, and stroke are all life-threatening emergencies. He is of the opinion that their risk can be minimized by getting regular check-ups, being screened for cardiovascular disease, and taking the prescribed medications and regular follow up with the doctor.. Dr. Mehrotra also highlights the importance of adopting a healthy lifestyle by quitting smoking and tobacco in any form, avoiding alcohol, exercising regularly, having a low-fat diet, keeping weight under control, managing diabetes, hypertension and other health conditions.