Heart disease remains the number-one killer among men and women across the world. Medical student Rachel Xuereb highlights the difference between heart failure and heart attack and how to recognise the warning signs.
There is a vast spectrum of heart and blood vessel diseases, many of which are related to a basic underlying process called atherosclerosis. This occurs when an accumulation of fat, cholesterol and other substances, together called plaque, builds up in the walls of arteries, making them narrow and thus more difficult for blood to pass through.
Plaques may rupture and blood clots may form over them, causing complete blockage of the artery with complete obstruction to blood flow. If this occurs in an artery supplying blood to the heart muscle – a coronary artery – it leads to irreversible damage to the heart muscle, therefore a heart attack.
The heart requires oxygen to function well, which is transported by blood. When oxygen and nutrients do not reach the heart muscle in the required amount as a result of narrowing of a coronary artery, ischaemia occurs. This results in chest pain, known as angina, during exercise or emotional stress. This may be a warning sign of a heart attack.
A heart attack occurs when part of the heart muscle dies as a result of complete blockage of a coronary artery. This is referred to medically as a myocardial infarction (MI). It presents with severe crushing chest pain usually at rest. Pain may also be felt in the shoulders and down the arms, the neck or jaw or even over the stomach. One may also feel short of breath. Other symptoms include sweating, nausea or light-headedness –these are especially more common in women experiencing a heart attack.
The earlier one starts taking preventive measures, the better the outcome
It is vital to seek help as soon as possible should one experience any of these symptoms. It is safer to get any chest pain checked out. The faster one reaches hospital to be treated the more heart muscle is saved – minutes matter! Calling 112 may be the fastest way to get immediate help.
The blocked coronary artery may be opened up in an emergency procedure called Primary Percutaneous Coronary Intervention (PCI) if the heart attack is recognised early enough.
If treated promptly, the heart muscle eventually starts to heal. However, scar tissue forms in the damaged area. This does not contract as well as normal healthy tissue. Therefore, it can impact on how well the heart functions as a pump. Those who survive a heart attack would have to make important lifestyle changes and be on medications to prevent another episode and lead a normal life.
A heart attack may be caused by many factors, some of which can be avoided and others not. The latter include ageing, male sex and a family history of early heart disease.
However, one can decrease the chances of having a heart attack by avoiding smoking, which increases the amount of plaque in the arteries, lowering cholesterol levels, controlling high blood pressure, exercising at least five times a week, attaining the ideal body weight, avoiding stress and limiting alcohol intake, having a healthy diet and controlling blood sugar if one is diabetic.
Heart failure is another type of heart disease, where the heart does not pump as well as it should. So even though the heart keeps on working, it does not supply enough blood and oxygen to the body cells, thus it cannot keep up with its workload.
Heart failure is a serious condition, however, if it is managed well with medications and lifestyle changes, it is possible to lead a normal life. Successful treatment depends a lot on one’s willingness to get involved in managing this condition.
At first the heart tries to compensate by ‘enlarging’, that is developing more muscle mass and beating faster. Blood vessels in the body also narrow to keep blood pressure up, trying to make up for the heart’s loss of power. Moreover, the body diverts blood away from less important tissues and organs to the heart muscle and brain. But these temporary measures only mask the underlying problem: unless properly treated, heart failure continues and worsens until these compensatory processes no longer work.
So the heart cannot keep up with the body’s demand, and as a result, one gets tired and short of breath easily. Everyday activities such as walking, climbing stairs and carrying bags can become very difficult. Another problem is becoming breathless while lying down, so one may need to use more than one pillow and sleep propped up.
Moreover, as the heart cannot keep up with its work, blood accumulates in the pulmonary veins (the vessels that return blood from the lungs to the heart), causing fluid to leak into the lungs. This results in persistent coughing that produces white or pink blood-tinged phlegm. Fluid also builds up in the body tissues and the feet, ankles, legs and abdomen can swell up. One might also have a lack of appetite and a feeling of the heart racing.
Heart failure results from the added stress of health conditions that either damage the heart or make it work too hard. All of the lifestyle factors that increase the risk of heart attack and stroke – smoking, being overweight, eating foods high in fat and cholesterol and physical inactivity – can also contribute to heart failure.
Conditions that may lead to heart failure include coronary artery disease, suffering from a heart attack in the past, uncontrolled high blood pressure, abnormal heart valves, disease or inflammation of the heart muscle, heart defects present at birth, severe lung disease, obesity and diabetes.
One can do a lot to prevent disease from developing and the earlier one starts taking preventive measures, the better the outcome.