You’re woken at 5.30 in the morning with an uncomfortable feeling in your chest. There’s an ache in your left arm and your throat feels tight. You sweat profusely but feel cold. Hopefully at this point you realise something’s wrong and you dial 999, but many don’t and wait far too long.
These are typical symptoms of a heart attack. Although you’re most likely to be an older man, we see heart attacks in many women and occasionally in those as young as 30 to 40. The symptoms are rarely like those depicted on films and TV. Most patients tell us they don’t have severe pain; more likely they have chest heaviness or discomfort, sometimes they just have arm, jaw or back pain.
An ambulance arrives quickly. Paramedics have become experts in recognising the symptoms of a heart attack. They quickly assess you. Once the diagnosis is made, oxygen is given via a mask, an intravenous line will be inserted in a vein in your arm to deliver drugs, you are given an initial dose of aspirin and then taken to hospital.
Up until about five years ago treatment for a heart attack was with clot-busting drugs. These drugs aimed to dissolve the blood clot that forms in a coronary artery, which causes a heart attack. Although effective in many patients, some people would have severe bleeding as a complication of this treatment.
The symptoms are rarely like those depicted on films and TV
Then a series of groundbreaking trials showed that taking patients directly to a specialist cardiac centre and carrying out an immediate procedure, called a coronary angioplasty, to directly remove the blockage, produced significant benefits with an impressive reduction in the risk of dying.
You see a cardiologist immediately and it’s decided that you require an immediate angiogram. A small tube is placed into an artery in your wrist. Further tubes are passed to your heart and dye injected into the arteries that supply blood to your heart. The blocked artery causing the problem is identified. A suction tube is passed into your artery and manoeuvred towards the blockage. The offending blood clot is literally sucked out. Blood flow through the artery is restored and you feel relief from your symptoms. A tube called a stent is positioned in the narrowed area of your artery where the blockage had occurred.
This type of treatment has led to a dramatic reduction in deaths in people who have a heart attack. The procedure takes about half an hour after which you are closely monitored on the coronary care ward.
Whereas a few years ago you would have stayed in hospital for at least a week, nowadays, as long as significant damage to your heart muscle has been avoided, you are likely to go home after 48 hours. You will feel tired for some time, but there is every chance you will make a full recovery and get back to normal daily life.
Of course, cases vary in complexity and some patients will be kept in hospital for longer and may require further procedures. The amount of heart muscle damage will vary depending on how quickly, after the start of the heart attack, the artery is opened up and blood flow restored.
The story doesn’t end there. You go home with a number of tablets to protect you from another heart attack. You are invited to attend a cardiac rehabilitation programme. You’ll be advised on issues such as when you can return to work, when you can drive and when you can start having sex again. The main aim is to return you to a normal active life.
Dr Andrew Deaner is consultant cardiologist at King George and the London Chest Hospitals, and clinical director of acute medicine at Barking, Havering and Redbridge University NHS Trust.