Regional Heart misconceptions: "It can't be a heart attack - but it can!”

Heart disease: The UAE & Egypt report rising numbers and declining age. Dr Robert Smith addresses the subtleties of Heart attacks.

اذا كنت مقيما في دبي، اضغط هنا لقراءة المقال باللغة العربية (If you are based in Dubai click here to read the article in Arabic)

اذا كنت مقيما في مصر، اضغط هنا لقراءة المقال باللغة العربية  (If you are based in Egypt click here to read the article in Arabic).

Last December, at the World Cardiac Congress, the world's best cardiologists converged to discuss how to enhance heart health and tackle globally challenging conditions. The Chairman of the Emirates Cardiac Society revealed at the sidelines of the event numbers that keep him and the UAE regulators hard at work, “The threshold for cardiac arrests and cardiovascular disease (CVD) worldwide is 65 years, while people in the UAE are suffering from the CVD at the age of 45."

In 2015, the UAE's Ministry of Health and Prevention reported that CVD is a leading cause of mortality in the country and 22% of CVD deaths were attributable to heart attacks. In Egypt, the World Health Organization (WHO) statistics indicate that CVDs are also the leading cause of death in Egypt, accounting for 46% of total deaths.

The number continues to go up, particularly in modern societies, where stress is rising, downtime declining and heart symptoms going amiss. Dr Robert Smith, consultant interventional cardiologist at Royal Brompton & Harefield Hospital Specialist Care, the UK's largest specialist heart and lung centre, advises, "Heart symptoms can vary quite significantly from one patient to the next. Gender differences and ethnicities also report different experiences during a heart attack."

Understanding a heart attack

Heart attacks are a blockage of the coronary arteries, resulting in not enough blood getting to the heart muscle. The typical mechanism by which this occurs is when coronary plaque within an artery ruptures, resulting in a clot. 

Dr Smith emphasises "The important thing I want readers to remember is that a person does not necessarily go into a full cardiac arrest straight away" which likely is what misleads many patients. When a clogged artery blocks the blood flow to the heart muscle, it is starving it of oxygen and nutrients."  The result can be severe damage to the heart's pumping power, leading to incurable heart failure.

Spotting the signals

Dr Smith describes, "People imagine that if there is no crushing chest pain or pressure like an elephant sitting on their chest, it can't be a heart attack – well it can." Other symptoms could be a dull ache in the chest or pain in the arms, shoulders and jaw - and these do not have to present themselves on the left side, as people might think. Pain is not always an indicator of a heart attack. “Some patients, particularly diabetics, may not feel any pain at all. They will, however, be suddenly hit by profound sweating, nausea and look extremely dreadful," adds Smith.

"Classically the severe crushing pain and 'belt around the chest' feeling is most often reported by Caucasian males, whereas an Asian woman might report a much sharper type of pain. However, this may be down to differences in language, or the way each person relates to the pain they experience—people can give very different descriptions of the same symptom."

Symptoms across gender, ethnic and cultural lines

Royal Brompton and Harefield hospitals– are world-renowned for their expertise, standards of care and research breakthroughs. As the private patients unit of Royal Brompton and Harefield NHS Foundation Trust, is a heart and lung specialist tertiary centre which only provides heart and lung care. The hospital handles advanced, complex, and rare cases.

Heart attacks can and do present differently across racial, cultural as well as gender lines, presenting a very complex area that sometimes does not carry medical differences in the heart. Classical boxing of symptoms to represent a particular condition could prove dangerous, and Dr Smith stresses, "While the symptoms can be variable, the main point is that the patient looks very unwell. They are suddenly pouring sweat, possibly looking paler than they normally would, they feel awful and look awful."

Keeping it simple and smart

Without intervention, risk factors such as elevated cholesterol levels, obesity, physical inactivity, high blood glucose, smoking and hypertension will increase. Research findings indicate that cardiovascular disease remains the leading cause of death in the UAE, 36 per cent of all deaths in the UAE. In Egypt, health statistics from the Ministry of Health (2017) indicated that 90.1 per cent of Egyptians do not eat healthy food and consume less than five meals per day.

Patients concerned about their health should have regular sit-downs with their doctor to check on vitals and to run blood tests. Health screenings for CVD increases the likelihood of early identification and management, including lifestyle interventions. Positive changes to lifestyle and diet, including regular physical activity and healthy eating, can delay or prevent the onset of risk factors associated with CVD.

He closes with advising, “In cases of emergencies always rely on Emergency Services; you absolutely should not drive them to the hospital. Call the emergency services and stay with them, taking note of any changes in condition that occur. That way, if the person has passed out by the time the ambulance arrives, you can offer a rundown of events. However, the most important reason is that if the patient goes into full cardiac arrest in an ambulance, they can be resuscitated. So, keep things simple and call for help.”