Monday January 27 2014

What you should know about heart attacks

Earnest Oloya lies at the Heart Institute, Mulago, where he is

Earnest Oloya lies at the Heart Institute, Mulago, where he is recovering after he suffered a heart attack. photo by Abubaker Lubowa 


Last week, news about the sudden death of celebrated BBC presenter Komla Dumor, aged 41 took the work by surprise. He had suffered a heart attack that killed him. Dr Emmy Okello, a cardiologist at the Uganda Heart Institute explains that heart attacks happen when coronary arteries that supply heart muscle with blood flow become narrow from a buildup of fat, cholesterol and other substances that together are called plaque.

“When a plaque in a heart artery breaks, a blood clot forms which then blocks blood flow through the heart muscle,” he explains, adding that when the heart muscle is starved for oxygen and nutrients, as a result, damage or death occurs.

Who is at risk?
Dr Okello says although there are several predisposing factors for heart attack, having high blood pressure is the most common. According to Dr Okello, diabetes, obesity, consuming foods in high cholesterol and lack of physical activity are also contributing factors top heart-related diseases.

Complications of heart attacks
During an attack, the heart is damaged due to lack of blood and oxygen. This damage can lead to several complications immediately following the attack or later in recovery.

Dr Okello says a person who suffers heart attack has high chances of survival if they seek treatment early.

Complications following a heart attack also depend on what part of the heart was damaged, the extent of the damage, and the duration from the time the symptoms appeared.

“The most common complication following a heart attack is heart arrhythmia. Because of damage to the muscle, the heart can start to beat erratically as it struggles to keep pumping,” he explains.

Repeat attacks
Unfortunately, recurrent heart attacks are common. Studies show that as many as 20 per cent of people who suffer from heart attack will experience an additional attack within a period of six weeks.

Heart failure
Sometimes a heart attack damages the heart muscle so much that the heart can no longer function properly. Heart failure is a condition in which the heart can no longer pump adequate supply of blood to your body, resulting in shortness of breath and fatigue. In some cases, the damage may be severe, resulting into chronic heart failure.

Heart valve damage
Dr Okello explains that the four valves in the heart which let blood in and out can be damaged when a person suffers a heart attack, causing blood to leak in the wrong direction.

Blood clots
These happen when blood is not being pumped to the heart. Clots can go in any part of the body, but for most heart attack patients, these clots go in the brain, causing excessive bleeding and subsequently leading to strokes.

Signs and symptoms
The most common symptom that come with heart attacks is chest pain or a feeling of discomfort. Dr Okello says that the pain is usually heavy and the patient will feel as if their heart is expanding within the chest.

“This is a signal that some parts of the heart have started dying and such a patient should be rushed to the hospital within 12 to 24 hours,” states Dr Okello.

He says that most heart attacks involve discomfort in the centre of the chest that lasts for a few minutes or keep recurring thereafter. The discomfort can be mild or severe, and sometimes the pain feels like an indigestion or heartburn.
However, not all heart attacks begin with a sudden, crushing pain.

According to Dr Muhoozi Rwakaryebe, a cardiothoracic surgeon at the Second Xiangya Hospital, Central South University in China, warning signs and symptoms of a heart attack are not the same for everyone.

“Some heart attacks start slowly as mild pain or discomfort. While some people do not have symptoms at all, often called a silent heart attack, in some cases, the signs and symptoms happen suddenly,” he explains.

In some people however, the signs may develop slowly, over hours, days, and even weeks before the attack occurs.

Other common signs and symptoms that a person can have during a heart attack include upper body discomfort in one or both arms, the back, neck, jaw, or stomach, shortness of breath with or before chest discomfort, nausea, vomiting, lightheadedness or fainting, and sudden occurrence of sweat.

Recommended tests and treatment
The diagnosis of heart attack is based on an individual’s symptoms, personal and family medical history, and the results of tests.

At the Uganda Heart Institute, patients who present with symptoms of heart attack are tested for Echocardiogram (ECG) within 20 minutes on arrival at the hospital. An echocardiogram is a test that uses sound waves to create a moving picture of the heart. It allows doctors to see the heartbeat, valves and other structures of the heart so that they are able to identify the problem.

The most advanced test for this however is the electrocardiogram (EKG) which detects and records the electrical activity of the heart. Dr Rwakaryebe says the EKG is a standard evaluation to see the heart activity, measure the chambers, valves as well as evaluate its functioning.

Blood tests are also helpful for diagnosing a heart attack. This is because during an heart attack, heart muscle cells die and burst open, letting certain proteins out in the bloodstream. These are called cardiac protein enzymes.
“Blood tests can measure the amount of proteins in the blood. Higher than normal levels of proteins in the bloodstream is evidence of a heart attack,” Dr Okello states.

Dr Okello says the key to managing and preventing heart attacks is ensuring early treatment. So when you suspect you have any of the signs listed above, do not sit back and wait, consult your doctor immediately.


High blood pressure is a condition that can lead to coronary heart disease. It happens when blood pushes against the walls of the arteries as the heart pumps blood, causing damage.

Cholesterol is a fat made by the liver from the saturated fat that we eat. It is essential for healthy cells, but if there is too much in the blood it can lead to heart disease

Cigarette smoke contains thousands of chemicals including nicotine – an addictive drug that affects brain and muscle activity and increases your blood pressure, making your heart work harder .

Obesity is considered one of the leading causes of life-threatening diseases. If you are overweight, the probabilities of developing heart disease, diabetes, and high blood pressure increase significantly.

One man shares his story of recovering after a heart attack

Earnest Oloya is admitted at the Uganda Heart Institute, Mulago hospital after suffering a heart attack. As the 65-year-old retired civil servant lies on one of the six beds at the institute, several tubes have been fixed through his arms and connected to a heart monitor.

The tubes are used to administer medication. Although Oloya’s wife is seated next to him, she prefers not to be part of the interview.

Routine check-up
Oloya has been admitted to the hospital since January 18, but his troubles had started on January 12, when he visited his doctor for routine medical check-up.
This time however, after examinations were conducted, his doctor recommended a blood pressure test, and results showed that his blood pressure levels were high.

“I was treated and given drugs for controlling my blood pressure. I was taking the drugs until Thursday night when I got an heart attack,” he narrates.
“On that day, I stayed home as the doctor had asked me to rest because of the medication I was taking to stabilise the blood pressure levels. I watched television but at some point I got bored and decided take a cup of tea before going to bed,” he explains.

According to Oloya, after taking tea, he took the stairs to his bedroom but along the way, he felt pain in the chest.

Experiencing symtoms
“The pain lasted for a few minutes. My chest was heavy as if it was expanding and about to burst, but I struggled and reached the bed,” states Oloya.

“Within minutes, I was sweating profusely and my clothes and bed sheets were all soaked in sweat. My arms too became painful as if something was tearing me up,” he recalls. His heart beat became too fast – another condition associated with heart attack.

But even with these signs, Oloya did not think it was a heart attack, let alone having a heart-related condition.

He was then rushed to Kadic Hospital, where upon arrival the doctors suspected him to have suffered a heart attack, and tests carried out later confirmed so.
Oloya was then referred to the Heart Institute at Mulago hospital.

However, by the time he arrived at the hospital, it was past the 24 hours within which he would have got treatment to either remove the clot or given tablets to dissolve the clots that had formed in his body.

He is still admitted at the facility receiving treatment to control both his blood pressure as well stabilise his heart.
Doctors at the facility say he is out of danger, although he continues to take drugs to prevent another heart attack.