Heart Attack

A heart attack (myocardial infarction) happens when blood flow to a part of the heart is suddenly blocked — usually by a blood clot forming on a cholesterol plaque in one of the coronary arteries. Without blood flow, heart muscle starts to die within minutes. Heart attack is a medical emergency — the faster the artery is reopened, the more heart muscle is saved. Indians tend to have heart attacks at younger ages than Western populations and often at lower body weight.

Warning signs — don't ignore these

• Chest pain or pressure — often in the centre, can spread to the left arm, jaw, back, or upper abdomen. May feel like squeezing, heaviness, or burning.
• Breathlessness — with or without chest pain
• Sweating — cold, clammy
• Nausea or vomiting
• Unusual, severe fatigue or weakness
• Dizziness, lightheadedness, fainting
• Palpitations

Women often have less typical symptoms — breathlessness, back or jaw pain, indigestion-like feeling, unusual fatigue. Don't dismiss these.

People with diabetes may have silent heart attacks with few or no symptoms — any sudden, unexplained breathlessness or weakness is worth checking.

What to do if you or someone else may be having a heart attack

• Call for help immediately — dial 112
• Chew (don't swallow whole) a regular aspirin tablet unless allergic — this is standard first-aid
• Sit or lie in a comfortable position; loosen tight clothing
• Stay calm; don't drive yourself to the hospital if possible — an ambulance can start treatment earlier
• If the person becomes unresponsive and isn't breathing normally, start CPR
• Every minute matters — "time is muscle"

Risk factors

• Age (risk rises; in Indians often from 40s onwards, sometimes earlier)
• Family history of early heart disease
• Male sex (though women's risk rises after menopause)
• Smoking and tobacco (cigarettes, bidis, chewing tobacco)
• High blood pressure
• High cholesterol
• Diabetes
• Obesity — particularly central (belly) obesity, which is especially relevant in South Asians
• Physical inactivity
• Unhealthy diet — high in salt, refined carbs, saturated/trans fats
• Long-term stress, poor sleep
• Excess alcohol
• Air pollution

Diagnosis and treatment

• ECG (often immediately), blood tests (cardiac troponin), echocardiogram
• Angiography — to see the blocked artery
• Treatment to reopen the artery — either angioplasty (balloon and stent) or clot-dissolving medicines; done as quickly as possible after arrival
• Medicines to prevent further damage and future events — antiplatelets, statins, beta-blockers, ACE inhibitors
• Cardiac rehabilitation after recovery — supervised exercise, risk-factor management, emotional support; meaningfully improves outcomes

Preventing a first (or next) heart attack

• Stop smoking and tobacco completely
• Control blood pressure, cholesterol, and diabetes with medicines + lifestyle
• Regular physical activity — walking, yoga, swimming, cycling
• Heart-healthy diet — whole grains, pulses, vegetables, fruits, nuts; less salt, sugar, refined carbs, and fried foods
• Maintain healthy weight; watch waist size (men <90cm, women <80cm as South Asian targets)
• Manage stress; get enough sleep
• Take prescribed medicines consistently — don't stop on your own
• Annual check-up after age 40 (earlier with family history or other risk factors)