It is usually a burning or a crushing chest pain which typically starts in the centre of the chest but can radiate to any other part of the chest from the central point of origin. Some patients describe a band around the chest and the pain can also radiate up into the throat, the jaw, the teeth, the ears, either shoulder and even to the back.

 
The pain might be associated with symptoms of:

• Sweating
• Nausea
• Vomiting

A heart attack occurs when the cap of said Cholesterol plaque ruptures, thereby exposing the contents to the circulating blood. This leads to clot formation on top of the plaque, thereby obstructing the artery completely and thus depriving the dependent heart muscle of blood and oxygen. This area of heart muscle then starts dying off and from this it is clear that time is of the essence to preserve heart muscle.

“This message, of getting patients with a suspected heart attack to appropriate medical care as quickly as possible, is a bit of a hobby horse of mine and I love to educate the general public about this very important subject. It is also very important to remember that your GP should not be your first port of call in the event of a suspected heart attack, but rather a hospital with Cath Lab facilities” advises Dr Fourie.

The cardiologist will try to open the blocked artery in a procedure called PTCA and stent placement.

• This will be preceded by an angiogram where a sheath will be inserted into the big femoral artery in the leg or in the radial artery in the wrist.
• From here, catheters are passed to the openings of the coronary arteries which run on the outside of the heart to perfuse heart muscle with blood and oxygen.
• Contrast medium (dye) will be injected into the arteries to document the anatomy.
• The obstruction will be documented and one will then proceed to try and pass a very thin wire across the obstruction into the distal part of the artery.
• This will be followed by either balloon angioplasty to enlarge the inner lumen of the artery in order to facilitate stent placement or, if the clot burden is heavy, we might try and syringe the clot out of the obstructed artery before proceeding with ballooning followed by stent placement.

• A smoking history
• Hypertension (especially poorly controlled hypertension)
• High Cholesterol levels
• Diabetes mellitus
• A family history of premature cardiovascular events
• Obesity and a sedentary lifestyle
• Abnormally high stress levels

From this it is clear that although one cannot alter one’s genetic disposition, you can alter your cardiac risk profile quite substantially.

• Lifestyle modification such as cessation of smoking
• Weight loss
• A controlled diet with good quality protein and complex carbohydrates with restriction of salt, simple carbohydrates, simple sugars and animal fat.




A big part of my practice is dedicated to addressing risk factors and improving on the cardiac risk profile of patients.