Heart Attack Symptoms, Causes, and treatments

Table of content

1. An overview

Before going into a detailed discussion on relevant aspects related to heart attack, it is essential to highlight the definition, location, function, importance, and other key issues concerning the heart lying in the human body.

The heart is a single organ but acts as a double pump. It carries oxygen-poor blood to the lungs when it unloads and then it picks up oxygen. The heart is a muscular organ that circulates blood. The heart lies at the heart of the blood circulation system and is located between the lungs and just behind and slightly left of the breast bone. The base of the heart lies along the body’s midline with the apex pointing toward the left side.

This is because the heart points to the left 2/3rd of the heart’s mass lies on the left side and the rest i/3rd lies on the right. In this connection, it needs to be asserted that the chest pain on the left side does not necessarily mean a heart problem. The size of the heart for the kids is the same as the fist and the weight is 250- 300 gm. And in the case of the adults, the size of the heart is about 2 times of the fist.

So far as the heartbeat is concerned, it is about 100000 times a day and 36.5 million times a year. During the average lifetime for Asian people (71.5 years), the heartbeat is 2.5 billion times.

The main function of the heart is to pump blood in the body through the network of arteries and veins called the cardiovascular system.

The heart has 4 chambers:

2 atria and 2 ventricles. The left atrium receives oxygen-rich blood from the lungs and pumps it into the left ventricle. The right atrium receives oxygen-poor blood from the body and pumps it into the right ventricle. The right ventricle pumps the oxygen-poor blood to the lungs.

Metaphorically, heart means the ‘chief’/ the ‘central point/ the dearest. (For instance, he lives in the heart, i.e. the central point of the town / she is my sweetheart i.e. the dearest / a  hearty i.e. grand reception was accorded on him/he is a hearty i.e. kind and noble person, etc). All these common usages pertaining to the heart, rightly signify the indispensability of the heart to survive for humans.

2. Heart attack

A heart attack is the death of a segment of a heart muscle caused by the loss of blood supply. In contrast, heart failure occurs when the heart muscle does not pump blood.

And stroke is the death of a brain cell due to a lack of oxygen caused by the blockage of blood flow to the brain.  On the other hand, heart disease includes all the conditions affecting the function and structures of the heart, such as heart attack / coronary artery disease (narrowing of the arteries) / arrhythmia (irregular heart rhythms) / heart failure/heart valve disease / congenital heart disease (it is the most common type of heart defect which starts at birth and is a problem related to the structure of the heart) / cardiomyopathy (heart muscle disease), etc.

Conclusively, most heart attack involves discomfort in the center of the chest that lasts for more than a few minutes or it may go away and return. It can feel like uncomfortable pressure. Left chest pain is often assumed to be a heart attack which may not be true. Again pain in the right chest should not be ignored at all

3. Heart attack  vs. Cardiac arrest

Heart attack and cardiac arrest are often mistakenly used as synonyms. In fact, they are different on the following grounds.

3.1) A heart attack is a circulation problem that occurs when blood flow to the heart is blocked. On the other hand with SCA (Sudden Cardiac Arrest), the heart malfunctions. It suddenly and unexpectedly stops beating.

3.2) A heart attack can cause a cardiac arrest in which death occurs as the heart suddenly stops working in the right way. This is caused by Arrhythmias (irregular heart rhythms). The most common Arrhythmias in cardiac arrest is  Ventricular fibrillation (This is a condition when the heart’s lower chamber suddenly starts beating  chaotically. And the heart does not pump blood. Death arrives within a few minutes after the heart stops)

However, cardiac arrest may be reversed if CPR (Cardio-pulmonary Resuscitation) is perfumed and a defibrillator (It is a treatment procedure that delivers a dose of electric current called counter shock) is used soon to shock the heart and restore a normal heart rhythm.

4. Different medical terms for heart attack

ACS (Acute Coronary Syndrome): It is a situation in which the blood supplied to the heart muscle is suddenly blocked.

• STEM- 1: It is a type of heart attack that is caused by a complete blockage in a coronary artery.
• NSTEM- 1: It is a type of heart attack in which an artery is partially blocked and in consequence, severely reduces blood flow.
• Myocardium: It implies the death or damage of an area of a heart muscle resulting from a blocked blood supply to that area.
• Coronary thrombosis: It implies the formation of a clot in one of the arteries that supply blood to the heart muscle.

5. Potential Complications

The most common complications following damage to the heart in the wake of a heart attack  are stated below:

5.1) Arrhythmia's

It refers to the abnormal heart rhythm which may be placed into 3 categories

• Tachycardia (Breathing too quickly)
• Bradycardia  (Breathing too slowly)
• Atrial fibrillation (Breathing irregularly)

Arrhythmias can develop after a heart attack as a result of damage to the heart muscle. The damaged muscles disrupt electrical signals used by the body to control the heart. Some arrhythmias, such as tachycardia are mild and cause symptoms that include: palpitation (the sensation of heart racing in the chest or throat) / chest pain /dizziness (it is the momentary drop in blood pressure and blood flow to the head that occurs when one gets up from bed too quickly from a seated or a lying position) or lightheadedness (It is a common and typically an unpleasant sensation of dizziness and/or feeling that one may faint.

It can be short-lived, prolonged, or rarely occur. In addition to dizziness, the individual may feel as though the head is weightless) /fatigue(it is extreme tiredness resulting from mental or physical (exertion) /breathlessness (It may appear in different forms, such as difficulty in catching the breath, noisy breathing, very fast and shallow breathing, increase in pulse rate, wheezing, chest pain, skin that looks pale and slightly blue, especially around the mouth and cold clammy skin)

Other arrhythmias may be life-threatening

(These are: complete heart block- which is a condition where electrical signals are unable  to travel from one side of the heart to the other so that the heart can’t pump blood properly / ventricular arrhythmias- which is a condition where the heart begins beating faster before going into spasm when it totally stops pumping known as  sudden cardiac arrest)

Conclusively, all these life-threatening conditions relating to arrhythmias can be a major cause of death 24- 48 hours after a heart attack.

5.2) Cardio-genic shock

It is similar to heart failure but is more serious. It crops up when the heart muscle is damaged so extensively that it can no longer pump the blood needed to maintain most of the body's functions. Symptoms include mental confusion /cold hands and feet / reduced or nil urine output/rapid heartbeat /rapid breathing with difficulty/ pale skin.

Conclusively, once the initial symptoms of cardiogenic shock have strengthened the foothold, surgery may be needed to restore the functioning of the heart.

5.3) Heart valve problem

The patient will feel difficulty in catching breath/weakness/chest discomfort /palpitation/swelling of ankles, feet, and abdomen/ rapid weight gain.

5.4) Heart rupture

It is a laceration of the ventricles of the heart.

6. Signs, symptoms, and diagnostic tests of heart attack

Signs are mostly objective phenomena detected by the doctor through suitable test results, while symptoms are subjective phenomena observed and experienced by the patients. The diagnosis is identifying the root problem through applying various tests, observing symptoms as well as interrogating the patient about his feelings, lifestyle, notably food habits, and finally recording the genetic and personal history pertaining to the disease.

6.1) Heart attack Symptoms

Some heart attacks are intense and arrive all of a sudden. But mostly, it comes slowly and with mild pain and discomfort. The major symptoms are stated as follows:

• Chest discomfort
• Discomforts in other areas of the upper body
• Shortness of breath: The term is medically known as dyspnea. The condition is described often as tightening in the chest/ air hunger/ feeling of suffocation. The prime cause behind the shortness of breath is massive obesity which is again considered a great risk factor for heart attack. Shortness of breath can occur with or without chest discomfort.

Other symptoms: Other possible symptoms include cold sweat (a state of sweating triggered by fear, anxiety, stress, or illness)/ lightheadedness /nausea (it is a feeling of sickness with an inclination to vomit).

6.2) Heart attack diagnostic tests

The diagnostic tests may be broadly classified into :

• Invasive test: The test includes drawing and testing sample blood as well as inserting and threading a thin hollow tube (called a catheter) into a blood vessel to get and examine an inside view.
• Non-invasive test: Non-invasive cardiac test measures the heart’s activity through external imaging and electrocardiograph.

The diagnostic tests include:

• ECG (Electrocardiogram): It is the test to diagnose a heart attack.  The test records the electrical activity of the heart via electrodes attached to the skin. Because the injured heart muscles do not conduct electrical impulses.  The  ECG  test ascertains whether a heart attack has already occurred or not.
• Echocardiogram (Echo): It is a test that uses a high-frequency sound wave (ultrasound) to take pictures of the heart.
• Chest X-ray: A chest X-ray produces images of the heart/lungs/air passage/blood vessels/ bones of the spine and the chest. An X-ray is a non-invasive medical test that helps physicians diagnose and treat the disease.
• CCT (Cardio-computed Tomography): It is a non-invasive test that uses X-rays to take pictures of the heart. Modern CT scanners can work very fast and examine in detail. They can take images of the heartbeat and detect blockages in the heart arteries.
• PET (Position Emission Tomography): It is a nuclear medicine functional imaging technique that is used to observe metabolic processes (it produces breaking down and oxidizing food molecules) in the body as an aid in diagnosing the disease.
• SPECT (Single Photon Emission Computed Tomography): It is a nuclear medicine tomography imaging technique using Gamma rays. It is quite similar to the conventional nuclear planar using a  Gamma camera which is able to produce 3-dimensional images.
• ETT (Exercise Tolerance Test): It is an efficient method to ascertain how well the heart behaves during exercise. The test is applied to monitor the heart’s activity as well as examine the blood pressure, and pulse rate during the test.
• EST (Exercise Stress Test): It is also known as the Treadmill test. As the body works harder during the test, it requires more oxygen and the heart pumps more blood. The test can also detect whether blood supply is enough in the arteries during the test.
• Holter Monitor: In medicine, it is a type of “Ambulatory Electrocardiography Device“ for cardio monitoring of the electrical activity pertaining to the cardiovascular system. The test must continue at least for 24 hours and often for  2 weeks at a time.

Caution: The Holter Monitor must be taken off during bath or swimming, lest it should be wet and damaged.

• MPI (Myocardial Perfusion Imaging or scanning): It is a nuclear medicine procedure that illustrates the function of the heart muscle. It evaluates many heart conditions (such as coronary artery disease/ hypertrophic cardio-myopathy/heart wall motion abnormalities).
• Cardiac Cauterization: It is a procedure to diagnose and treat cardiovascular abnormalities. During the procedure, a long thin tube  (called a catheter) is inserted into an artery or vein (inside the groin/neck/or arm) and threaded through the blood vessels running up to the heart.  During the test blood pressure as well as blood flow can be measured.
• Tilt Table Test: For performing the test, the patient needs to lie on the bed (which is tilted at different angles 30 degrees- 60 degrees), while the machine monitors the blood pressure/electrical impulses in the heart/ oxygen level. Additionally, the test can detect the cause of fainting spells. The test is performed in a special room.
• TEE (Trans-esophageal Echocardiogram): It is a powerful diagnostic tool and is an alternative way to perform an echocardiogram. The test involves a special probe containing an ultrasound transducer at its tip (which is passed into the patient’s esophagus). The test allows the doctor to evaluate the image.

7. Causes and risk factors of heart attack

In fact, causes are the agents directly responsible for the occurrence of the disease. In most cases, it is not clear what mainly causes the disease. Again, a  risk factor is not necessarily a cause. A risk factor may be anything that increases the likelihood for a patient to develop the disease. (For instance, aging is a vital risk factor for any malignancy, but it cannot be a cause).

7.1) heart attack Causes

Veritably, the heart muscle needs oxygen to survive. A heart attack occurs when the blood flow (that brings oxygen to the heart muscle) is severely reduced or completely cut off. This happens because the coronary arteries (that maintain the uninterrupted blood flow to the heart muscle) get narrowed due to the build-up of fat and cholesterol (it is a waxy fat-like substance that is found in the cells within the body. The body needs cholesterol to make some hormones, vitamin- D, and other substances that help digest food. But excess of anything is bad. A high cholesterol level can trigger a heart attack) which together are called plaque. This blood clot blocks the blood flow running through the arteries to the heart muscle. In consequence, it leads to ischemia (It is an inadequate blood supply to an organ or a part of the body, especially in the heart muscle). The heart muscle is starved of oxygen and nutrients when a part of the heart becomes numb and damaged. The ultimate result is a heart attack.

Sometimes a coronary artery contracts or goes into spasm. When this happens the artery narrows and as a result, the blood flow to that part of the heart muscle declines or stops.

Another cause of heart attack is spasm (it is the sudden involuntary muscular contraction) which occurs in normally appearing blood vessels as well as in the vessels partly blocked by atherosclerosis (It is a disease of the arteries characterized by deposition of fatty materials on their inner walls). A severe spasm can cause a heart attack.

Another cause of heart attack is spontaneous coronary artery dissection due to spontaneous tearing of the coronary artery wall.

7.2) Heart Attack Risk factors

The risk factors that invite heart attack may be categorized under 2  broad heads:

7.2.1) Unavoidable risk factor

Aging: As people move on the age path without any break, the more they become aged, the more likely they are to develop all malignant diseases including heart attack. As one ages, so do the blood vessels which become flexible and make it harder for blood to flow easily.

Advice: It is essential for the aged people to watch:   when/where/what amount/ what foods and drinks they take on a regular basis. Because,  if aging is paired with an unhealthy sedentary lifestyle (such as unhealthy and junk foods and drinks loaded with excessive amounts of sugar, salt, and unhealthy fats, in addition to physical inactivity as well as smoking and alcohol), then the risk of a heart attack becomes too high.

Gender: Males, in general, have a higher risk of heart attack, and additionally, they develop heart attack  much  earlier in life (as compared to females)

Heredity including race: Children of parents (having heart disease) are more likely to develop heart disease themselves in the course of time. Additionally, Africans/Americans/Hispanics (as compared to Caucasians) have a higher risk of heart attack (partly due to high blood pressure and partly due to obesity.

Advice: Since aging/gender/heredity can neither be changed nor controlled, it is well-advised to be cautious and exert control over only the modifiable risk factors.

7.2.2) Avoidable risk factor

7.2.2.1) High blood pressure: The normal blood pressure for a healthy person is 120/80 mm Hg (the top number indicates systolic and the bottom number indicates diastolic blood pressure). The higher the blood pressure, the higher the risk of a heart attack. High blood pressure raises the heart’s workload causing the heart muscle to thicken and get stiffer. The stiffening of the heart muscle ultimately causes the heart to function abnormally which  increases the risk of heart attack (in addition to stroke and kidney failure)

7.2.2.2) High blood cholesterol: As blood cholesterol rises, so does the risk of a heart attack.

• LDL (Low-Density Lipoprotein): Since LDL is bad cholesterol, a low level of LDL Is always preferred for a healthy heart. Unhealthy food habits (such as red meat, and diets high in saturated and trans-fats) can raise LDL cholesterol.
• HDL (High-Density Lipoprotein): It is good cholesterol and as such, a higher cholesterol level is typically better for heart health. A low level of HDL cholesterol obviously puts people at higher risk of developing heart attacks.
• Triglycerides: These are the most common type of fats in the body. Ideally, for an adult, normal triglycerides (fasting) are 10- 190 mg/ml. However, the normal level of triglycerides may slightly differ depending on age as well as gender.

A high level of triglycerides combined with a high level of LDL and a low level of  HDL cholesterol can trigger atherosclerosis which causes the build-up of fatty deposits inside the artery wall inviting the risk of a heart attack in addition to stroke.

7.2.2.3) Diabetes: It is a life-threatening disease that increases the risk of developing cardiovascular diseases including heart attack.

The normal blood glucose for a non-diabetic adult is 3.33-  6.11 mm ol/L (fasting). The glucose level for a non-diabetic adult (not fasting) is below 8.8 mm ol/L.

Blood glucose is the body’s main source of energy. But blood glucose can only enter cells provided there is insulin in the bloodstream. Without insulin, the cells would starve, After we eat, blood sugar concentration rises

7.2.2.4) Other risk factors

Obesity:

Before discussing the harmful effects of obesity in inviting the risk of heart attack, it seems essential to highlight the relevant concept of ideal and healthy weight (in contrast to unhealthy weight which includes: obesity/ overweight /underweight).

Ideally, weight is measured by BMI (Body Mass Index = W/H2.  Where: W = weight in kg and H2 = squire of height in meters). Taking an instance of height (1.7  meters), the related BMI for different body weights is:

• BMI = 20- 25 (for an ideal weight)
• BMI = 25- 30 (for an overweight)
• BMI =  over  30  (for an obese)
• BMI =  below  5 (for an underweight)

In the case of the obese, people have excessive body fat – especially, at the waist. They are more likely to develop heart disease including heart attack and stroke. Even if other risk factors are totally  absent, a single risk factor like obesity is strong enough to invite a traumatic heart attack

Unhealthy diets:

A healthy diet means a healthy life. Similarly, an unhealthy diet (in utter disregard of aging and other health problems) if taken regularly and indiscriminately, will simply invite other controllable risk factors (such as High blood pressure/ bad cholesterol of high amount/diabetes/ obesity, etc).

Physical inactivity:

A sedentary inactive life will seriously activate the risk factors for heart attack. Regular moderate physical activity helps to reduce the risks of cardiovascular diseases including heart attack.

Stress:

Stress is a major risk factor for heart attack. People under stress, are normally found addicted to smoking and alcohol. (or they may smoke and drink more than before when they were free from stress and anxiety).

Alcohol:

Addiction to alcohol is a great risk factor for any malignancy and for any age. Additionally, this expensive bad habit has no social and religious recognition.

Smoking:

Therefore smoking is the gateway for most of the malignancies to enter mightily. Smoking invites early death At least  1 person dies every 10 seconds somewhere in the world only due to smoking-related diseases including heart attack (source: the World Health Organization, 2010).

8. Heart Attack Treatments

8.1) Procedures applied

The following treatment procedures are applied to bring heart attacks under control.

• Angioplasty: It is a special tubing with an attached deflated balloon that is threaded up to the coronary arteries.
• Angioplasty Laser: It is similar to angioplasty except that the catheter has a laser tip that opens the blocked artery
• Artificial; heart valve surgery: The procedure involves the replacement of an abnormal or diseased heart valve with a healthy one.
• Atherectomy: It is similar to angioplasty except that the catheter has a rotating shaver on its tip to cut away the plaque from the artery.
• Bypass surgery: The procedure treats the blocked heart arteries by creating new passages for blood to flow to the heart muscles.
• Cardiomyoplasty: It is an experimental procedure in which skeletal muscles are taken from the patient’s back or abdomen.
• Heart transplant: The treatment procedure removes a diseased heart and replaces it with a donated human healthy heart.
• Minimally invasive heart surgery: The procedure is an alternative to standard bypass surgery.
• Stent procedure: It is a wire mesh tube used to prop and open an artery during angioplasty.
• TMR (Trans-myocardial Revascularization): It is a laser used to drill a series of holes  (into the heart’s pumping chamber) from the outside of the heart.
• Radiofrequency ablation: The procedure involves a catheter with an electrode at its tips (which is passed through the veins into the heart muscle).to carefully destroy the selected heart muscle cells in a very small area.

8.2) Types of medications

Heart attack treatment includes a variety of drugs. The doctor will recommend the best combination of heart attack medicines depending on age/specific health problems and other conditions.

• Anticoagulant: It is used to treat the heart, certain blood vessels, and lung conditions.
• Antiplatelet agent: The drug is used to prevent the formation of blood clots. Further, the drug prevents the blood platelets from sticking together.
• ACE (Angiotensin Converting Enzyme): The drug expands the blood vessels and reduces resistance by lowering the levels of angiotensin- 2. It allows blood to flow more easily and makes the heart more active to function easily.
• Angiotensin- 2  Receptor Blocker: The drug, (unlike lowering the level of angiotensin 2 as an ACE inhibitor) prevents the chemicals from having any adverse effect on the heart and the blood vessels. This halts the blood pressure from going up.

Conclusively, high blood pressure is injurious to heart health.

• Angiotensin Receptor Neprilysin Inhibitor: It is an enzyme that breaks down natural substances in the body that widen narrowed arteries. By inhibiting neprilysin (also known as “Membrane Metellio  Endopeptidase“), these natural substances can operate their normal functions. The drug helps:  improve the artery openings/ ease blood flow /reduce sodium (salt) retention/decrease strain on the heart.
• Beta Blocker: The drug normalizes the heart rate and reduces the impact of cardio attacks.  Additionally, the drug brings high blood pressure under control and makes the heartbeat normal without exerting any additional stress on the heart.
• Combined Alpha and Beta Blockers: These are used as an intravenous drip for patients experiencing a hyper-intensive crisis. They usually apply in the case of the outpatients (It refers to the patient who attends a hospital for treatment without staying there overnight) having high blood pressure as well as heart failure.
• Calcium Channel Blockers: The drug interrupts the movement of calcium into the cells of the heart and blood vessels which exerts a salutary impact on blood flow.
• Cholesterol-lowering Medications: Initially, the drug statins are used to lower high blood cholesterol. But if the condition is not improving and additionally, serious side effects crop up, then other options apply.
• Digitalis: It is a drug to treat congestive heart failure and heart rhythm problems.
• Diuretics: The drug causes the body to rid itself of the excess fluids and sodium through urination. The excretion of urine and excess fluids helps relieve the heart’s workload. Additionally, the drug reduces the build-up of fluid in the lungs and other parts of the body (such as ankles and the legs). Different diuretics remove the fluids at varied rates and through different methods.
• Vasodilator: The drug relaxes the blood vessels and increases the supply of blood and oxygen to the heart and consequently reduces the workload borne by the heart. The drug is available as pills to swallow and tablets to chew.

8.3) DAPT (Dual Anti Platelet Therapy)

Heart attack/ patients treated with stents in their coronary arteries/patients who undergo CABG (Coronary Artery Bypass Graft) surgery are treated at the same time with 2 types of antiplatelet agents to prevent blood clotting.

One antiplatelet agent is aspirin. Almost everyone with coronary artery disease (including those who have had a heart attack/ stent/CABG) is treated with this aspirin throughout the rest of their lives. In addition to aspirin, the 2nd type of anti-platelet agent (P2Y12 inhibitor) is usually prescribed for months or years.

There are 3 P2Y12 inhibitors that doctors prescribe. These are: Clopidogrel /Presugrel /Ticagrelor. Studies show that the 2 drugs (Prasugrel /Ticagrelor) are stronger than Clopidogrel and are considered a bit better in reducing the complication of blood clots.

8.4) Home Remedy

The patient who has been hit by the 1st heart attack should always remain alert to prevent the 2nd attack. As such, of the 2  Hs (Home and  Hospital), the home should always be well equipped with emergency treatment facilities, notably, with emergency medicine under the advice of a specialist. Research studies show that most heart attacks in general hit in the morning hours  (4 AM- 10 AM). And the sufferer is most likely to stay at home during this time. The emergency need at home during the time will be to chew or swallow an aspirin (unless one has an allergy, or has been advised by the doctor never to take it)

Conclusively, aspirin reduces blood clotting and helps monitor blood flow through the narrowed arteries.

9. Key global information

• Research studies show that on average, 50%- 75% of patients survive after the 1st attack.
• After surviving the 1st attack, 20% of them (age 45 years and over) are likely to experience the 2nd attack within 5 years after the 1st.
• Death on account of heart attack mostly occurs after 65 years.
• Globally, heart disease (including heart attack) is the 2nd  leading cause of death (followed by cancer).
• At least 68% of diabetic patients (over 65 years) die of heart disease (including heart attack).
• Heart attack is rarely fatal, but a sudden cardiac arrest is fatal in 95% of cases.
• In general, Africans, Americans, and Hispanics (as compared to Caucasians) are more likely to develop heart attacks on account of the highly prevailing risk factors: high blood pressure and obesity.                                                                                                   
• Every year in the USA approximately 1.5 million people are hit by heart attack (including stroke) and among them, more than 50% die.

10. Concluding remark

10.1) Heart attack is a frightening and terrible experience for those who have survived the 1st attack and it should be 1st priority for them not to wait for the 2nd. After treatment, the patient is likely to receive advice and instructions from the doctor pertaining to lifestyle in general and food habits in particular. All the “DO’s and Don’ts” as prescribed by the specialist should be meticulously followed in order to escape the 2nd attack which might be more dangerous and life-threatening.

10.2.) Although aging is a great risk factor for heart attack, it may arrive at any time without warning signs (common symptoms). Research studies show that multiple risk factors arrive after age 40. In some cases, it may arrive much earlier. Veritably, a young age with a young mind and youthful happy moments, cannot be a guarantee against a heart attack which sometimes arrives suddenly and mightily. Therefore, people having major risk factors (notably,  heredity paired with obesity), should regularly consult physicians along with diagnostic test results (even if no symptom is apparently experienced by them).

Conclusively, the “Wait and see approach” invites only time killing that may kill the waiter.

11. TIPS

• H = HEART (the attack  is one of the most frightening diseases)
• E = ECG (is an important test for diagnosing heart attack)
• A = AFTER (the 1st  heart attack, never wait for the 2nd)
• R = RISK (for heart attack is higher in case of high blood pressure patients)
• T = TESTS(for diagnosis are broadly classified into the invasive and non-invasive tests)
• A = ACUTE (a coronary syndrome is another medical term for heart attack)
• T = TIME (should never be wasted even if a heart attack is mild)
• T = TREATMENT (procedure depends on age, specific health problems, and other conditions)
• A = ARRIVAL (heart attack is sudden and intense in some cases)
• C = CHEST (pain on the left side is not necessarily a heart attack, yet it should not be ignored)
• K = KEY(symptoms are: discomfort in the chest and other areas/shortness of breath/ nausea)