HEART ATTACK: OUR NEW EPIDEMIC!

Kenny walked into the accident and emergency area in a city hospital on a Monday morning. He had noted vague chest discomfort during the night but ignored it. He did not sleep very well and by morning, his wife was concerned. He did not think it warranted a hospital checkup but his wife prevailed on him to pass by for a quick review on his way to the office. He knew she wouldn’t let him rest until he had been examined.

Every Monday, Kenny’s office had a scheduled strategy meeting to start the week and it started promptly at 8.00a.m. He opted to attend the meeting first then go to the hospital afterwards. The doctor who reviewed him found a healthy 38 year old gentleman who was mildly overweight based on his body mass index calculation, with borderline blood pressure, but who otherwise appeared healthy. He made a tentative diagnosis of upper oesophageal reflux disease (a condition where the opening at the junction of the food pipe and the stomach is a bit loose and acidic stomach contents move up the food pipe causing discomfort).

Most emergency rooms have a tendency of having a higher than average number of young men seeking care on Monday mornings for non-specific complaints, mostly in an effort to squeeze a sick note out of the doctor so as to go home and nurse the weekend hangover. It was easy to dismiss Kenny into that category but he appeared quite alert and did not have any alcohol breathe. Taking the cautious path, the doctor ordered for an electrocardiogram of Kenny’s heart and blood samples to check out his cardiac enzymes.

Kenny opted to walk back to the office and get some work done while his lab tests ran. 45 minutes later, as the doctor walked to the tea room for a break, the nurse beckoned him to the phone. The lab technologist was breathless on the phone asking about Kenny. He could not believe the results because Kenny had walked to the lab, yet his enzymes were hitting the roof. Kenny was having a heart attack!

The doctor quickly called Kenny and was relieved to hear him respond to the call in person. He ordered him not to leave his desk as the hospital dispatched an ambulance to collect him from the office. Kenny was wheeled to the high dependency unit heavily protesting. He could not comprehend how close he was to death yet he felt just fine. His wife was overwhelmed.

Kenny was the talk of the doctors’ tea room for days. He was a classic case of near miss. He did not exhibit any overt risk factors for a heart attack yet here he was, hooked onto monitors, wondering what would become of him. He mostly ate right, drank little, worked out at least three times a week and preferred to walk instead of driving, whenever he could. Yet here he was, sharing a room with people who looked like they needed to be in the HDU, when he clearly felt it was a case of mistaken identity.

Serial blood tests showed a rise then a steady decline of his enzymes as he responded to treatment. His wife could not understand why Kenny would have a heart attack. She broke the cardinal rule, she underestimated the power of genetics. Heart attacks have a demonstrated a strong familial tendency, backed by research. This means that for people who have lost family members to heart attacks, they have an increased risk of developing heart attacks themselves. Throw in high blood pressure, high cholesterol and smoking you have a perfect recipe for disaster. Kenny may have stayed on the straight and narrow but he had lost his father to a heart attack and his uncle had suffered a stroke.

He couldn’t thank his wife enough for nagging him to get to hospital. Her persistence saved his life. He has learnt that in lifestyle diseases, there is no common denominator. His best friend Alvin has lived his life on the fast lane, always the party animal, drinking, smoking and filling up on all manner of unhealthy foods, has never set foot in a gym and drives everywhere, even to the gate to pick the paper on Sunday, yet he is as fit as a fiddle at his annual medical checks. Alvin always jokes that he will leave a good looking corpse.

At younger ages, heart attacks are more prevalent among men than women. This may be attributed to the protective function of oestrogen during the reproductive age. However, with advanced age, women catch up and in America for instance, they have even surpassed men since 1984. This could be because on average, women live longer than men.

We may be a developing country but our heart attack rates are skyrocketing at an alarming rate. This is in part due to improved diagnosis but also largely as a result of our changing lifestyles and food consumption.

What is troubling though is that our emergency response to heart attacks is not up to speed. One could have a heart attack right in the middle of an emergency room in the hospital and still die as most emergency rooms are not well equipped, vital life-saving drugs are not available and most health workers are not trained in acute cardiac life support. To top it off, we do not have adequate critical care services to cater for the population.

As dietary fads continue to take centre stage among our middle class, it is well worth noting that all the raw spinach juice in the world will not protect you from a heart attack if you do not mind the rest of your lifestyle and have a proper annual medical checkup. Every individual must have their individual risk assessment done and advised accordingly.