Heart Attack | symptoms, Causes, treatments
1. An overview
Before going into detailed discussion on relevant aspects related to heart attack, it is essential to highlight the definition, location, function, importance and other key issues concerning 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 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 mid-line with the apex pointing toward the left side.
This is because the heart points to the left and 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 the 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 case of the adults, the size of heart is about 2 times of the fist.
So far as the heart beat 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 heart beat 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 sweet heart 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 heart, rightly signify the indispensability of heart to survive for humans.
2. Heart attack
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 death of a brain cell due to lack of oxygen caused by the blockade 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's (irregular heart rhythms) / heart failure / hart 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) / cardio-myopathy (heart muscle disease) etc.
Conclusively, most of the 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 on 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 synonym. In fact they are different on the following grounds.
3.1) A heart attack is a circulation problem which 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 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 which 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 it severely reduces blood flow.
- Myocardium: It implies the death or damage of an area of a heart muscle resulting from blocked blood supply to that area.
- Coronary thrombosis: It implies the formation of a clot in one of the arteries that supplies blood to the heart muscle.
5. Potential Complications
The most common complications following damage to the heart in the wake of heart attack are stated below:
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 which 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 occurring. 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 breath, 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- it is a condition where electrical signals are unable to travel from one side of heart to other, so that the heart can’t pump blood properly / ventricular arrhythmias- it 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 during 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 blood needed to maintain most of the body functions. Symptoms include: mental confusion /cold hands and feet / reduced or nil urine output/rapid heart beat /rapid breathing with difficulty/ pale skin.
Conclusively, once the initial symptoms of cardio -genic 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 the 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 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. And diagnosis is identifying the root problem through applying various tests, observing symptoms as well as interrogating the patient about his feelings, life style , notably the food habits and finally recording the genetic and personal history pertaining to the disease.
6.1) Heart attack Symptoms
Some heart attack are intense and arrive all on 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, 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 does 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 make 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 the physicians diagnose and treat the disease.
- CCT (Cardio-computed Tomography): It is a non-invasive test that uses X- rays to make picture of the heart. Modern CT scanners can work very fast and examine in details. They can take images of the heart beat 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 to diagnose 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, pulse rate during the test.
- EST (Exercise Stress Test): It is also known as 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 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/or neck/or arm) and threaded through the blood vessels running up to the heart. During the test blood pressure as well as the 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 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, heart muscle needs oxygen to survive. A heart attack occurs when the blood flow (that brings oxygen to 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 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 heart attack) that 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). And the heart muscle is starved of oxygen and nutrients when a part of the heart becomes numb and damaged. The ultimate result is 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 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 regular basis. Because, if aging is paired with unhealthy sedentary life style (such as, unhealthy and junk foods and drinks loaded with excessive amount of sugar, salt and unhealthy fats, in addition to physical inactivity as well as smoking and alcohol), then the risk of heart attack becomes too high.
- Gender: Males in general have higher risk of heart attack and additionally, they develop heart attack much earlier in life (as compared to female)
- Heredity including race): Children of parents (having heart disease) are more likely to develop heart disease themselves in course of time. Additionally, the Africans/Americans/Hispanics (as compared to the Caucasians) have 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
- 184.108.40.206) 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 indicated diastolic blood pressure). Higher the blood pressure, higher is the risk of 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)
- 220.127.116.11) High blood cholesterol: As blood cholesterol rises, so does the risk of heart attack.
Since LDL is a bad cholesterol, a low level of LDL Is always preferred for healthy heart. Unhealthy food habits (such as red meat, diets high in saturated and trans-fats) can raise LDL cholesterol.It is a good cholesterol and as such, higher cholesterol level is typically better for heart health. Low level of HDL cholesterol obviously puts the people at higher risk to develop heart attack.These are the most common type of fats in the body. Ideally, for an adult, normal triglycerides (fasting) is 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 high level of LDL and low level of HDL cholesterol can trigger atherosclerosis which causes the build up of fatty deposits inside the artery wall inviting the risk of heart attack in addition to stroke.
- 18.104.22.168) 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). And 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 blood stream. Without insulin, the cells would starve, After we eat, blood sugar concentration rises
22.214.171.124) Other risk factors
Before discussing the harmful effects of obesity in inviting the risk of heart attack, it seems essential to highlight the relevant concept 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 meter). Taking an instance of height (1.7 meters), the related BMI for different body weight is:
a) BMI = 20- 25 (for an ideal weight)
b) BMI = 25- 30 (for an overweight)
c) BMI = over 30 (for an obese)
d) BMI = below 5 (for an underweight)
In 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 the traumatic heart attack
126.96.36.199.2) 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 cholester of high amount/diabetes/ obesity etc).
188.8.131.52.3) 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 cardio vascular diseases including heart attack.
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).
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.
Therefore smoking is the gateway for most of the malignancies to enter mightily. Smoking invites early death At least 1 person dies in 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 apply to bring heart attack under control.
- Angioplasty: It is a special tubing with an attached deflated balloon which 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 deceased 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 artery.
- By pass surgery: The procedure treats the blocked heart arteries by creating new passages for blood to flow to the heart muscles.
- Cardio-myoplasty: 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.
- Radio frequency 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.
8.2.1) Anticoagulant: It is used to treat the heart, certain blood vessels and lung conditions.
8.2.2) Anti platelet agent: The drug is used to prevent the formation of blood clots. Further, the drug prevents the blood platelets from sticking together.
8.2.3) 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 make the heart more active to function easily.
8.2.4) Angiotensin- 2 Receptor Blocker: The drug, (unlike lowering the level of angiotensin 2 as 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.
8.2.5) Angiotensin Receptor Neprilysin Inhibitor:
It is an enzyme that breaks down natural substances in the body that widens narrowed arteries . By inhibiting neprilysin (Aso 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.
8.2.6) Beta Blocker: The drug normalizes the heart rate and reduces the impact of cardio attack. Additionally, the drug brings the high blood pressure under control and makes the heart beat normal without exerting any additional stress on the heart.
8.2.7) Combined Alpha and Beta Blockers: These are used as intravenous drip for the patients experiencing hyper intensive crisis. They usually apply in 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 hart failure.
8.2.8) Calcium Channel Blockers: The drug interrupts the movement of calcium into the cells of the heart and blood vessels which exerts salutary impact on blood flow.
8.2.9) Cholesterol lowering Medications: Initially, the drug statins are used to lower high blood cholesterol. But if the condition is not improve and additionally, serious side effects crop up, then other options apply.
8.2.10) Digitalis: It is a drug to treat congestive heart failure and heart rhythm problem.
The drug causes the body to rid itself of the excess fluids and sodium through urination. The excretion of urine and excess fluids help 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.
8.2.12) Vasodilator: The drug relaxes the blood vessels and increases the supply of blood and oxygen to the heart and consequently reduces the work load 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 treats with stents in their coronary arteries/patients who undergo CABG (Coronary Artery Bypass Graft) surgery, treats at the same time with 2 types of anti-platelet agents to prevent blood clotting.
- One anti-platelet agent is aspirin. Almost everyone with coronary artery disease (including those who have had a heart attack/ stent/CABG) are treated with this aspirin throughout the rest of their lives. In addition to aspirin, a 2nd type of anti-platelet agent (P2Y12 inhibitor) usually prescribe for months or years.
- There are 3 P2Y12 inhibitors that doctors prescribe. These are: Clopidogrel /Presugrel /Ticagrelor. Studies show that the 2 drugs (Presugrel /Ticagrelor) are stronger than Clopidogrel and consider a bit better in reducing the complication of blood clots.
8.4) Home remedy
The patient who has hit by the 1st heart attack, should always remain alert to prevent the 2nd attack. As such, of the 2 Hs (Home and Hospital), 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 attack in general, hit in the morning hours (4 AM- 10AM). And the sufferer is most likely to stay at home during the time. The emergency need at home during the time will be to chew or swallow an aspirin (unless one has 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% patients survive after the 1st attack.
- After surviving the 1st attack, 20% of them (having 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 occur after 65 years.
- Globally, heart disease (including heart attack) is the 2nd leading cause of death (followed by cancer).
- At least 68% diabetic patients (over 65 years) die of heart disease (including heart attack).
- Heart attack is rarely fatal, but sudden cardiac arrest is fatal in 95% cases.
- In general, the Africans, Americans and the Hispanics (as compared to the Caucasians) are more likely to develop heart attack on account of the highly prevailing risk factors: high blood pressure and obesity.
- Every year in USA approximately 1.5 million people hit by heart attack (including stroke) and among them more than 50% die.
10) Concluding remark
10.1) Heart attack is a frightening and a terrible experience to 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 habit in particular. All the “DO’s and Don’ts” as prescribed by the specialist should meticulously follow 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, still it may arrive at any time without warning signs (common symptoms).Research studies show that multiple risk factors arrive after age 40. In some case it may arrive much earlier. Veritably, young age with young mind and youthful happy moments, cannot be a guarantee against the heart attack which sometimes arrive suddenly and mightily. Therefore, for the people having major risk factors (notably, heredity paired with obesity), they should regularly consult a physicians along with diagnostic test results (even if no symptom is apparently experienced by them).
Conclusively, “Wait and see approach” invites only time killing that may kill the waiter.
- H= HEART ( 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 invasive and non-invasive test)
- A= ACUTE (coronary syndrome is another medical term for heart attack )
- T= TIME (should never be wasted even if heart attack is mild )
- T= TREATMENT (procedure depends on age, specific health problems and other conditions)
- A= ARRIVAL (of heart attack is sudden and intense in some cases)
- C= CHEST (pain on left side is not necessarily a heart attack, yet it should not be ignore)
- K= KEY(symptoms are: discomfort in the chest and other areas/shortness of breath/ nausea)-