By Dr Talat Khan
A heart attack, or myocardial infarction, happens when a part of the heart muscle does not get enough blood. If there is delay in treatment to restore blood flow, the damage to the heart muscle occurs to a greater extent. According to data provided by the Indian government, there was a significant 12.5 per cent rise in heart attack cases in 2022 alone. The latest 'Accidental Deaths and Suicides in India' report by the National Crime Records Bureau indicated that 32,457 individuals succumbed to heart attacks in 2022, a notable increase from 28,413 deaths due to heart attacks in year prior.
Women are susceptible to heart attacks at an early age. Post the Covid-19 pandemic, people’s lifestyle habits have changed. They are leading a more inactive lifestyle. This is being correlated with the increased incidence of heart diseases.
A diet consisting of high salt, coupled with smoking, stress, inactive lifestyle, and insomnia, increases the risk of having heart attacks.
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Causes of heart attack
A heart attack occurs as a result of reduced oxygen-rich blood supply to the heart muscle. This may happen due to the presence of plaque in coronary arteries (atherosclerosis). A blood clot forms when plaque in a heart artery breaks open and blocks the blood flow. As it stops blood flow to the heart muscle, the muscle begins to die. The longer an artery stays blocked, the higher the damage. This can result in permanent heart damage.
The degree of damage to the heart depends on the area supplied by the blocked artery and the time spent in between injury and treatment. The blocked artery should be opened as soon as possible to reduce heart damage.
Symptoms of heart attack
The symptoms of a heart attack are quite variable. These include chest pain (pressure, tightness, pain, squeezing or aching), pain or discomfort that spreads to different parts of body (shoulder, arm, back, neck, jaw, teeth, upper belly), excessive sweating, fatigue, acidity, dizziness, nausea, and shortness of breath.
Women may have atypical symptoms such as pain in the left shoulder or arm, neck pain and backache. Unfortunately, the first symptom sign of a heart attack is cardiac arrest.
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Screening
The risk factors for cardiovascular disease are older aged males with hypertension, diabetes, and dyslipidemia. Sometimes, the initial symptom is heart attack itself in asymptomatic individuals, making screening more important.
The Framingham risk score is a well-characterised risk assessment tool recommended as a first step in coronary risk assessment for screening all individuals. By including risk factors such as age, gender, total cholesterol, LDL cholesterol, and blood pressure, mainly systolic, and tobacco smoking, a patient's risk for myocardial infarction and cardiac death can be easily estimated up to 10 years.
Newer Preventive screening and risk assessment tests
Advanced biomarker research and development related to cardiovascular diseases in the past 30 years has led to more sensitive screening methods, emphasising on early detection and diagnosis along with improved treatments resulting in favourable clinical outcomes.
Biomarkers can be grouped based on disease specificity such as biomarkers of heart failure (BNP, NT-proBNP, ANP & ST-2) and atherosclerotic coronary disease (troponin I, Troponin T, CPK-MB.
They can also be grouped according to their use in CVD, such as in acute changes (copeptin, high sensitivity Troponin, galectin-3, ST2) and chronic stage of CVD to estimate prognosis (coronary calcium by CT).
Higher concentration of BNP is associated with greater probability of a diagnosis of heart failure. Circulating ANP on the other hand is overall more unstable in blood compared to BNP or NT proBNP and therefore, has a limited use in diagnosis or prognosis.
Cardiomyocyte necrosis releases Troponin I or T (cardiac isomers of proteins from troponin-tropomyosin complex) in the circulation of an individual and they are typically useful in the detection of myocardial ischemia.
High sensitive Troponin T and troponin I are also elevated in patients with severe heart failure and hence, studied for the prediction of heart failure. Copeptin levels are elevated in the immediate post-ischemic period and also correlate with increased risk of mortality and new-onset heart failure.
ST-2 is a receptor from the interleukin family. Levels of blood ST-2 markers are also shown to predict risk of deaths and of new onset heart failure. Small non-coding RNAs that are microRNAs play a significant role in regulation of cardiac hypertrophy, fibrosis and heart failure.
Genetic biomarkers are the future of predictive testing due to their utility, coexistence with cardiovascular diseases, and an advantage over traditional risk factors.
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Conclusion
Dr Jacqueline Tamis-Holland quoted “Time is Muscle. The sooner you start treatment, the better the outcome”. Post diagnosis of a heart attack, the risk of a reinfarction for the next five years is 13 per cent for men and 40 per cent for women. Golden hour, which refers to the first 60 minutes of symptoms, is decisive and useful for rapid treatment so that further heart damage can be prevented.
Utilising biomarkers as surrogate end points for predictive and prognostic values will likely dictate our future of cardiovascular events and will also open up avenues to evaluate biomarkers as possible targets for drug delivery and development.
(The author is the doctor in-charge, Medical Genetics, Metropolis Healthcare Limited).
[Disclaimer: Information provided in this article is for general guidance only. Individual results may vary. It is important to consult a healthcare professional, who knows your body type and medical history, before implementing the suggestions and information provided herein].