Recognising possible heart-attack warning signs

If you suspect a heart attack, act immediately

Do not wait to see if it passes. Every minute without blood flow costs heart muscle. If you or someone near you may be having a heart attack:

• 01
  Stop what you are doing. Sit or lie down straight away — do not keep working, walking or driving.
• 02
  Call our 24/7 emergency line. +234 806 142 4614 is staffed around the clock — tell us what is happening and that you are coming.
• 03
  Unlock your door. So that anyone coming to help — family, a neighbour, emergency personnel — can reach you if you become unable to move or answer.
• 04
  Chew 300 mg aspirin, if you are not allergic to it. Chewing (rather than swallowing whole) gets it into the bloodstream faster; it can help limit clot formation while you get to hospital.
• 05
  Do not drive yourself. Have someone else drive you, or go by ambulance — a heart attack can cause sudden collapse or a dangerous rhythm without warning.

Go to the nearest emergency department immediately. This advice holds even if you are not certain — it is always safer to be assessed and found well than to wait at home.

Understanding a heart attack

A heart attack (myocardial infarction) happens when blood flow to part of the heart muscle is suddenly and severely reduced or cut off, usually because a fatty deposit (plaque) inside a coronary artery ruptures and a blood clot forms over it, blocking the artery. The heart muscle downstream of the blockage is starved of oxygen and, if flow is not restored quickly, begins to die. Muscle that dies does not grow back — which is why speed matters so much: "time is muscle."

The coronary arteries are the heart's own blood supply, running over its surface and feeding the muscle that pumps blood to the rest of the body. A blockage in one of them is different from a blockage elsewhere — it directly threatens the pump itself, which is why heart attack symptoms can also affect breathing, blood pressure and consciousness.

What a heart attack may feel like

Symptoms vary between people, and some are easy to dismiss as something else. These are common descriptions, offered to help you recognise a possible heart attack quickly — not a checklist to work through calmly before acting.

• ●Central chest pressure, tightness, squeezing, fullness or pain that may come and go or stay constant
• ●Discomfort spreading to an arm (often the left), the back, neck, jaw or upper abdomen
• ●Shortness of breath, with or without obvious chest discomfort
• ●Cold sweat, nausea, vomiting, light-headedness or a sense of impending doom
• ●Unusual, unexplained fatigue, sometimes for hours or days before other symptoms

Symptoms differ in women and in people with diabetes

Chest pain is the best-known warning sign, but it is not the only one, and relying on it alone causes dangerous delays for two large groups of patients.

Women having a heart attack more often have little or no classic chest pain. Instead, the leading symptoms may be shortness of breath, unusual fatigue, nausea, indigestion-like discomfort, or pain in the back, jaw, neck or one or both arms. Because these symptoms overlap with less serious everyday complaints, they are frequently put down to stress, indigestion or tiredness — and the heart attack is recognised later than it should be.

People with diabetes can have long-standing nerve damage (neuropathy) that blunts pain signals, including pain from the heart. A heart attack in someone with diabetes may cause little or no chest pain at all — a "silent" heart attack — presenting instead as breathlessness, unexplained sweating, sudden weakness, nausea or vomiting, or a general sense of being unwell. Anyone with diabetes who feels suddenly and unaccountably unwell should be assessed urgently, chest pain or not.

What causes a heart attack

Almost all heart attacks come from the same underlying process, building up over years before the sudden event.

Coronary artery disease

Fatty deposits (plaque) build up gradually inside the walls of the coronary arteries, a process called atherosclerosis. Plaque narrows the artery over time, but a heart attack usually happens suddenly, when a plaque's surface cracks or ruptures and the body's clotting system reacts to the injury, forming a clot that blocks the artery abruptly — often in an artery that was not even the most narrowed one beforehand.

Other, less common causes

• ●A coronary artery spasm, which temporarily cuts off blood flow without a fixed blockage
• ●A spontaneous tear in the artery wall (dissection), more often in younger patients
• ●A blood clot travelling from elsewhere in the body and lodging in a coronary artery
• ●Severe oxygen shortage from another cause (major bleeding, severe anaemia, dangerously low blood pressure) overwhelming an already narrowed artery

Who is more likely to have a heart attack

Risk factors add up — the more a person has, the higher the risk, and several are especially relevant in Nigeria:

• ●High blood pressure — very common in Nigeria and often undiagnosed, it damages artery walls over years
• ●Diabetes — damages blood vessels and can mask warning symptoms
• ●High cholesterol
• ●Smoking or tobacco use of any kind
• ●Obesity and low physical activity
• ●A family history of heart attack or early heart disease
• ●Increasing age
• ●Chronic kidney disease
• ●Long-standing stress, poor sleep and heavy alcohol use

What happens if a heart attack goes untreated

The longer an artery stays blocked, the more heart muscle is lost, and the higher the risk of serious complications.

Heart failure. Muscle that has died can no longer contract; if enough is lost, the remaining heart muscle may not pump strongly enough for the body's needs.

Dangerous rhythm disturbances. Damaged heart muscle is electrically unstable and can trigger a chaotic rhythm (ventricular fibrillation) that stops effective pumping — the main reason sudden death can occur in the first hours of a heart attack, and why emergency care must not be delayed.

Cardiogenic shock. Rarely, damage is severe enough that the heart cannot maintain blood pressure and blood flow to vital organs, a life-threatening emergency requiring intensive care.

Mechanical complications. Uncommonly, damaged heart muscle can tear or a heart valve can be affected, both needing urgent surgical assessment.

How Cardiocare investigates suspected heart attack

Suspected heart attack is assessed immediately, in parallel with the actions above — diagnosis and treatment happen together, not one after the other:

• 01
  Immediate ECG. A painless recording of the heart's electrical activity, taking minutes, that can show a heart attack in progress and helps decide how urgently treatment is needed.
• 02
  Cardiac blood tests (troponin). A blood test measures a protein released when heart muscle is damaged; it is often repeated over hours to track the pattern.
• 03
  Urgent cardiology assessment. A specialist reviews the ECG, blood results, symptoms and examination together to confirm the diagnosis and plan next steps.
• 04
  Coronary angiography. Where indicated, a catheter-based test using dye and X-ray imaging maps the coronary arteries directly and can move straight into treatment if a blockage is found.

How a heart attack is treated

Treatment aims to restore blood flow as fast as possible and then protect the heart from further damage.

Restoring blood flow

Available through Cardiocare's on-site cardiac catheterisation ("cath") laboratory:

• ●Primary angioplasty. A catheter is guided to the blocked artery, a balloon opens it, and a stent (a small mesh tube) is usually left in place to keep it open
• ●Clot-dissolving medicine (thrombolysis). Used in selected situations where angioplasty is not immediately available, to break down the clot
• ●Bypass surgery. For selected patients, particularly with multiple blocked arteries, surgery reroutes blood flow around the blockage

Medicines, by class

Alongside restoring blood flow, medicines protect the heart and reduce the risk of another event; your clinician will discuss the right choice and dose for you:

• ●Antiplatelet medicines — including aspirin, keep platelets from clumping together to form new clots
• ●Statins — lower cholesterol and help stabilise plaque in the artery walls
• ●Beta blockers — reduce the heart's workload and help protect it after injury
• ●ACE inhibitors or related medicines — support the heart's pumping function and control blood pressure

Living well after a heart attack

Recovery continues well beyond discharge, and daily choices genuinely change future risk:

• ✓Take every prescribed medicine exactly as directed, even once you feel well
• ✓Attend cardiac rehabilitation if offered — supervised, gradually increasing activity rebuilds fitness safely
• ✓Stop smoking completely, and avoid second-hand smoke
• ✓Work with your team on blood pressure, cholesterol and diabetes control
• ✓Eat a heart-healthy diet, with attention to salt, and stay physically active as advised
• ✓Know the warning signs above and act on them without hesitation, even after treatment

Preparing for your follow-up appointment

What to bring

• ✓A list of all medicines you take, including herbal and over-the-counter preparations
• ✓Discharge summaries, ECGs or angiogram reports from any emergency treatment
• ✓Your HMO card or payment details
• ✓A valid means of identification

What we will ask

What happened, when symptoms started, what treatment you received, how you have felt since, and any new or ongoing symptoms.

Questions worth asking us

• ●How much heart muscle was affected, and what does that mean for me?
• ●What is my personal risk of another heart attack, and how do we lower it?
• ●When can I return to work, driving and daily activities?
• ●Is cardiac rehabilitation available to me?