The clock ticks away in a heart attack. Doctors have dubbed the first three hours of its occurrence the 'golden hours' if the all-important heart muscle is to be saved.
Few people expect to have a heart attack. However, it can happen to anyone, coming out of the blue - a nauseous sensation, a crushing feeling in the chest, then gasps for air.
A heart attack heralds the impending death of the heart muscle, when the flow of oxygen-carrying blood - supplied by the coronary artery - is suddenly blocked.
Preceding this event, the coronary artery would already have become narrowed by plaque build-up from cholesterol and fats. All it takes is a sudden blood clot formation on top of the plaque to deliver the final blow.
The part of the heart that is 'blocked' then dies due to a lack of oxygen. It is this lack of oxygen that causes the crushing chest pain that accompanies a heart attack.
Within the first three hours of an initial attack, the heart muscle can still be saved by an emergency procedure - ballooning and stenting - to keep the coronary artery open.
If this can be done, there is a 95 per cent chance of survival. Hence the chance of death within three hours of having this procedure is less than 5per cent.
A delay of six hours can mean the chance of death leaping to 18 per cent.
During this emergency procedure, an angioplasty is performed in which a catheter and balloon are used to open up the artery. A stent is then inserted to keep the artery open.
As emphasised, all this must ideally be done within three hours.
My most recent patient, Mr L, a 36-year-old businessman, is a few kilograms overweight. He does not smoke and has no history of heart disease in his family.
He has a health check every year and, aside from elevated cholesterol levels, has a clean bill of health.
Ironically, he was on his way to the gym when he had a heart attack.
Wisely, Mr L went straight to a hospital when he broke out in cold sweat and experienced 'stuffiness' in his chest. He told me he had no idea he was having a heart attack but he somehow knew he needed attention.
Within an hour of reaching the hospital, he had that life-saving operation.
That was Step One. Mr L will, from now on, need cardiac rehabilitation, which includes dietary advice to get his weight down, stress management, an exercise regimen and medication to deal with his cholesterol levels.
We see 1,200 heart attack patients per year at the National University Hospital. About 350 are the classic 'sudden attacks', as Mr L had, requiring immediate intervention.
Other heart attacks are so small only a blood test can show them up.
Many factors, including where the blockage occurs and how extensive the damage to the heart is, determine the extent of the attack.
When the balloon angioplasty clears the blockage in the heart, seeing a patient being relieved of pain is the most satisfying part of my job. It is what drives my team of five, when we find ourselves rushing to the hospital to help a heart attack patient, whether it is 3pm or 3am.
Team effort is required for the heart intervention procedure. The best results come from practice and experience.
However, not every patient is as lucky as Mr L. I operate on 250 patients a year, of which 20 per cent are emergency cases.
Of this 20 per cent, I will lose one patient because the heart has been irreparably damaged. That is why it is so important to seek treatment as soon as you suspect you are having a heart attack.
Every heart attack patient says he or she has had a 'wake-up call' and promises to change his or her lifestyle. Mr L told me he will do so a few hours after his operation. I hope he sticks to his promise to take better care of his health.
Sadly, many revert to their old habits of eating badly, smoking, not exercising and living a stressful life.
Community-based support groups can help keep bad habits at bay.
The Singapore Heart Foundation has cardiac rehabilitation facilities at the community level. Heart attack survivors should volunteer to form support groups at these facilities throughout the country.
Support from such survivors can help others recover quickly from the traumatic event. A rehabilitation programme after a heart attack also helps one to learn more about the disease and prevent its recurrence.
Through frequent sharing sessions and participation in rehabilitation exercises and activities together, bonds are forged and this can be very useful in the physical and mental recovery of patients.
Adjunct Associate Professor Tan Huay Cheem is the director of the National University Heart Centre Singapore, located in National University Hospital. He has been performing angioplasty on heart attack patients for 12 years. He was the president of the Singapore Cardiac Society from 2003 to 2005.
This story was first published in Mind Your Body, The Straits Times, on Jan 8, 2009.
