Tuesday, November 24, 2009
Kisah Benar .... Heart Attack
Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot.
Recently one of my friends suffered a major heart attack , Alhamdulillah, fortunately , he survived the ordeal and below was his true story for us as reference. No doubt that all of us will die one day, but, some experience like this is worth to be shared among us.
So here is his story…
It was late Saturday night and I was watching a documentary on Nat. Geo. Everyone had gone to bed hours earlier. My wife had been preparing to leave for her one week trip to Institute Aminuddin Baki at Genting Highland the next morning.
It started with pain around the shoulder region spreading to the arms. My neck felt very uncomfortable. It’s something I always get whenever I sit in a weird position for an extended time (in this case I am sitting where the TV is on my right side so I have to turn my head when watching) or I also gets it after hours in front of the computer. So I though, it’s because of the way I was sitting that causes it but I had only sat there for about 10 minutes. Earlier, I was sitting comfortable with the TV straight. So I decided I should just go to bed. After all its already about 1:30 in the morning. Normally, lying flat on the bed helps as I have done so many times after sitting for hours in front of a computer.
Just as I was going up the stairs, I started to feel a little dizzy and my stomach feels weird and warm. When I got in the bedroom, the a/c was on and it was quite cool. I lie down on the bed. Minutes later I started to sweat- cold sweat. The sweating was so bad that it started dripping from my head and the back of my ears. My stomach feels like I have eaten too much (I did not really ate a lot that night…it just felt that way). It feels as if it I am having a bad case of indigestion and heartburn. Minutes later I started to feel like I am going to puke. It’s the same feeling when you get a severe headache, sweat and feels like you are going to vomit (but this time no headache).
I got up, went downstairs and grab myself minyak cap limau. I always keep this handy for stomach discomfort or “angin”. The sweating is getting worst and as I sat on the sofa, sweat started to drip on to the floor. There was so much of it that my shirt is all wet so I took it off and put my shirt on the floor where the sweat was dripping.
I drank a glass of warm water and decided to go back to the bedroom. The dizziness is still there. My arms felt numb all the way to my fingers. I thought if I could get some sleep then all of these would go away. So I lie down on the bed. I was so sleepy that in between awake and sleep I could tune to my heart beat. It sounded weird, irregular. At this point my breathing was very heavy. The warm in my stomach feels like its moving up to the chest area.
I keep thinking and trying to figure out what was going on. Is it just “angin” or indigestion or is it due to food poisoning.
I got up, went to the toilet and tried to make myself puke but couldn’t. So I came back into the bedroom and sits at the edge of the bed. My face was already very pale, I feel very tired and the sweating was still very bad, dripping on the floor . Still sitting on the edge of the bed and feeling very tired and sleepy, I remember asking my sister in law a year earlier about the symptoms she had when she had a heart attack and it seems all the symptoms are there. I still could not believe that I am having a heart attack.
About half an hour had passed and I am still about 50-50 whether to wake up and inform my wife. Then I thought…if this is really a heart attack, then I could die tonight. I thought of my lovely wife and my kids and finally decided to wake my wife up and inform her what is going on. She was surprised to see my shirt was all wet and my face very pale and sweat dripping. I told her that the symptom I am having is very much like the one her sister had told me and that we should go to hospital.
It only took us about 15 minutes to make it to the hospital. When we arrived at the emergency ward, I could barely walk. I was so tired and was having difficulty breathing. I was immediately asked to lie down and an ECG was performed. An oxygen tube was placed in my nostril and I can see nurses and hospital assistants running towards me. At this point the pain had spread to the jaw and teeth.
The nurses started to poke my wrist and the back of my hands with needles. A drip was connected to my right arm while at the same time a machine that controls a small bottle of medicine was injected on my left hand. I was asked to place a small tablet of medicine under my tongue.
Half an hour later the sweating stops and it feels a little better. In the meantime, my wife who was still waiting outside was still not informed of what had happened to me. It was 2 hours later that she started to inquire what is happening and she was told that I had suffered a major heart attack.
After completing two bottles of drips, I was then pushed into the ICU. ECG/EKG was performed every half an hour for the rest of the night as well as throughout the next day. When the doctor came in the morning, I was informed that I had suffered a major heart attack.
On the scale of 0 to 10, where 0 means alive and 10 means dead, the doctor asked me where I think I stood. I thought for awhile and said 6.5. He said no and said that it was actually about a 9.5. I was so shocked. The doctor then started to give me a cardio 101 lesson and explained that they had injected me with the strongest clot busting drug in the world when I arrived. Clot buster thins the blood and helped to ensure blood continue to flow but does not really solve the blockage problem.
I suppose the clot buster is almost similar to the chemical we use in our kitchen sink when it gets clogged.
After 4 days in ICU I was confirmed stable and plans were being made to move me for further observation in the general ward. An appointment was made with the heart specialist in Penang GH but I had to queue for about a month before I could even see the doctor and performing an angiogram/angioplasty would then take another couple of months.
I decided I do not want to wait and asked the doctor whether I could be transferred to a private hospital. The doctor was very helpful and recommended a specialist for me at the KPJ hospital in Bandar Perda. He called up the doctor (Dr Safari) and make arrangements to send me there.
When I arrived at about 7pm, Doctor Safari greeted me. He said I was very lucky and that the fast action of going to the hospital saved me. He then scheduled for an angiogram and also an angioplasty immediately the next morning. An angiogram is to see how bad the clot was and where it is. It is also to determine the condition of the other coronary arteries (there are 3 main ones). A balloon angioplasty is to clear the blockage in the artery thus allowing blood to flow again.
The procedure took several hours with only little pain and discomfort. Although the procedure is safer than an open heart surgery, it is still dangerous and could be life threatening. A flexible catheter is injected into the groin artery and then guided all the way up to the heart. Then a dye was injected and on the x-ray screen you could determine where the blockage was. I still have an 80% blockage (the clot buster I guess managed to clear about 20% which helped to allow blood to flow back into my heart. It did not resolve the problem in whole). Was told that when a blood flow to the heart is blocked, any portion of the heart that did not get enough blood and oxygen would then die off, permanently. This then causes the heart to be weak and disrupt its efficiency. Mine was considered a major because the clog happens in the main artery which could damage a huge portion of the heart below it.
Once the blockage is determined, a small balloon is inflated to push the clogs against the artery walls and a drug coated stent (a sort of wire mesh tube) is placed to ensure the arteries do not collapse again. When the balloon is deflated and removed, the stent stays and overtime would become part of the coronary artery. The stent is treated with some types of drugs to prevent a recurrence of abnormal narrowing due to further clotting of the blood since it is made of metal and it attracts blood platelet to stick to it. I was not able to walk or even move my right leg the first 6 hours after the procedure. I spent another day in the hospital and was released the next day with a month long MC.
So what were the symptoms again?
1. Pain around neck and shoulder region and spreading to the arms(in my case it was the left arm).
2. Feeling of indigestion and/or heartburn. Feel warm in the stomach that slowly moves up to the chest.
3. Pressure, fullness or pain in the center of the chest
4. Sudden weakness, dizziness, fainting, sweating, nausea or shortness of breath
Some people (men) have the classic symptoms of severe pain in the chest (feels like someone is squeezing your heart) but I only felt a little pain when I was already in hospital. The above 4 symptoms however, should be generally true to heart attacks in both men and women.
If you suspect you are getting a heart attack. Go quickly to the hospital. Every second counts.
There can be several causes for heart attack. Among them are high Cholesterol, family history of heart attack, living with inactive lifestyles, diabetes, overweight, high blood pressure, etc.
For me, based on my lab results, my cholesterol level was 5.9 (ref =<5.2 so it’s not actually very high, LDL is 4.2 which is higher than the ref point of <2.6), Blood Pressure was ok(for my age), family history=none and blood sugar level was just a little higher than ideal. Lifestyles was so and so. So what was the actual cause? Well the cause is plaque rupture on the coronary artery lining. Plaque are fatty deposits and substances that accumulated on inner walls of the arteries. They are soft but have a hard covering on the outside. When the cover ruptures or cracks, it exposed the soft fatty inside. When blood platelet comes to the area, they form blood clot around the plaque. The plaque together with blood clot then clogs the artery.
Cigarette smoking was said to be the most likely culprit that triggers the heart attack. Chemicals in cigarettes causes toxic effect on the lining of the blood vessels and inflamed the arteries which then increase buildup of plaque as well as stiffening of the artery walls which then causes the plaque to rupture . Cigarettes also makes the platelet stickier and more likely to clot. They also makes the smokers less likely to dissolve the clot. When the plaque ruptured they then set up a series of event which results in formation of the clot and consequently clogs the coronary artery. Smoking also causes the release of adrenalin that speeds up heart rate and causes arteries to squeeze. All these contribute to making the clogging worst.