Chest pain that feels like pressure or tightness can be an indicator of serious and life-threatening heart disease and should be evaluated promptly.
Chest pain, especially if it develops suddenly and is associated with a cold sweat, is highly suspicious of a heart attack. The recommended course of action is to present to a hospital which is capable of diagnosing and treating acute heart condition emergencies.
You should go to the emergency department (casualty) and inform the medical staff immediately that you are experiencing chest pain /discomfort.
The nurse and doctor who will attend to you will measure your blood pressure, pulse, oxygen saturation and temperature, you will be asked a few questions about your chest pain, perform a physical examination and an electrocardiogram (ECG) – a recording of the electrical activity of the heart. All this should be done within 10 minutes of your arrival.
The ECG forms the basis of early decision-making and helps the doctor decide whether you are having an acute heart attack (ST elevation myocardial infarction, STEMI) – which is a type of heart attack resulting from the sudden blockage of the artery that supplies heart muscles.
An acute heart attack (STEMI) requires prompt treatment to re-establish blood flow in the blocked artery.
A heart attack will present with symptoms like chest pain/discomfort which typically occurs on the left side of the chest, but can be anywhere between the neck and the umbilicus. It is often described as a squeezing pain or heaviness.
Pain may sometimes be felt in either arm, the jaw, teeth, neck, upper abdomen or back. With a heart attack you are also likely to have difficulty breathing, nausea or vomiting, sweating, dizziness or loss of consciousness/collapse.
For complete blockage (STEMI), the blocked artery should be opened up as soon as possible. Two options are available: Primary Percutaneous Intervention (Primary PCI) – This procedure is performed in the cardiac catheterization laboratory (cathlab), which is a special x-ray suite.
The second treatment is a clot-busting/dissolving drug or thrombolytic – These are medications that are injected into a vein and work by circulating in the bloodstream and dissolving the clot in the heart.
This treatment works most efficiently when given within 3 hours of developing chest pain. While thrombolysis is a very effective treatment, it may fail to reopen the artery thus necessitating the patient to be taken for angioplasty anyway – rescue PCI.
Resuming physical activity
Survivors of heart attacks are commonly anxious about subsequent physical activity, exercise and indeed getting back to work.
In view of this, all our patients undergo cardiac rehabilitation which is a set of activities that helps recover their physical health. It also helps patients who are not physically active get more confidence to start an active lifestyle.
Cardiac rehabilitation is a set of graduated physical activities given by physiotherapists over a duration of six weeks. It monitors the heart, blood pressure, and workload of the heart in watts. Most people can get back to work in a month after developing a heart attack.
What about sexual activity?
Most people have anxiety about returning to sexual intimacy after a heart attack. It is good to discuss with your cardiologist when it is safe to resume sexual activity.
For most people, this may be possible once they can tolerate a moderate amount of physical exertion. Generally, this is after at least two to four weeks of having a heart attack.
Some of the medications prescribed for your heart may interfere with your sex drive or ability to maintain an erection and achieve an orgasm.
If you feel this may be the case, please bring it up with your cardiologist to see if there are alternative medications. You should not stop any of these medications on your own accord.
Medications which contain nitrates may cause dangerous drops in blood pressure if taken together with medicines that treat erectile dysfunction such as sildenafil (Viagra) and tadalafil (Cialis).
You should always discuss this with your cardiologist before you use any of these medications.
Dr Ngunga is a Consultant Interventional Cardiologist at Aga Khan University Hospital, Nairobi.