How do we know if we’re about to have a heart attack?

Heart disease is entirely preventable yet it remains the number one cause of death in Australia for both sexes. Just the other day an old patient contacted me out of the blue, a fit 36-year-old gym junkie who’d just had two stents inserted in the blocked arteries of his heart.  The last time we measured his cholesterol it was entirely normal and aside from a slightly elevated blood pressure and a family history of heart disease there was no indication that he was about to face a life-threatening heart attack.  He was exercising with a friend when he experienced chest discomfort.  His friend dialled 000 and initially his concerns were dismissed as a routine attack of anxiety.   It was only when the pain escalated and he repeated the emergency call that the ambulance team was mobilised and his ailing heart was salvaged.  He was lucky.  The outcome could have been catastrophic and life-ending.

  When I reflect on what could have been done differently to prevent this from happening there are what is considered the standard risk factors for heart disease and these include elevated cholesterol and blood pressure, smoking, being overweight and a family history of heart disease, a parent who has had a heart attack before the age of 60 increases the risk.  Aside from assessing and managing these appropriately there are other blood tests including measuring homocysteine and lipoprotein (a), substances you might not never have heard of, which like elevated cholesterol raise the odds of having a heart attack. 

  Beyond these to get a more complete picture of how well the blood vessels of your heart are doing A CT scan which measures your calcium score, an indicator of the build-up of plaque or cholesterol that is obstructing your arteries, is a pretty good heart attack predictor.  A very low calcium score suggests a lesser risk, close to zero and the likelihood of a heart attack in the next 5 years is similarly just about non-existent.  Recent research however suggests that what’s even more reliable is the CT angiogram test.  To do this test at an Xray clinic dye is injected which then allows the blood vessels of the heart to be visualised and blockages to be identified and targeted, something that might be missed if a CT scan which only assesses the calcium score is done. 

  Having this kind of evaluation makes it much less likely that you will land up in the back of an ambulance on the way to having your arteries surgically unblocked or even worse tragically still being one of the many for whom your first heart attack is your last.

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