How do a heart attack and stroke differ?
A lot of people use these terms interchangeably.
Heart attack refers to damage to the heart muscle. Stroke refers to paralysis of limbs or face or any other neurological function due to damage to the brain resulting from clotting or bleeding in the blood vessels of the brain. They are clinically different and the terms should ideally not be interchanged.
What time of the day does one usually get a heart attack?
Heart attacks can occur at any time of the day. However, due to various neuro-hormonal variations associated with the circadian rhythm, some clustering of heart attacks is noted in the mornings between 6 am and 12 noon. Some physicians have noted more heart attacks in the wee hours, i.e., between 3 and 6 am.
What should I do if I have symptoms suspicious of a heart attack?
First, seek help. Make any person in proximity aware of your situation. The most important step to ensure a safe outcome in a heart attack is to see that you reach a hospital with appropriate facilities as soon as possible. It is a good practice to be aware of the hospitals around you and the facilities they provide. When someone has chest pain or other symptoms suggestive of a heart attack, the immediate first aid should be to take 350 mg of the soluble form of Aspirin (common trade names Disprin or Aspisol in India). Ideally, the tablet should be chewed because the medicine is absorbed from the mucosal membrane of the oral cavity and starts to act immediately. If the patient cannot chew the tablet for some reason, the tablet can be dispersed in a small quantity of water and taken orally. If I see someone who is having a heart attack, what can I do to ensure he survives till help arrives? Call the nearest hospital with cardiac facilities as soon as you recognise that someone around you might be having an ongoing attack. Shift the person to a comfortable position and reassure them. If possible, give them an Aspirin tablet to chew. While waiting for help to arrive, monitor their breathing and pulse. If they lose consciousness, initiate Cardiopulmonary resuscitation (CPR).
What are the common causes of heart disease?
Various risk factors increase the chances of a person having a heart attack. Smoking, High Blood pressure, Diabetes. physical inactivity, high cholesterol levels, obesity, and poor diet are important risk factors. These can be potentially controlled to reduce heart attack risk. Therefore, these are termed Modifiable Risk factors.
Older age, male sex, family history, Post-menopausal state in women are factors that can increase heart attack risk but cannot be altered. These are called non-modifiable risk factors.
South Asians appear to have a very high risk of having heart attacks at a younger age, compared to Caucasians and Asians such as Japanese.
How can I reduce my risk of developing heart disease?
A disciplined lifestyle would not only take care of the heart but also keep other diseases at bay. The key changes are
Quit smoking
Exercise regularly
Maintain a healthy weight
Control blood pressure and diabetes well
Keep cholesterol levels in check
Manage stress
How are heart attacks treated?
As soon as a diagnosis of heart attack is made, blood-thinning medications (Aspirin, Clopidogrel are common ones) are administered. The definitive treatment is Coronary angiography followed by primary coronary angioplasty to restore blood flow in the coronary artery causing the attack.
However, if for some reason, angioplasty cannot be performed, certain medicines (thrombolytic drugs, or clot busters) are administered in the form of injections. Primary Angioplasty is a more effective and safer form of treatment for a heart attack, but in some circumstances (e.g., remote areas) these drugs can be life-saving.
What is Coronary Angiography?
It is a procedure to detect blockages in the blood vessels of the heart. A thin hollow tube or catheter is inserted via the artery of the forearm or the thigh. Through this catheter, a special contrast dye is injected into the coronary arteries and X-ray images are obtained to visualize the blood flow in the coronary arteries.
What is Coronary Angioplasty?
Coronary angioplasty is a procedure performed to widen narrow or blocked sections of the coronary vessels thereby restoring the blood flow. A thin balloon is inserted into the coronary artery and inflated at the site of the block to widen the narrowed artery. This makes a way for the opening of the blockages. A stent is generally then placed to prevent future blockages.
Can a stent get blocked again? Is it possible to insert another stent in the same place?
Yes. In about 5-10% of patients, especially those who are not on medication, have uncontrolled diabetes, develop kidney failure, or continue to smoke, stents can show narrowing (restenosis). If a disciplined lifestyle is not followed, new blockages can appear in other areas of the vessels too.
Stent restenosis can be treated by balloon angioplasty, a second stent, drug-coated balloons, or by Bypass surgery.
What is Coronary Artery Bypass Grafting (CABG) Surgery?
Coronary Artery Bypass Grafting (CABG) is a procedure where a surgeon makes new routes (bypass) around blocked or narrowed coronary arteries with one or more grafts allowing increased blood flow to the vessel past the blockage. These grafts are typically healthy blood vessels from the chest, arm, or leg of the patient.

