This article first appeared in Kannada in ಕ್ಷ ಕಿರಣ, Dr Shashikiran Umakanth’s column in the Vishwavani daily. The Inside Story is its English edition. ಈ ಲೇಖನವನ್ನು ಕನ್ನಡದಲ್ಲಿ ಓದಿ
World Heart Day came and went on 29 September. All day long, WhatsApp, Facebook and Instagram were full of red and pink hearts, and of status messages that said “Protect your heart” and “A salute to the heart”.
As a doctor, I was glad to see it. But when I talk to patients who come to the hospital, or listen to friends and acquaintances discussing these things, one thought keeps coming back. We love the heart enormously. And we are thoroughly confused about what goes wrong with it!
A young man collapses in the gym in the middle of a workout, and dies. People shake their heads: “Poor fellow, a heart attack at that age.” The television channels run the same news as breaking news: “Death due to cardiac arrest.” And somewhere in a newspaper, the headline reads: “Youth dies of heart failure.”
Small wonder that the ordinary reader’s head spins. Heart attack, heart failure, cardiac arrest… are these three names for one disease? You may well have wondered why we doctors insist on confusing everyone with different words for the same thing. But in medicine, these are three entirely different problems. They have different causes, they show themselves in different ways, and they need different treatment. So let us put a full stop to the confusion, today, for good.
To make it easy, imagine the body as a well-built vehicle. The heart is its engine. Three different things can go wrong with an engine, and those three are our three conditions.
1. Heart Attack: A “Plumbing” Problem
An engine needs fuel to run, and the heart’s fuel is blood. Just as debris can choke the pipe that carries petrol to an engine, fat and cholesterol can build up inside the coronary arteries, the pipes that carry blood to the heart muscle itself. When one of these pipes is blocked, blood stops flowing, suddenly, to one part of the heart muscle. Starved of oxygen, the cells of that muscle begin to die. This is what we call a heart attack.
The engine has not switched off. It is still running, but it is sputtering and struggling for want of fuel. The person stays conscious. There is a heavy, crushing weight in the middle of the chest, as though an elephant had put its foot down on it. Heavy sweating, even in an air-conditioned room. A sense of choking, of not getting enough air. The pain may spread to the left arm or to the jaw.
What to Do
At such a time, the person can tell you clearly that they have chest pain, or a heaviness in the chest. If they reach a hospital at once, doctors can find the blocked artery with an angiogram and open it with a stent, a tiny tube of wire mesh, rather like a spring, that holds the artery open. A life is saved. Here the “golden hour”, the first hour or two, matters more than anything else. The sooner the treatment, the more heart muscle is saved… and with it, the life.
2. Cardiac Arrest: An “Electrical” Problem
The heart has its own electrical system, an extremely delicate one, that keeps it beating steadily in a fixed rhythm. When that system short-circuits without warning, the heart stops beating altogether. All at once. This is a cardiac arrest.
Think of a car cruising at a hundred kilometres an hour. Its battery, or its electronics, fails completely, and the car dies in the middle of the road. That is what happens here. There is no time even to complain of pain. With no warning at all, the person drops to the ground, unconscious, like a felled tree. There is no pulse. Breathing has stopped.
What to Do
This is the most urgent of emergencies. Someone must start CPR (cardiopulmonary resuscitation) at once, pressing down hard on the centre of the chest with both hands, again and again, or use a defibrillator, the machine that delivers an electric shock to the heart. Without one or the other, no blood reaches the brain, and within three to five minutes the person is lost.
Note: a large heart attack can damage the heart’s electrical system and set off a cardiac arrest. The two are different problems, but one can lead to the other.
Every responsible citizen should know how to give CPR. Today, that is a necessity.
3. Heart Failure: A “Mechanical” Problem
Hear the word “failure” and people panic. The heart has stopped working, they think; the story is over. But heart failure does not mean the heart has stopped! It means the heart has grown weak. It no longer has the strength to pump as much blood as the body needs.
Think of an engine that has grown old and worn, and lost its power. On a flat road it still runs, after a fashion. Ask it to climb a steep ghat and it labours and gasps, as if it were short of breath. The wear comes from long-standing high blood pressure, from muscle damaged by an earlier heart attack, or from heart muscle that has simply weakened with age.
When the pump weakens, fluid begins to collect in the lungs and in the legs. Even a short walk leaves the person exhausted and breathless, and the legs swell. They may wake at night feeling as though they are suffocating.
What to Do
Unlike a cardiac arrest, heart failure does not take a life in an instant. With the right medicines and sensible changes in the way one lives, it can be kept well under control.
The Simple Formula
Here, in short, is the formula to remember:
- Heart attack is the plumbing problem: an artery is blocked, the blood supply stops, and the heart muscle is damaged.
- Cardiac arrest is the electrical problem: the electrical system fails, and the heartbeat stops without warning.
- Heart failure is the mechanical problem: the heart has lost its pumping strength, and grown weak.
Knowing the difference is not about adding to our medical knowledge. It is about responding correctly in an emergency. Starting CPR at once in a cardiac arrest matters just as much as getting a heart attack patient to hospital within the golden hour.
My message this World Heart Day is simply this. The next time someone mixes up these words, sit them down and tell them the story of the engine! And keep the engine of your own vehicle, the heart, well serviced. Wholesome food, daily exercise, and a mind that is happy and quick to smile… that is the best engine oil there is.
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