Three symptoms appear 1 month before someone dies from a heart attack

Dr Nighat reveals heart attacks symptoms in women

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A heart attack is a medical emergency that requires a swift response to limit the amount of damage inflicted on the heart muscle. Unfortunately, some heart attacks have more subtle symptoms and may therefore be missed or overlooked. A 2017 study published in The Lancet Public Health suggested this was occurring with devastating frequency in England, with certain symptoms going overlooked up to a month prior to heart attack deaths.

In this study, the researchers examined records of all 446,744 NHS hospital stays in England between 2006 and 2010 that recorded heart attacks, as well as the hospitalisation history of all 135,950 heart attack deaths.

The records included whether or not patients who died of a heart attack had been admitted to hospital in the past four weeks and if so, whether signs of heart attack were recorded as the main cause of admission (primary diagnosis), additional to the main reason (secondary diagnosis), or not recorded at all.

Of the 135,950 patients who died from heart attack, around half died without a hospital admission in the prior four weeks, and around half died within four weeks of having been in hospital.

21,677 (16 per cent, or one in six) of the patients who died from heart attack had been hospitalised during the four weeks prior, but heart attack symptoms were not mentioned on their hospital records.

The authors said there are certain symptoms, such as fainting, shortness of breath and chest pain, that were apparent up to a month before death in some of these patients, but doctors may not have been alert to the possibility that these signalled an upcoming fatal heart attack, possibly because there was no obvious damage to the heart at the time.

These results suggest that possible signs of upcoming fatal heart attack may have been missed.

The researchers also found that of all patients admitted with a heart attack, those whose heart attack was recorded as secondary to the main condition were two to three times more likely to die than patients whose records stated heart attack as the main condition.

Lead author Doctor Perviz Asaria, from the School of Public Health at Imperial, said at the time: “Doctors are very good at treating heart attacks when they are the main cause of admission, but we don’t do very well treating secondary heart attacks or at picking up subtle signs which might point to a heart attack death in the near future.

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“Unfortunately in the four weeks following a hospital stay, nearly as many heart attack deaths occur in people for whom heart attack is not recorded as a primary cause, as occur after an admission for heart attack.”

The authors said at the time of publication that more detailed investigation must be done to identify reasons for these results so that more deaths from heart attack can be prevented.

Co-author Professor Majid Ezzati, also from Imperial’s School of Public Health, said at the time: “We cannot yet say why these signs are being missed, which is why more detailed research must be conducted to make recommendations for change. This might include updated guidance for healthcare professionals, changes in clinical culture, or allowing doctors more time to examine patients and look at their previous records.

“What we are now asking is, if symptoms are being missed where they could have been discovered using the available information, how should care now be organised and what changes need to be made to prevent unnecessary deaths.”

Co-author Professor Paul Elliott from Imperial’s School of Public Health added at the time: “In addition to these findings for people who entered hospital but for whom a diagnosis of heart attack was not made, heart attack deaths are still occurring in large numbers among people who never reach hospital.

“This highlights the need for continued emphasis on prevention as well as better diagnosis and treatment.”

How to prevent a heart attack

Making lifestyle changes is the most effective way to prevent having a heart attack (or having another heart attack).

According to the NHS, there are three main steps you can take to help prevent a heart attack (as well as stroke).

These are:

  • Eat a healthy, balanced diet
  • Do not smoke
  • Try to keep your blood pressure at a healthy level.

Eating a healthy diet means shunning foods containing high levels of saturated fat, as they increase levels of LDL cholesterol in your blood, warns the NHS.

LDL cholesterol is a precursor to heart disease.

Foods high in saturated fat include:

  • Pies
  • Fried foods
  • Sausages and fatty cuts of meat
  • Butter
  • Ghee (a type of butter often used in Indian cooking)
  • Lard
  • Cream
  • Hard cheese
  • Cakes and biscuits
  • Foods that contain coconut or palm oil.

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