Second heart attack risk: What survivors need to watch for

Heart attacks are caused by the sudden occlusion of any of the 3 coronary arteries or their branches supplying blood to the heart muscle. These arteries are about 8 -10 cm long. A heart attack is best managed by performing an angiogram and opening the closed artery using a balloon and often a stent.

The fat in the food that you eat is absorbed from the intestine and is carried into the blood in the form of triglycerides and chylomicrons. These are cholesterol-rich molecules, and they are depleted of their cholesterol by the muscle, which has an enzyme called lipoprotein lipase. The remaining cholesterol is now carried back to the liver and is re-secreted. This is often known as the LDL or the low-density lipoprotein, and is associated with heart disease. This LDL contributes to the cholesterol deposit in the arterial lining, which is called plaque. People who exercise less or eat a lot of junk food often have high LDL cholesterol levels. LDL cholesterol levels are also genetically controlled, and therefore, other factors may also be at play in people who have high LDL cholesterol.
Plaque is covered by a layer of thin tissue, which gets damaged due to sudden unaccustomed exertion, stress, smoking, hypertension, and diabetes. The cholesterol deposits under the artery's inner lining (referred to as endothelium) suddenly get exposed, leading to sudden closure of the artery due to clot formation. This results in the sudden closure of the vessel, inducing a heart attack.

If the risk factors of diabetes, hypertension, smoking, stress, obesity, high cholesterol levels, high lipoprotein (a), junk food, and dietary indiscretions continue to remain, then new narrowing of arteries can develop, pre-existing narrowing can worsen, or the already placed stent can develop tissue growth and start to close.
Often, the patient gets complacent and restarts smoking and eating sweets and junk food with petty justifications. Some people consult other friends and colleagues and decide to leave medicines halfway through, resulting in uncontrolled risk factors and aggravation of the disease. All of this results in people getting a second heart attack.

Chest pain, shortness of breath, palpitations, or easy fatigue can be symptoms of the progression or onset of new coronary artery disease. It is advised that all cardiac patients exercise regularly, as this would help them pick up symptoms early, in the event of worsening of coronary artery disease.

5 principles of good heart health -
Right Food
What to Avoid? Sweets, sugars, and excessively refined oils.
What is Allowed? Milk, curd, butter, desi ghee, egg, fish, chicken, fruits and vegetables, nuts like walnuts and almonds, and filtered oils of their region.
Right Exercise
Walking 30 -45 minutes a day, 5 days a week, is recommended.
Strength training exercises twice a week are also advocated to improve body posture and reduce falls.
Right Medicines
Keep diabetes, hypertension, cholesterol, weight, thyroid status under control, and don’t stop heart medicines on your own.
Right Habits
No smoking, tobacco, alcohol, or addictions.
There are good medicines available to help wean off tobacco, smoking, and alcohol addiction by reducing the urge.
Right Thoughts
Improved sleep rhythm and meditation. Your body repairs itself when you go into deep sleep; therefore, if you are working on an inverted sleep rhythm or if you keep yourself on electronic devices, then your sleep quality gets affected, and you are not able to heal yourself.
Meditation helps you calm down and reduce your basal inflammation of the body. It helps you combat stress of daily life.

Your cardiologist has various tools from ECG, Echocardiogram, Treadmill Test, CT Coronary Angiography, Stress Myocardial Perfusion Study to Coronary Angiography to assess your condition. Please follow up with a cardiologist on periodic basis to stay healthy.

Yes, just like the first time, if it does happen again, it can be fixed by another stenting procedure. But it is better to PREVENT YOUR SECOND ATTACK BY BEING CAREFUL AND RESPONSIBLE FOR YOUR HEALTH. Never miss your follow-up schedules and routine screenings to maintain your heart health. Visit your doctor immediately if you suspect any heart issues again or have symptoms like angina or breathlessness.
Dr. (Gp Capt) Ashish Chauhan, Consultant – Interventional Cardiology, Manipal Hospital Whitefield, Bengaluru