By Evangeline T. Capuno
More often than not, people are confused between a heart attack and stroke.
Award-winning film director Celso Ad. Castillo just came from the printing press where he was checking on his book, Celso Ad. Castillo: An Autobiography and His Craft. His wife observed that he was tired.
The couple were already in their bed when the director complained of chest pain.
“His son came to my house at 1:45 a.m.” recalls John, the brother of Direk Celso. When John learned that his brother was complaining of chest pains, he shares, “we rushed him to the hospital. (But) on the way, I had an inkling he won’t make it anymore.”
John was right; his brother didn’t make it. Direk Castillo, 69, died of heart attack.
Myocardial infarction
Heart attack (known in the medical parlance as myocardial infarction) “is a medical emergency in which some of the heart’s blood supply is suddenly and severely reduced or cut off, causing the heart muscle to die because it is deprived of its oxygen supply,” explains The Merck Manual of Medical Information.
Heart attacks are most commonly due to the blockage of a coronary artery, following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (cholesterol and fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting restriction in blood supply and ensuing oxygen shortage, known as ischemia, if left untreated for a sufficient period of time, can result in the damage or death (infarction) of the heart muscle tissue, which is called the myocardium.
An uncommon cause of a heart attack is a clot from part of the heart itself. Sometimes, a clot forms in the heart, breaks away, and lodges in a coronary artery. Another uncommon cause is a spasm of a coronary artery that stops blood flow. Spasms may be caused by drugs such as cocaine, or by smoking, but sometimes the cause is unknown.
Red flags for heart attacks
Are there telltale signs that a person can recognize while experiencing a heart attack? Yes, according to the Merck Manual. It states that about two out of three people who have heart attacks experience intermittent chest pain, shortness of breath, or fatigue a few days beforehand. The episodes of pain may become more frequent even after less and less physical exertion. “Such unstable angina may culminate in a heart attack,” warns the Merck manual.
Generally, the most recognizable symptom is pain in the middle of the chest that may spread to the back, jaw, or left arm.
Furthermore, according to the ADAM Medical Encyclopedia, the pain can be severe or mild. It may feel like: a tight band around the chest, bad indigestion, something heavy sitting on your chest, and squeezing or heavy pressure. The pain usually lasts longer than 20 minutes.
“The pain of a heart attack is similar to the pain of angina but is generally more severe, lasts longer, and isn’t relieved by rest or nitroglycerin,” the Merck Manual states. Angina is a suffocating, choking pain, which is felt in the chest. The pain is felt or brought on by exercise, and is relieved by rest, and occurs when the blood supply to the heart muscle is inadequate.
Other symptoms of a heart attack include a feeling of faintness and a heavy pounding of the heart. Irregular heartbeats may seriously interfere with the heart’s pumping ability or may cause the heart to stop pumping effectively (cardiac arrest), leading to a loss of consciousness or even death.
Stroke
“Don’t confuse a stroke with a heart attack,” reminds Dr. Isadore Rosenfeld, bestselling author of The Best Treatment. “A stroke is what happens when the blood supply to a portion of the brain is interrupted; a heart attack is what you suffer when the blockage is in an artery within the heart.”
On the evening of December 11, 2004, movie star Fernando Poe, Jr. was admitted to St. Luke’s Medical Center in Quezon City after complaining of dizziness at a Christmas gathering in the premises of his production studio. He suffered from a stroke and slipped into a coma while being treated for a brain clot. Without regaining consciousness, he died at the age of 65.
After heart attack, stroke is the second leading cause of death in the Philippines. The incidence of stroke in the country is 486 out of 100,000 of the population, according to Dr. Jose Navarro, former president of the Philippine Neurological Association, who quoted a study published in the Philippine Journal of Neurology.
Around the world, the statistics on the prevalence of stroke is staggering. The Geneva-based World Health Organization reports that stroke affects 15 million people worldwide. About five million people died from stroke and another five million are permanently disabled. “One in six people worldwide will have a stroke in their lifetime,” deplores Dr. Romulo Esagunde, a neurosurgeon and board member of the Philippine Society of Ultrasound in Clinical Medicine Inc. “Every six seconds, stroke kills someone; and every other second, stroke attacks a person regardless of age or gender.”
Two types of stroke
There are two types of strokes: ischemic and hemorrhagic. “About 80 percent of strokes are ischemic – due to a blocked artery,” explains The Merck Manual of Medical Information. “Brain cells, thus deprived of their blood supply, do not receive enough oxygen and glucose (a sugar) which are carried by blood.” Hemorrhagic strokes, on the other hand, are caused by the rupture of weakened brain vessels, resulting in bleeding into the brain tissue and compression of surrounding structures. This is most often caused by severely elevated blood pressure.
Symptoms of ischemic stroke and hemorrhagic stroke may be similar, depending on the area of the brain affected. They may even coexist in one clinical case. Thus, differentiating between ischemic and hemorrhagic strokes may be difficult, and would necessitate the need for specialized brain imaging procedures such as CT Scan and MRI.
Common early symptoms of stroke are the following: sudden weakness or paralysis of an arm, a leg, mouth, or one side of the body; sudden dimness or loss of vision, particularly in one eye; sudden confusion, with difficulty speaking and understanding speech; loss of balance and coordination, leading to falls; sudden severe headache with no apparent cause; and abnormal sensations or less of sensation in an arm or a leg or on one side of the body.
Time is brain
“Many other symptoms may also occur,” the Merck manual points out. “People who have a symptom [suggestive of stroke] should seek medical attention immediately.”
Experts urge Filipinos to be aware of the symptoms and should know who to call and go to in case stroke happens. Once the brain is damaged, it is already irreversible. “Prompt attention could make a big difference in the outcome following a stroke,” says Dr. Willie T. Ong, an internist-cardiologist and author of several health books.
There are no known first aid treatments with this illness which many patients think are sufficient to reverse the stroke process. According to Dr. Navarro, the treatments readily available to prevent grave disability from stroke can only be obtained from the hospitals.
A study conducted by the National Stroke Association in the United States has shown that 80 percent of stroke is preventable. In fact, the incidence of strokes in Western countries in recent decades has declined, mainly because people are more aware of the importance of controlling high blood pressure and high cholesterol levels, and quitting smoking and drinking alcoholic beverages.
“Controlling these factors can go a long way in preventing stroke,” the Merck manual claims. — ###
