Do you feel like there's an elephant sitting on your chest?

Manila, Philippines - One can change the animal to fit the local context. Elephants are not endemic to the Philippines, after all. But whether it feels like a tamaraw, a giant crocodile or a full-grown dugong sitting on your chest, you could be in serious trouble. If you have oppression, chest pain, and difficulty in breathing, you might be experiencing acute coronary syndrome.

Acute coronary syndrome (ACS) refers to the conditions resulting from sudden reduced blood flow to the heart. These include unstable angina (or discomfort and unremitting chest pain), or a heart attack that results when a coronary artery has been blocked so that the heart muscle is damaged because it is starved of blood and oxygen supply. Any type of ACS is considered serious and should be treated right away.

“In treating ACS, we say time is muscle,” says cardiologist Dr. Fed Cheng of Cardinal Santos Medical Center. “Earlier treatment means less muscle damage and a better prognosis.”

Dr. Cheng notes that delays in treatment are most often caused by the patient’s denial that something is seriously wrong. And too often, we hear of people suffering fatal heart attacks after brushing off ACS symptoms as indigestion, or while trying to “sleep off” the oppression and pain. Nearly one in six patients may die within the first year of their heart attack.

But while chest pain and discomfort, which may involve pressure, tightness, and fullness, are the most common symptoms to indicate that there is something wrong with your heart, there are other signs that can signal ACS. These include pain or discomfort in one or both arms, the jaw, neck, back or stomach, shortness of breath, generalized weakness, dizziness, sweating, and nausea and vomiting.

Studies have also shown that the frequency of symptoms associated with ACS differs between men and women. In a study “Symptom Presentation of Women with Acute Coronary Syndrome” published in the journal The Female Patient, for instance, researchers Dr. John G. Canto, Robert Goldberg, etc. noted, “Generally, women are more likely than men to experience middle or upper back pain, neck pain, jaw pain, shortness of breath, paroxysmal nocturnal dyspnea (shortness of breath), nausea or vomiting, indigestion, loss of appetite, weakness or fatigue, cough, dizziness, and palpitations.” Asymptomatic (presenting no symptoms) ACS is also more common among women and diabetic patients.

The best alternative, of course, is to avoid ACS altogether. Dr. Cheng enumerates the components of secondary prevention: smoking cessation, good blood pressure control, good lipid management, physical activity, proper weight management, and good diabetes management. Influenza vaccination, too, is advised because viruses have been shown to increase the incidence of atherosclerosis or thickening of the artery walls. In addition, there are the renin angiotensin aldosterone system blockers (RAAS). RAAS is a hormone system that regulates blood pressure, and its activation results in vasoconstriction or the narrowing of blood vessels due to the contraction of the blood vessel’s muscular walls. Beta blockers and anti-platelet agents or anticoagulants, too, have proven to be beneficial for patients with hypertension and ACS.

The latest of these anticoagulants is Ticagrelor. At the Manila launch of the new drug by pharmaceutical company AstraZeneca, Dr. John French, head of department and director of cardiovascular research of Liverpool Hospital in Sydney, Australia, said that this newest oral treatment shows “faster onset and greater inhibition of platelet aggregation compared to clopidogrel.” Clopidogrel is an agent that is used to inhibit blood clots from forming and clogging blood vessels in coronary artery disease, cerebrovascular disease, and peripheral artery disease.

“The landmark PLATO study (A Study of Platelet Inhibition and Patient Outcomes) showed that ticagrelor is superior to clopidogrel in reducing the risk of vascular death and heart attack in patients with ACS,” says Dr. French. 

But why should ACS and its prevention be a public concern? An increase in the incidence of cardiovascular diseases has numerous socio-economic implications. And alarmingly, we see people getting fatal heart attacks at a younger age.

 What and where is the problem?

“There is poor control of the various risk factors,” says Dr. Eugene Reyes, vice president of the Philippine Heart Association. “There is poor compliance, lack of awareness, and a lack of knowledge. There is that mindset where patients don’t want to know if they are sick.”

Moreover, there is the reality that a patient’s socio-economic status can impede access to medications, thereby affecting recovery outcomes. Clearly, there is much to be done in striving for a better healthcare system. 

What can be done?

Dr. Reyes recommends that local collaborations be strengthened to improve heart attack management in the Philippines. Apart from promoting public awareness about the disease, the goal is to create a national program to control risk factors, provide continuing education for physicians and health workers, establish a standard of care, and establish an ACS registry while continuing to identify problems and creating solutions.

“The problems of disease management are related to lack of awareness on the part of the patient, late recognition, delay in treatment, and late intervention,” shares Dr. Reyes. “Thirty-three hours is the mean time before a patient goes to the hospital emergency room.”

Thus, cardiovascular disease (CVD) and CAS prevention can begin as an individual effort. The goal is to prevent atherocslerosis to avert heart attack. Apart from a healthy lifestyle, exercise, and regular checkups with your doctor, eating right contributes to keeping you safe from heart attacks.

“Fish oils have been shown to reduce CAS events,” says Dr. Reyes.

But what about the reports of deadly mercury in deep sea fish? Certainly, that is an entirely different matter.