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Heart Attack Essays

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What is a Heart Attack?

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A heart attack is a medical emergency that occurs when blood supply to part of the heart is suddenly cut off.

The heart muscles are supplied by the coronary arteries, which branch off from a major artery called the aorta. Heart attack occurs when one or more of the coronary arteries becomes blocked. This lack of blood supply and oxygen can cause injury to the heart muscle and if supply is prevented for more than 20 minutes, the part of the muscle tissue failing to receive blood may die. The medical term for a heart attack is myocardial infarction or MI.

• Chest pain – The chest may feel tight, pressured and heavy as if it is being squeezed
• Pain in other areas – The pain may radiate to other parts of the body such as the arms (usually the left arm), the neck, jaw, back and abdomen
• Feeling dizzy or lightheaded
• Shortness of breath
• Nausea and vomiting
• Coughing or wheezing
• Severe anxiety that is often described as a sense of impending doom

Not all chest pain indicates a heart attack. Indigestion commonly causes chest pain and can be mistaken for a heart attack, if severe. Conversely, a mild heart attack can be mistaken for indigestion. Some cases of heart attack are completely painless, particularly among the elderly, women and people with diabetes .

Diagnosis and treatment

A diagnosis of heart attack is based on the findings of an electrocardiogram (ECG). People admitted to hospital with suspected heart attack will be given an ECG within ten minutes of arrival. An ECG machine records the electrical signals generated by the heartbeat and a doctor can interpret this information to assess how well the heart is functioning. The treatment approach to heart attack depends on the type of heart attack the patient has had. Segment elevation myocardial infarction is the most severe form of heart attack and a patient with this condition will immediately be assessed for treatment to unblock the coronary artery.

The surgical procedures available to treat heart attack include coronary angioplasty and coronary artery bypass graft. Medications that may be administered to break down the clots include reteplase, alteplase, and streptokinase.

• https://medlineplus.gov/
• https://www.heart.org/
• https://www.tuh.ie/
• http://www.nhs.uk/conditions/heart-attack/Pages/Introduction.aspx

Further Reading

• All Heart Attack (Myocardial Infarction) Content
• What Causes A Heart Attack?
• Heart Attack Symptoms
• Heart Attack Diagnosis
• Heart Attack Treatment

Last Updated: Jul 8, 2023

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

Please use one of the following formats to cite this article in your essay, paper or report:

Mandal, Ananya. (2023, July 08). What is a Heart Attack?. News-Medical. Retrieved on August 16, 2024 from https://www.news-medical.net/health/What-is-a-Heart-Attack.aspx.

Mandal, Ananya. "What is a Heart Attack?". News-Medical . 16 August 2024. <https://www.news-medical.net/health/What-is-a-Heart-Attack.aspx>.

Mandal, Ananya. "What is a Heart Attack?". News-Medical. https://www.news-medical.net/health/What-is-a-Heart-Attack.aspx. (accessed August 16, 2024).

Mandal, Ananya. 2023. What is a Heart Attack? . News-Medical, viewed 16 August 2024, https://www.news-medical.net/health/What-is-a-Heart-Attack.aspx.

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i had a heart attack 8 years ago six months after i started going to the gym for three months and gave it up , i have started going again am i doing any damage by going into the steam room and using the juczzi can you let me know please as i love using them

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Heart Attack: Health Information Patient Handout Essay

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Introduction

What is a heart attack, risk factors, how to recognize a heart attack: warning signs and sex differences, helpful online resources.

Maintaining cardiovascular health remains an extremely significant task of every individual since the proper work of the human heart supports the functioning of other organs. Heart attacks can be listed among the most dangerous health issues due to their ability to stop the work of the heart muscle.

The importance of the issue relates to the fact that many people are unable to recognize a heart attack because its symptoms can be diverse and atypical. The patient handout is designed for adult men and women who want to learn more about a heart attack, ways to recognize it, and risk factors.

Myocardial infarction is the scientific term used to denote a heart attack. It is known as one of the most dangerous forms of coronary heart disease. A heart attack occurs due to the disturbance of blood supply to certain parts of the heart. As a result, the heart muscle becomes unable to fulfill its functions, and it causes permanent changes in the work of the human heart that vary in harmfulness (Roland, n.d.).

Nowadays, cardiologists single out three types of heart attacks (Roland, n.d.):

• STEMI (ST-Elevation Myocardial Infarction) is characterized by the complete blockage of the coronary artery; the ST segment is a part of the ECG curve that represents the period of the cardiac cycle when both cardiac ventricles are active;
• NSTEMI (Non-ST-Elevation Myocardial Infarction) is a heart attack during which the coronary artery is not fully blocked; therefore, it causes less damage than the previous type;
• Unstable angina pectoris is the so-called “silent” heart attack, involves no CA blockage.

Although the demographic characteristics of people who experience heart attacks are extremely diverse, specific factors should be taken into account to define measures helping to improve and maintain cardiovascular health. Risk factors are heterogeneous in nature, and some of them cannot be eliminated or reduced since they present things that people cannot control. In general, there are two groups of risk factors increasing the probability of heart attacks.

To begin with, there are factors that cannot be changed. Despite the inability to control them, people who belong to the groups listed below can contribute to their cardiovascular health by seeing a cardiologist on a regular basis.

Unchangeable risk factors (American Heart Association, 2016):

• Advanced age – risks of having heart attacks are increased for people older than 60;
• Being a male – heart attacks are more common in men;
• Family history of heart disease;
• Ethnicity – people who do not belong to the Caucasian race, are at increased risk of heart attacks;

Assessing your risks of having a heart attack in the future, it is pivotal to pay attention to risks that exist due to a lack of self-care and being irresponsible when it comes to health. The risk factors that can be modified include the following (American Heart Association, 2016):

• Diabetes – risks of cardiovascular disease increase when the level of blood sugar is not properly controlled;
• Obesity – being overweight or obese can be detrimental to cardiovascular health, affecting blood pressure and physical activity;
• Sedentary lifestyle – when there is a lack of exercise, even moderate cardiovascular load becomes quite dangerous;
• Unhealthy habits – smoking, alcohol abuse, and eating too much food with saturated fat are detrimental to cardiovascular health.

Every person should be aware of warning signs indicating a myocardial infarction. Increasing patient education is pivotal since the timeliness of emergency care is the key to decreasing mortality rates (McGonigle & Mastrian, 2018). Apart from self-help measures, every person should know how to provide first aid to other people (see Figure 1).

A heart attack is often preceded by early symptoms that should never be ignored. Do not hesitate to request medical assistance if you have one or more of the following symptoms:

• Periodical chest pain;
• Chest pain radiating to jaw or neck;
• Increased body perspiration;
• Queasiness;
• Respiratory embarrassment (Story, n.d.).

Importantly, recent studies in the field of cardiology indicate that the signs of heart attack depend upon patients’ sex. As it has been stated, men usually face greater risks of having heart attacks. Specific symptoms that are more typical for heart attacks in men include chest pain with varying degrees of intensity and pain in the upper half of the body.

When it comes to pain in men, areas that can be involved include the back, stomach, arms, and shoulders (Story, n.d.). Also, heartbeat changes act as an important sign of heart attacks in men. Unlike women, men having heart attacks often indicate sensations that are similar to the symptoms of digestive troubles such as stomach discomfort.

The symptoms of heart attacks that are present in both women and men include difficult breathing, dizziness, and the presence of cold sweat. Therefore, many signs can be used to identify this condition regardless of the patient’s sex. Nevertheless, there is a range of warning signs that are more common in women. To begin with, they include excessive tiredness; it can take place after strenuous activity or for no reason. Other symptoms commonly reported by women include difficulty sleeping, throat or jaw pain, and anxious feelings (Story, n.d.).

To get more information on the health issue and related research, visit the following websites:

• Thrombosis Adviser;
• American Heart Association;
• Healthline;
• The Heart Foundation.

American Heart Association. (2016). Understand your risks to prevent a heart attack . Web.

McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones and Bartlett Learning.

Roland, J. (n.d.). Types of heart attacks: What you should know . Web.

Story, C. (n.d.). Symptoms of a heart attack . Web.

What to do when someone is having a heart attack . (n.d.). Web.

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Home — Essay Samples — Nursing & Health — Myocardial Infarction — An Overview of Myocardial Infraction or Heart Attack

An Overview of Myocardial Infraction Or Heart Attack

• Categories: Myocardial Infarction

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Words: 1389 |

Published: Mar 14, 2019

Words: 1389 | Pages: 3 | 7 min read

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Knowledge of Signs and Symptoms of Heart Attack and Stroke among Singapore Residents

Joy li juan quah.

1 Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597

2 Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608

Si Oon Cheah

3 Medical Department, Singapore Civil Defence Force, 91 Ubi Avenue 4, Singapore 408827

E. Shaun Goh

4 Acute and Emergency Care Centre, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828

Nausheen Doctor

Benjamin sieu-hon leong.

5 Emergency Medicine Department, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074

6 Accident & Emergency Department, Changi General Hospital, 2 Simei Street 3, Singapore 529889

Michael Yih Chong Chia

7 Emergency Department, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433

Marcus Eng Hock Ong

8 Office of Clinical Sciences, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857

Aim . To determine the level of knowledge of signs and symptoms of heart attack and stroke in Singapore resident population, in comparison to the global community. Methods . A population based, random sample of 7,840 household addresses was selected from a validated national sampling frame. Each participant was asked eight questions on signs and symptoms of heart attack and 10 questions on stroke. Results. The response rate was 65.2% with 4,192 respondents. The level of knowledge for preselected, common signs and symptoms of heart attack and stroke was 57.8% and 57.1%, respectively. The respondents scored a mean of 5.0 (SD 2.4) out of 8 for heart attack, while they scored a mean of 6.8 (SD 2.9) out of 10 for stroke. Respondents who were ≥50 years, with lower educational level, and unemployed/retired had the least knowledge about both conditions. The level of knowledge of signs and symptoms of heart attack and stroke in Singapore is comparable to USA and Canada. Conclusion . We found a comparable knowledge of stroke and heart attack signs and symptoms in the community to countries within the same economic, educational, and healthcare strata. However older persons, those with lower educational level and those who are unemployed/retired, require more public health education efforts.

1. Introduction

Heart attack and stroke are leading causes of death globally. The World Health Organisation estimates that 7.3 million deaths globally were due to coronary heart disease and 6.2 million were due to stroke in 2008 [ 1 ]. By 2030, almost 23.6 million people will die from cardiovascular disease every year [ 2 ].

Singapore has gone through rapid economic progression since the postwar era. In 2010, she was ranked third in the world by the International Monetary Fund organization in terms of gross domestic product (GDP) per capita [ 3 ]. According to United Nations statistics, from 2005 to 2010, Singapore is ranked the 1st globally for lowest infant mortality rate at 1.92 infant deaths per 1 000 live births and ranked 10th for life expectancy at birth with a mean of 80.6 years in 2010 [ 4 ]. In terms of literacy rate, Singapore has been ranked by the World Bank to be within the top 30 nations in the world, with a literacy rate of 96% [ 5 ].

The paradigm of public health care in Singapore has shifted from managing infectious diseases to “lifestyle diseases,” including tackling the increasing incidence of strokes and heart attacks. It has been projected that, between 2006 and 2015, the number of acute resident hospitalisations for ischaemic heart disease and stroke would have increased by 21% and 57% each year, respectively [ 6 ]. In 2011, ischemic heart disease accounted for 16.4% of all principle causes of death while cerebrovascular disease (including stroke) accounts for 9.0%, being the 2nd and 4th most common causes of death, respectively [ 7 ]. This is similar to United States, where heart attack is the most common cause of death and stroke is the 4th [ 8 ] and similarly in Europe [ 9 ].

Both heart attack and stroke have better outcomes with time-sensitive treatments such as percutaneous coronary intervention (PCI) and thrombolysis [ 10 – 12 ]. This makes it important for prompt recognition of signs and symptoms of heart attack and stroke, allowing earlier presentation to the hospital for immediate treatment, reducing mortality and morbidity.

For heart attack symptoms, studies conducted in the United States [ 13 ], United Kingdom [ 14 ], and Australia [ 15 ], showed a median interval of 2.2 hours to 6.4 hours before presentation. Our sole local study on presentation times found that the median time from the first onset of chest pain to presentation at the Emergency Department (ED) for ST elevation myocardial infarction is rather similar, with a delay of 173 mins (interquartile range [IQR]: 270 mins), and median time from the worst chest pain to presentation at ED was at 131 mins (IQR: 191 mins) [ 16 ].

For stroke, the same dilemma applies for delayed time presentation from symptom onset to hospital. Hospitals in the USA report that only 59% of stroke patients arrive in hospital within 3 hours of onset of symptoms [ 17 ]. Data from Europe [ 18 ] shows 40% to 56% arrive within 6 hours. A Singapore study performed in 1997 shows that similarly 41.4% arrive within 3 hours, 54.5% within 6 hours, and 68.5% within 12 hours [ 19 ]. Inability to recognize signs and symptoms of acute stroke has been cited as an important reason for delayed presentation.

In Singapore, there has been no study conducted on community understanding of heart attack symptoms. For stroke symptoms, there was only a small study of 150 stroke patients performed in 1997, evaluating their knowledge [ 20 ].

This study aimed to determine the current level of knowledge of the signs and symptoms of heart attack and stroke in the Singapore resident population, in comparison to other countries in the world with similar economic, educational, and health-care standards. We hypothesize that, given the similar time delays from the first presentation of symptoms to ED attendance, the level of knowledge for both conditions, compared to the rest of the developed world, may not differ much.

Singapore is a country with a land area of 712.4 square kilometers and a population of 4.98 million in 2009 [ 21 ]. The population is multiracial with the major ethnic groups being Chinese, Malay, and Indian.

The Health Promotion Board conducts an annual population-based study known as the Omnibus Survey to assess the current level of health knowledge and to gauge the efficacy of its various health programmes. In 2009, 7,840 household addresses were randomly selected using a 2-stage stratified sampling design. This study was exempted from ethics committee review as it was an anonymous survey.

Trained interviewers visited each selected household, from November 2009 to March 2010, to conduct face-to-face interview in one of the four national languages: English, Mandarin, Malay, or Tamil. From each household, the “Next Birthday” method was employed to select either a Singapore citizen or permanent resident aged between 18 and 69 to participate. Those not contactable after 3 visits at 3 different timings or refused to be interviewed or do not speak any of the four national languages were considered as nonrespondents.

Each respondent was given eight questions on signs and symptoms of heart attack and ten questions on stroke, in a True/False manner. For example, respondents would be given a statement, “Prolonged crushing, squeezing, or burning pain in the centre of the chest is a sign/symptom of heart attack” (True/False). Each question is scored 0 for a wrong answer and 1 for the correct answer, with a minimum score of 0 and a maximum score of 8 marks or 10 marks, respectively, for heart attack and stroke. These scores were then summed up and categorized as either low or high scores according to the following scale: for heart attack: low 0–4 points (≤50%) and high 5–8 points (>50%), while, for stroke: low 0–6 points (≤50%) and high 7–10 points (>50%). Although these scales, like most, are arbitrary, they serve the purpose of allowing for the standardized comparison of knowledge levels among groups.

The signs and symptoms of both heart attack and stroke were obtained from the Singapore Health Promotion Board Public Health Educational Resources [ 22 , 23 ], to assess the effectiveness of current health education campaigns addressing these items.

2.1. Signs and Symptoms of Heart Attack

Consider the following:

• prolonged crushing, squeezing, or burning pain in the center of the chest,
• pain that radiates from the chest area to the neck, arms, shoulders, or the jaw,
• shortness of breath,
• chills and sweating,
• weak pulse,
• cold and clammy skin, gray pallor, a severe appearance of illness.

2.2. Signs and Symptoms of Stroke

• sudden numbness or weakness usually on one side of the body,
• sudden confusion or a fit,
• difficulty in speaking or understanding,
• sudden difficulty in seeing in one or both eyes,
• sudden difficulty in walking,
• difficulty in swallowing,
• sudden severe headache with no known cause,
• loss of concentration and memory,
• loss of control of passing urine or passing motion (incontinence),
• sudden severe giddiness, loss of balance, or coordination.

All data were analysed using the statistical package SPSS (version 17.0; SPSS Inc., Chicago, IL). Total counts of each symptom correctly identified were tabulated and overall percentages of correct answers were calculated. The heart attack and stroke scores were summed up for each respondent, and the overall results of the respondents were described as mean scores with a calculated standard deviation. The P values with 95% confidence intervals were analysed by an unpaired two-tailed t- test, stratifying data by the studied variables, such as age and gender. Statistical significance was set at P < 0.05.

Of the 7,840 households randomly selected from the validated sampling frame, a total of 4,192 respondents participated in the survey, giving a response rate of 65.2%. The sociodemographics of the respondents are shown in Table 1 , which is similar to the Singapore resident population, corroborated with the population census in 2009.

Demographics of survey respondents ( N = 4,192).

# PSLE: Primary School Leaving Examination.

In this study, the current level of knowledge for both signs and symptoms of heart attack and stroke was fair regarding both conditions, in almost equal proportions, 57.8% and 57.1%, respectively. The respondents scored an overall mean of 5.0 (SD = 2.4) out of 8 for heart attack, while they scored an overall mean of 6.8 (SD = 2.9) out of 10 for stroke ( Table 2 ).

Descriptive statistics of heart attack and stroke knowledge scores of survey respondents.

# Correct answers received one point and were calculated separately using the following scale.

For the heart attack knowledge scores: low scores = 0–4 points or ≤50% and high scores = 5–8 points or >50%. For the stroke knowledge scores: low scores = 0–6 points or ≤50% and high scores = 7–10 points or >50%.

85.1% of the respondents correctly identified prolonged crushing, squeezing, or burning pain in center of heart as a symptom of heart attack, while 72.9% recognized shortness of breath as another symptom. Only 66.6% correctly identified pain radiating from chest area to neck, arms, shoulders, or jaw as a possible presenting symptom.

Regarding signs and symptoms of stroke, 92.7% of the respondents were able to recognize sudden numbness or weakness usually on one side of the body as a symptom, and 81.2% correctly identified sudden difficulty in walking while 78.8% agreed that difficulty in speaking or understanding speech can also be a symptom ( Figure 1 ).

Proportion of respondents who were aware of the signs and symptoms of heart attack and stroke ( N = 4,192).

Bivariate analysis of the independent variables stratified by high/low heart attack and stroke knowledge scores was conducted and the results are shown in Table 3 .

Bivariate analysis of knowledge of signs and symptoms of heart attack and stroke score by independent variables.

Respondents ≥50 years old had the least knowledge for both conditions, 53.2% for heart attack knowledge compared to 58.9% for those aged between 36 and 49, and 61% for those aged ≤35 ( P < 0.001). Similarly, the stroke knowledge was 52.4% for those aged ≥50 compared to 60.2% for those aged 36–49 and 58.4% for those aged ≤35 ( P < 0.001).

Respondents with a lower educational level exhibited slightly lower scores for both conditions. Those whose lowest educational level was the Primary School Leaving Examination or GCE “O-” Level or GCE “N-” Level certification scored 53.4% for the heart attack knowledge, as compared to 62.8% and 64.3% for those with a GCE “A-” Level/Diploma or a University Degree, respectively ( P < 0.001). The same was observed for their stroke knowledge of 53.9%, compared to 60.8% and 62.2% for those with a GCE “A-” Level/Diploma or a University Degree, respectively ( P < 0.001).

Respondents who were unemployed/retired at time of interview exhibited lower scores for both conditions. For heart attack knowledge, they scored 52.6% as compared to 60.8% for those who were employed ( P < 0.001). For stroke knowledge, they scored 52.3% as compared to 59.8% for those who were employed ( P < 0.001).

Multiple logistic regression model was performed using scores on the heart attack and stroke knowledge questions as the dependent variable. The independent variables entered into the model were age, gender, race, education level, and occupational status. The results showed that those with higher knowledge for both disease conditions were more likely to be female, to have higher levels of education, and were employed ( Table 4 ).

Multiple logistic regression analysis of factors associated with high heart attack and stroke knowledge score.

# PSLE: Primary School Leaving Examination; * P < 0.05; a OR: odds ratio; b CI: confidence intervals.

4. Discussion

In this study, we found that the current level of knowledge for signs and symptoms of heart attack and stroke was fair in the resident population. Those aged ≥50, with lower educational level, unemployed, or retired were the least knowledgeable.

5. Heart Attack Knowledge

Delay from symptom onset in a heart attack to presentation at hospital is an international concern. As mentioned in the Introduction section, studies conducted in the United States [ 13 ], United Kingdom [ 14 ], and Australia [ 15 ] showed similar median interval, of 2.2 hours to 6.4 hours before presentation, compared with Singapore [ 16 ]. One study suggested the most significant contributor to delayed treatment is the patient's ability to recognize the signs and symptoms of a heart attack [ 24 ]. An acute heart attack victim is popularly described as experiencing sudden excruciating chest pain, clutching onto one's chest, and collapsing. Other symptoms such as dyspnea, nausea, or syncope are lesser known [ 14 ]. In a major study in the USA, one-third of 434,877 subjects with confirmed diagnosis of myocardial infarction did not have chest pain on presentation [ 25 ]. When chest pain is not the main presenting complaint, patients may be confused about the severity of their symptoms and thus postpone seeking treatment.

From a global viewpoint, the level of knowledge of signs and symptoms of heart attack in Singapore is comparable to USA and Canada [ 26 , 27 ]. From 2005 to 2009, the Centers for Disease Control in USA collated data nationwide via telephone interviews with a total of 103,262,115 respondents on heart attack knowledge. Their aim was to compare knowledge between the nonrural and rural populations. Singapore is a city-state, thus singling out their nonrural population analysis for comparison; their results showed a higher knowledge, with 92.8% identifying at least one symptom correctly, compared to 85.1% in Singapore. They found the more educated and younger adults (19 to 65 years old) to have higher knowledge, congruent with our study. Unlike ours, there was also a racial and gender discrepancy with Hispanics and women scoring lower [ 26 ]. In Vancouver, Canada, an urban study published in 2008 showed more similar results to ours, with 83.6% identifying at least one out of 10 symptoms correctly. They also found that level of knowledge was higher in young respondents with higher education level and higher annual household income [ 27 ]. In Victoria, Australia, a similar study was also conducted in 2002, with similar results of 84.6% identifying at least one symptom correctly out of 10 symptoms. Respondents with higher educational levels reported higher number of symptoms correctly [ 28 ].

6. Stroke Knowledge

Regarding stroke knowledge, numerous studies have been done in USA, in different states. A large-scale study performed by the Centers for Disease Control, in 17 states, showed that, in 2001, public knowledge of major warning signs of stroke was high, with 94.1% of the 61 019 respondents being able to identify at least one stroke symptom, with the most commonly identified being sudden numbness or weakness of the face, arm, or leg [ 29 ]. This level of stroke knowledge appears to be comparable to our study of 92.7%. The study did not carry out stratification studies. Further analysis of 2 published articles in the USA, performed in similar urban adult populations, in Ohio, 2003, and Michigan, 2002, concurred with our study that younger respondents and those with higher educational level have a higher stroke knowledge level [ 30 , 31 ]. Telescoping into the Asia Pacific Region, in Victoria, Australia, a similar published study in 2001 shows 85.5% of 822 respondents correctly listing at least one stroke symptom [ 32 ]. This appears to be comparatively lower as compared to USA and Singapore. Despite that difference, again, stroke knowledge was found to be higher in those who are more educated. Age differences were not studied in this paper.

7. Taking One Step Forward

Overall, the heart attack and stroke knowledge in the Singapore resident population appears to be somewhat similar, in comparison to countries within the same economic, educational, and healthcare strata.

In USA, an initiative known as the Public Health Action Plan to Prevent Heart Disease and Stroke has been in place since 2003 [ 33 ]. A “Communications Implementation” group is tasked with effectively communicating the urgency and importance of preventing heart disease and stroke through a long-term strategy of public information and education. In their 2008 updated publication, their action steps included crafting clear, attention-grabbing public health messages with a social marketing strategy, to determine media avenues, understand the changing dynamics and interactive nature of web-based communications, employ “expression in popular humor,” and identify target audiences [ 34 ].

A similarly comprehensive plan is in place in Canada for both heart attack and stroke knowledge, known as the Canadian Heart Health Strategy and Action Plan, started in 2006 with its latest executive summary published in 2009 [ 35 ].

In Singapore, public health initiatives are primarily managed by government statutory boards, the Singapore Health Promotion Board (HPB). HPB concentrates on publishing informative and interactive content online, organizing nationwide campaigns complete with public health exhibitions, and putting up posters in public areas for the adult population. The Board also engages the student population during their health education curriculum classes, coupled with field trips to the HPB's health zone interactive exhibition periodically. Currently, we lack the supportive statistics to determine the effectiveness of such interventions. Also, our interventions are mainly targeted at the literate, working, and studying populations. This can explain the results of this paper, as to why older, unemployed/retired respondents with lower educational levels had a lower level of knowledge in cardiovascular signs/symptoms.

Even so, this study has shown that Singapore's community level understanding of sign/symptoms of heart attack and stroke is comparably similar to other developed countries with comprehensive action plans. This conclusion is heartening and assuring that public school health education and continuing public health advocacy by the Singapore Health Promotion Board appears to be heading in a positive direction.

At the same time, we recognize the need for greater public knowledge of signs and symptoms of heart attack and stroke in general. Furthermore, any public health education needs to emphasize the less common presenting complaints of both conditions. As with Canadian and American action plan experiences, continual reassessment of methods employed to promote public health messages is important to maintain relevance. In this manner, this study could be used as a baseline, to measure the effectiveness of future public health campaigns and to correlate with studies performed after intervention.

More targeted public health measures can be taken to raise knowledge in the appropriate groups, for example, the group ≥50 years old, which are at higher risks for both heart attack and stroke. Another group to consider is the unemployed and retired, as campaigns in workplaces may prove futile to aid the understanding of this group. Public health campaigns may need to be carried out in the media such as television and radio, with supporting talks and poster exhibitions in common public-use areas such as community centres, bus stops, or train stations. Addressing those with a lower educational level may require that the information in the campaigns be kept simple and succinct.

We intend to follow up with public health education efforts, which should be studied for their effectiveness in eventually lowering morbidity and mortality, as such, becoming a springboard for comparison before and after intervention.

8. Limitations

Two possible limitations of this study include nonrespondent and interviewer biases. As 34.8% of the selected households did not participate in the survey, the findings might be compromised by nonrespondent bias, although there is no reason to believe that nonresponders were more or less likely to be knowledgeable. To minimize interviewer bias, intensive training was given to all interviewers to standardize method of asking, prior to commencement of study. Interviewers were also randomly shadowed by staff of the Health Promotion Board to ensure quality of the interviews remained consistent. The strength of this study is the close relation of the demographics of the sample population to the true Singapore resident population in the survey year of 2009 [ 21 ].

This study has also made the assumption that being equipped with knowledge will translate into earlier treatment. However, some studies [ 36 , 37 ] have illustrated that there may be other barriers to early presentation to the hospital. These include a victim's perception of severity of symptoms, the person present with the individual at onset of symptoms, first contact for help (e.g., family member and family doctor), financial concerns, insurance coverage, and even previous negative experiences with healthcare institutions. Locally, no similar study has been conducted. Further studies in our local setting to explore other possible reasons why heart attack and stroke patients are not presenting to hospital earlier may be helpful.

9. Conclusion

We found a comparable knowledge of stroke and heart attack signs and symptoms in the community, to countries within the same economic, educational, and healthcare strata. However, there are still pockets of community which require more public health education efforts.

Acknowledgments

The authors would like to thank Dr. Jes Fergus, Ministry of Health, Singapore, and Health Promotion Board, Singapore, for the assistance in data analysis.

This paper was presented as poster presentation at (1) the Society for Emergency Medicine in Singapore Annual Scientific Meeting 2012, Singapore (February 2012), and (2) the SingHealth Duke-NUS Scientific Congress 2012, Singapore (August 2012).

Conflict of Interests

Marcus Eng Hock Ong has licensing agreement and patent filing (Application number 13/047, 348) with ZOLL Medical Corporation for a study titled “Method of predicting acute cardiopulmonary events and survivability of a patient.” There is no further conflict of interests for other authors.

Authors' Contribution

Marcus Eng Hock Ong and Joy Li Juan Quah contributed in study design, data analysis, paper preparation, and final approval before submission. Susan Yap, Si Oon Cheah, Yih Yng Ng, E. Shaun Goh, Nausheen Doctor, Benjamin Sieu-Hon Leong, Ling Tiah, and Michael Yih Chong Chia contributed in study design, paper preparation, and final approval before submission.

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Reflection and perspective are invited, collected, and presented here about the causes, care, control, prevention, epidemiology, and public policy of heart attacks.

• Introduction To Heart Disease

Introduction to Heart Disease

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The general term used to cover malfunctions of the heart is Heart Disease, or sometimes Cardiac Disease ("Cardiac" is a Latin term for the heart). Though there are multiple forms of heart disease, our discussion focuses on the two most common: Heart Attack and Heart Failure. This document is designed to teach you about heart attacks and heart failure: what causes these diseases, what forms these diseases take, and what can be done to treat these diseases when they occur. As both of these diseases are to some extent avoidable, we have also provided a discussion of preventative steps you can take to decrease your chances of having to deal with heart disease, or to minimize the negative effects of existing heart disease.

Please note that though this information is as accurate as possible, it is no substitute for a qualified physician's advice. Consult with your doctor before making changes to any treatment regimen you may be prescribed, and before beginning any program of exercise or other significant lifestyle change, especially if you have a known heart problem or are a middle-aged or older adult. There is no substitute for your doctor's advice.

Although heart disease can occur in different forms, there is a common set of core risk factors that influence whether someone will ultimately be at risk for heart disease or not. We start our discussion of heart disease by describing these common risk factors, and then move on to cover specific conditions.

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There are many factors that can increase your risk of getting heart disease. Some of these factors are out of your control, but many of them can be avoided by choosing to live a healthy lifestyle. Some of the risk factors you cannot control are:

• Gender : Men have a greater risk than women for developing heart disease. Men also are at greater risk of having a heart attack at a younger age. Unfortunately, these facts often mislead women into believing that they are not at risk for heart disease. This is not true; heart disease is the number one killer of women (just like men). Women and men should both take steps to prevent heart disease.
• Age : Simply put, the older you get, the greater risk you run for developing heart disease. It is estimated that four out of five individuals who die of coronary heart disease are 65 years of age or older. Further, at older ages women are much more likely to have a fatal heart attack than men.
• Family History : A family history of heart disease, high blood pressure (hypertension), and diabetes increases the chance you will develop heart disease. People with biological relatives who have heart attacks at a young age (i.e., less than fifty-five years old) are considered to have a "strong" family history of heart disease and are at much higher individual risk.

A person's family history of heart disease risk factors may also be affected by their ethnic background. For example, African Americans have a higher rate of hypertension. Since having uncontrolled high blood pressure increases an individual's chance of developing heart disease, African Americans tend to have a higher risk of developing heart disease. While your family background is not a certain indication that you will get heart disease, it can greatly increase your chances.

Fortunately, there are many other risk factors for heart disease that can be addressed by lifestyle habits and regular preventative medical care. Some of the more controllable risk factors include:

• Obesity : People who are overweight are more likely to have high blood pressure, which increases the heart's overall workload. They also tend to have high cholesterol levels, which increases the chances of developing a blockage in blood flow to the heart. Furthermore, obesity increases a person's chance of developing diabetes, another major risk factor for heart disease. Getting regular exercise and eating a healthy diet are some of the best ways to control obesity and associated medical complications. Any complications caused by obesity should be evaluated and treated by your physician.
• High Cholesterol : Cholesterol, a type of fat molecule, is an essential part of healthy cell membranes, and as such, is an essential part of a healthy body. Too much cholesterol in your blood, however, puts you at increased risk of heart disease. High levels of cholesterol and other fatty substances can cause Atherosclerosis, a disease in which fatty plaques build up on blood vessel walls, restrict blood flow to the heart and can ultimately cause a heart attack.

There are two different types of cholesterol: LDL (the so-called "bad cholesterol") and HDL (the "good" cholesterol). High levels of LDLs increase your chance of having a heart attack. In contrast, the higher your HDLs, the more protection you have against heart attacks. Your cholesterol levels are determined by a combination of age, gender, heredity, dietary choices and exercise. LDL cholesterol can be decreased through exercise and dietary changes such as avoiding saturated and trans fats. The best way to raise your HDL cholesterol is through exercising.

If your cholesterol levels cannot be kept at a safe level (the optimal number depends on your age, family history, and medical history such as whether you have diabetes or a history of heart attacks) with diet and exercise changes, then you and your physician can consider a prescription for cholesterol-lowering medications. People with a history of diabetes or heart attacks need to keep their LDL cholesterol lower than individuals who do not have that history.

• Smoking : Smoking is a major risk factor for heart attacks. Among other health consequences, smoking causes people's blood to clot more easily, and raises blood pressure, thereby putting their heart at risk. In terms of a heart disease prevention strategy, your best protection is to never start, or to quit smoking altogether if you already smoke.
• High Blood Pressure : Uncontrolled blood pressure increases your risk of heart disease. The higher your blood pressure, the harder it is for your heart to pump blood throughout your body. Like any other stressed muscle, an overloaded heart responds to exertion by growing bigger; by thickening its walls and increasing it's overall size. While these changes sound positive, they actually are harmful and are signs of heart disease. As the walls of the heart thicken, the heart chamber's volume becomes greatly reduced and less blood can be pumped each time the heart beats. Also, the thickened muscle walls make it harder for the heart to pump out what blood it is able to collect. Exercise, a healthy diet and medication (if needed) can all help maintain a healthy blood pressure and therefore, a healthy heart.
• Diabetes : As mentioned above, diabetes is a major risk factor for heart disease. A diabetic person's risk of developing heart disease is equivalent to the risk of a person who has had a previous heart attack. Diabetes is a disease of blood sugar regulation. People with diabetes are at greater risk for heart disease if their blood sugar is not kept under good control. In addition, diabetics also need to control their blood pressure and cholesterol levels. In fact, the cholesterol goal for a diabetic is as low as the goal for a person who has had a previous heart attack.
• Other Factors : Stress, drinking too much alcohol, and depression have all been linked to cardiovascular disease. Stress may cause some individuals to overeat, smoke, and/or drink excessively. Drinking can lead to higher blood pressure and obesity. While some studies have suggested that daily moderate alcohol intake (one drink a day) can reduce the risk of heart disease, there is a balance. Alcohol can be an addictive drug, and it is a source of 'empty' (i.e., with limited nutritional value) calories. These extra calories can cause weight problems and diabetes, both of which are associated with heart risks of their own. Any decisions about alcohol consumption as it relates to your heart should be discussed with your doctor.

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