Your heart muscle needs oxygen to survive. A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because coronary arteries that supply the heart muscle with blood flow can slowly become narrow from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis. When a plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow through the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI).

No. There are many causes of chest pain, many of which are not related to the heart. For instance, a pain in the chest that lasts only a few seconds is unlikely to be a heart attack.

Heart attacks usually present with chest pain but not always. Often patients will describe indigestion or heartburn. Some patients only experience nausea or a sensation of sweating. The pain can be felt also in the jaw and in the neck, and in the arms. Often a patient will mistake their pain as indigestion when a heart attack is occurring. This mistake is also made by some doctors if they are unable to do the tests to confirm the problem.

One very common type of chest pain is called angina, or angina pectoris. Angina occurs during exercise or stress when your heart rate and blood pressure increase and your heart muscle needs more oxygen. It is a recurring discomfort that usually lasts a few minutes and disappears soon after exercise or when the stress is removed. If you think you may have angina, you should see a doctor to decide if there is an issue that will put you at risk of a heart attack. .

Although some heart attacks are sudden and intense, most start slowly, with mild pain or discomfort. Some of the common signs include:

1. Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain
2. Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
3. Shortness of breath with or without chest discomfort
4. Other signs may include breaking out in a cold sweat, nausea or lightheadedness.

1. Tobacco smoke

   Smokers' risk of developing coronary heart disease is much higher than that of nonsmokers. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary heart disease. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. Exposure to other people's smoke increases the risk of heart disease even for nonsmokers.

2. High blood cholesterol

   As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, sex, heredity and diet. Here's the lowdown on:

   • Total Cholesterol: Your total cholesterol score is calculated using the following equation: HDL + LDL + 20 percent of your triglyceride level.
   • Low-density-lipoprotein (LDL) cholesterol = "bad" cholesterol: A low LDL cholesterol level is considered good for your heart health. However, your LDL number should no longer be the main factor in guiding treatment to prevent heart attack and stroke, according to the latest guidelines from the American Heart Association. For patients taking statins, the guidelines say they no longer need to get LDL cholesterol levels down to a specific target number. Lifestyle factors, such as a diet high in saturated and trans fats can raise LDL cholesterol.
   • High-density-lipoprotein (HDL) cholesterol = "good" cholesterol. With HDL (good) cholesterol, higher levels are typically better. Low HDL cholesterol puts you at higher risk for heart disease. People with high blood triglycerides usually also have lower HDL cholesterol. Genetic factors, type 2 diabetes, smoking, being overweight and being sedentary can all result in lower HDL cholesterol.
   • Triglycerides: Triglyceride is the most common type of fat in the body. Normal triglyceride levels vary by age and sex. A high triglyceride level combined with low HDL cholesterol or high LDL cholesterol is associated with atherosclerosis, the buildup of fatty deposits in artery walls that increases the risk for heart attack and stroke.
3. High blood pressure. High blood pressure increases the heart's workload, causing the heart muscle to thicken and become stiffer. This stiffening of the heart muscle is not normal, and causes the heart not to work properly. It also increases your risk of stroke, heart attack, kidney failure and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases even more.
4. Physical inactivity

   An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate-to-vigorous physical activity helps reduce the risk of heart and blood vessel disease. Even moderate-intensity activities help if done regularly and long term. Physical activity can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure in some people.

5. Obesity and overweight

   People who have excess body fat — especially if a lot of it is at the waist — are more likely to develop heart disease and stroke even if they have no other risk factors. Overweight and obese adults with risk factors for cardiovascular disease such as high blood pressure, high cholesterol, or high blood sugar can make lifestyle changes to lose weight and produce clinically meaningful reductions in triglycerides, blood glucose, HbA1c, and risk of developing Type 2 diabetes. Many people may have difficulty losing weight. But a sustained weight loss of 3 to 5% body weight may lead to clinically meaningful reductions in some risk factors, larger weight losses can benefit blood pressure, cholesterol, and blood glucose.

6. Diabetes mellitus

   Diabetes seriously increases your risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes increases the risk of heart disease and stroke, but the risks are even greater if blood sugar is not well controlled. At least 68% of people >65 years of age with diabetes die of some form of heart disease and 16% die of stroke. If you have diabetes, it's extremely important to work with your healthcare provider to manage it and control any other risk factors you can. Persons with diabetes who are obese or overweight should make lifestyle changes (e.g., eat better, get regular physical activity, lose weight ) to help manage blood sugar.

7. Stress

   Individual response to stress may be a contributing factor. Some scientists have noted a relationship between coronary heart disease risk and stress in a person's life, their health behaviors and socioeconomic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.

8. Alcohol

   Drinking too much alcohol can raise blood pressure, increase risk of cardiomyopathy and stroke, cancer and other diseases. It can contribute to high triglycerides, and produce irregular heartbeats. Excessive alcohol consumption contributes to obesity, alcoholism, suicide and accidents. However, there is a cardioprotective effect of moderate alcohol consumption. If you drink, limit your alcohol consumption to no more than two drinks per day for men and no more than one drink per day for women. The National Institute on Alcohol Abuse and Alcoholism defines one drink as 1-1/2 fluid ounces (fl oz) of 80-proof spirits (such as bourbon, Scotch, vodka, gin, etc.), 5 fl oz of wine or 12 fl oz of regular beer. It's not recommended that nondrinkers start using alcohol or that drinkers increase the amount they drink.

9. Diet and Nutrition

   A healthy diet is one of the best weapons you have to fight cardiovascular disease. The food you eat (and the amount) can affect other controllable risk factors: cholesterol, blood pressure, diabetes and overweight. Choose nutrient-rich foods — which have vitamins, minerals, fiber and other nutrients but are lower in calories — over nutrient-poor foods. Choose a diet that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats. And to maintain a healthy weight, coordinate your diet with your physical activity level so you're using up as many calories as you take in.

Source: The American Heart Association

Unfortunately, many heart attacks are not diagnosed, or diagnosed very late in Kenya. This is because patients or caregivers may fail to recognize the importance of the symptoms and not seek assistance. Some patients may present to a chemist or a small clinic where they are often misdiagnosed as acidity or pneumonia and inappropriately reassured and treated, with grave consequences. Heart attack diagnosis and treatment is also hindered by having very few facilities in the country that are capable of managing heart attacks. If you suspect you are having a heart attack, please rush to the nearest facility that is capable of managing a heart attack. At minimum this should be a hospital capable of doing an ECG and basic blood tests, and administering medications known as thrombolytics, or “clot busters”. Usually, you may need to be referred to larger hospital after this treatment for a procedure called an angiogram. Presently, the only hospitals where this is available are located in Nairobi. If you are a resident of Nairobi, you may benefit from an urgent angiogram and mechanically unblocking the blocked coronary blood vessels (primary percutaneous coronary intervention (PCI)). It is thus advisable to present to a PCI capable center when you suspect you might be having a heart attack. Remember time is of essence! Every minute since onset of chest pain means no oxygen supply to the heart and death of cells that make up the heart muscles. Thus, promptness of presentation to the hospital is of utmost importance. If you have no contraindications to aspirin (eg aspirin allergy, or bleeding ulcers), then you should take one tablet of aspirin (300mg) or 4 tablets of junior aspirin (each 75mg) if you suspect you are having a heart attack. These should be chewed then swallowed. Aspirin helps to thin the blood and reduce formation of clots.

Ambulance Service	Contacts
1.     Amref Flying Doctors Ambulance Service In Kenya	link
2.     AAR Emergency Ambulance	link
3.     Avenue Rescue Services	link
4.     Kenya Red Cross Society Ambulance	link
5.     Emergency Plus Medical Services In Kenya	link
6.     Phoenix Aviation Limited Ambulance Service In Kenya	link
7.     Intensive Care Air Ambulance Limited In Kenya	link
8.     St John Ambulance In Kenya	link