Dull chest aches, swollen legs and fainting spells: Possible signs of a silent heart attack

You may not have acute chest pains, but cardiologists warn these are telltale symptoms that require urgent medical attention

Not all heart attacks will have you clutching at your chest area in pain; other symptoms include nausea, swelling in your legs and cold sweats. PHOTO: GETTY IMAGES

Imagine getting ready for work, and suddenly noticing your legs are swollen, or feeling odd sensations such as a vague discomfort in your chest, nausea, cold sweats or increasing breathlessness.

You may be inclined to dismiss these as possible effects of work stress, but you could be experiencing a silent heart attack.

Dr Joshua Loh, a cardiologist at Mount Elizabeth Novena Hospital, says: "In our busy lives, we may easily write off some of these symptoms as anxiety or fatigue triggers. It is important to know that when in doubt, always consult your cardiologist to rule out the possibility of coronary artery disease or other serious heart conditions."

Watch out for signs

According to data from the Ministry of Health, almost one out of three deaths in Singapore in 2020 was due to heart disease or stroke. But often, heart attacks and strokes are preventable if treated early.

And while most associate heart attacks with a sharp pain that leaves you clutching at your chest, you may not even feel much pain at all.

Results from a 2019 Manulife survey revealed that seven out of 10 Singaporeans were unable to identify a heart attack, and only one in 10 can identify all the major symptoms of one.

"I had a patient in his forties who had an episode of chest pain that he ignored. It was a massive heart attack. Five days later, he came into the hospital with severe heart failure. His lungs were full of fluid, and his blood pressure was too low to support his organs.

"It was too late to open his heart artery because by that time, most of his heart muscle was dead. " says Dr Michael Ross Macdonald, cardiologist at Mount Elizabeth Hospitals.

"We stabilised him, and he was eventually discharged to return home. But with severe heart failure, he required multiple medications to be taken long term. He still gets short of breath after walking 180m."

Dr Kelvin Wong, cardiologist at Mount Elizabeth Hospital, advises that you seek medical attention immediately if you experience the following:

  • Chest discomfort (dull aches or tightness, rather than sharp pains)
  • Shortness of breath on exertion or when sleeping at night
  • Fainting or near-fainting spells,
  • Palpitations (a fast or irregular heartbeat)
  • Swelling of legs

Being aware of the dangers

Notably for women, symptoms may be atypical and vague. They include giddiness, nausea, back pain, jaw aches and breathlessness, sometimes without any chest pain.

Dr Wong also stresses that if you are predisposed to these conditions - heart disease and blocked arteries due to diabetes, a smoking habit, high blood pressure, a family history of heart diseases, high cholesterol, older age and a sedentary lifestyle - the importance of seeking immediate medical attention cannot be overstated.

Dr Michael Ross Macdonald, cardiologist at Mount Elizabeth Hospitals, concurs. He says: "Even if you are sure you're not having a heart attack, get yourself checked out urgently. When someone has a heart attack, the coronary artery is suddenly blocked, and the heart muscle does not get enough blood and oxygen.

"The longer it remains blocked, the more damage is done to the muscle. And often, it is irreparable. I have treated many patients who initially ignored chest pain, only to experience leg swelling and breathlessness a few months later. They developed heart failure because the pain they experienced a few months before was a heart attack that was not treated."

Time is of the essence

Cardiologists often use the phrase "time is muscle," meaning the longer someone delays treatment, the greater the damage to the heart muscle, resulting in a much lower chance of recovery. This is why those with risk factors and showing mild symptoms should see a specialist within the next day so they can get the necessary treatment within days.

IHH Healthcare's group of hospitals ensures patients enjoy a quick route from appointment to consultation to surgery - if needed - within 48 hours to minimise further damage done to the heart muscle.

Following an acute heart attack, the blocked artery needs to be opened quickly.

A damaged heart muscle can lead to heart failure, a condition that can make you breathless even walking short distances, or lead to strokes and kidney failure.

A coronary angioplasty, also known as a percutaneous coronary intervention (PCI), is the gold standard of treatment. Dr Loh says: "It is a life-saving procedure which involves the ballooning and stenting of a blocked coronary artery causing the heart attack. The sooner a heart attack patient gets to the hospital to receive treatment, the higher the odds of survival."

"In cases of narrowed heart arteries which are heavily calcified and hardened from years of cholesterol plaque build-up, the use of a special lithotripsy balloon that emits shockwave pulses break up the calcium effectively to allow for vessel expansion during stenting.

"This technology has helped us treat many of my patients effectively with angioplasty and stenting, who may otherwise have limited treatment options in the past."

Enjoying comprehensive medical care

Mount Elizabeth Hospitals are equipped with a full range of equipment and experience necessary to diagnose and treat heart diseases so that treatments such as complex angioplasty can be performed safely and effectively.

Aside from a strong team of experienced cardiologists and cardiothoracic surgeons who can ensure a proper diagnosis and the right selection of treatments, its hospitals have the facilities - such as modern cardiac imaging machines, robotic angioplasty devices and cardiac surgical facilities - to deliver a full set of cardiac services.

Mount Elizabeth Hospitals also have a wide pool of senior multi-disciplinary specialists to support the care of patients. This is important, according to Dr Paul Ong, a cardiologist at Mount Elizabeth Novena Hospital, since heart patients often have co-existing conditions such as kidney failure and diabetes.

Patients who have suffered a critical illness such as a heart attack or have undergone a major procedure such as heart surgery undergo a holistic rehabilitation programme under the watchful care of dedicated allied health professionals there.

They include physiotherapists, occupational therapists, dieticians, and specialised nurses who work together with the doctors to support patient recovery.

Are private hospitals really expensive?

Everyone deserves the best healthcare possible, but may still have the misconception that seeking treatment at private hospitals comes with a higher cost.

Dr Ong says that this is not necessarily true. According to the Ministry of Health, 70 per cent of Singapore citizens enjoy the protection of integrated shield plans. Most of these provide comprehensive coverage for in-hospital treatment in private hospitals.

What's more, with a private integrated shield plan complemented by a rider, medical expenses need not be exorbitant. And patients who are insured under such plans can receive treatment at private hospitals with minimum cash outlay.

To empower you to make informed decisions, Mount Elizabeth Hospitals have put in place tools and services to provide cost estimates for your health procedures and treatments.

The Hospital Bill Estimator calculates how much you have to pay out-of-pocket for common procedures based on your Private Integrated Shield Plan, with or without a rider.

If you require more information, WhatsApp or call the Parkway Insurance Concierge hotline (+65 9834 0999) for clarifications related to the coverage of your shield plans and panel doctors. Hotline staff are on hand to help you make an appointment with the specialist of your choice.

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