Walking out of the Tube station into the busy street in London’s Covent Garden, Vikie Shanks took a sharp breath as a wave of discomfort flooded over her.
She’d been suffering from bouts of what she’d assumed was indigestion for a couple of weeks, each one more uncomfortable than the last, but this one stopped her in her tracks.
‘Up until that point it had been a mere inconvenience, but this time, along with the pain in the upper part of my torso, I felt really unwell,’ recalls Vikie, from Kenilworth, Warwickshire. ‘I had to sit down on the pavement for about 20 minutes while the feeling passed.’
Vikie Shanks, 59, started suffering from pains in the stomach and thought she had indigestion. Two weeks later she discovered she’d actually had a series of heart attacks
Despite the severity of the episode, 59-year-old Vikie simply stopped at a nearby chemist to pick up some Gaviscon and got on with her day.
‘I remember thinking: “Should I get a taxi and go to hospital?” But once the pain dissipated, I decided against it. I didn’t want to bother them with something so trivial.’
What Vikie didn’t realise was that far from being ‘just’ indigestion, the real cause of her discomfort was a blockage in one of the main coronary arteries supplying blood to her heart.
She was, in fact, having a heart attack.
Vikie’s failure to recognise the symptoms of a heart attack is all too common, according to experts, who say our perception of what a heart attack looks or feels like is often wide of the mark – meaning people don’t get help when they should.
Far from the classic image of someone clutching their chest and falling to the ground – something the British Heart Foundation terms ‘a Hollywood heart attack’ – much more common are seemingly innocuous symptoms ranging from nausea and vomiting to sweating, breathlessness, jaw pain and, as Vikie experienced, a dull ache resembling heartburn or indigestion.
Seemingly innocuous symptoms ranging from nausea and vomiting to sweating, breathlessness, jaw pain and, as Vikie experienced, a dull ache resembling heartburn or indigestion are much more common than the classic image of someone clutching their chest and falling to the ground
‘Sadly, people frequently mistake their heart attack symptoms for other things,’ says Dr Niket Patel, a cardiologist at the Royal Free Hospital in London.
‘It can be difficult to disentangle the symptoms of a heart attack from those of acid reflux or heartburn, and it’s common for me to see people who didn’t want to burden the ambulance service or A&E by getting it checked out.’
He adds: ‘This is particularly disturbing because with heart attacks, time is of the essence. The longer you wait, the higher the chance of the heart muscle being permanently damaged.’
Heart attack or heart burn?
If you have persisting chest pain that’s accompanied by shortness of breath, sweating and/or dizziness it may be a heart attack. ‘The key is to understand your body and to consider what is normal,’ says Lucy Morton, senior cardiac nurse at the British Heart Foundation.
‘If it’s quite usual for you to experience some indigestion after a heavy meal, it’s probably nothing to worry about. But if that “indigestion” is out of the ordinary, prolonged or particularly severe, you should seek medical advice.’
A heart attack is usually the result of coronary heart disease, which occurs when the arteries supplying the heart muscle with blood become narrowed by a build-up of fatty materials.
The pain or discomfort felt from such narrowing is angina, while a full blockage can cause a myocardial infarction – the medical term for a heart attack.
Prompt treatment is vital as a delay in treatment for a heart attack can result in a cardiac arrest, where the heart stops pumping blood around the body. Without immediate treatment it can be fatal within minutes.
A heart damaged after a heart attack can’t repair itself and it can result in heart failure, where the heart can no longer pump blood around the body properly.
There are close to 200,000 UK hospital visits a year due to heart attacks. And the British Heart Foundation reports a spike in heart attacks each year from the start of the festive season through to spring, with 350 people dying from heart attack or stroke between December 2015 and March 2016 – a 14 per cent rise on the rest of the year, though precise reasons for this spike aren’t clear.
‘We need to be more vigilant at this time of year because heart attacks are more frequent,’ says Dr Patel. ‘We also need to be aware that we’re more likely to rationalise the symptoms and attribute them to festive over-indulgence.
‘It’s unnecessary for patients to be ringing 999 every time they experience indigestion but if people are unsure then it’s best to seek medical help,’ he adds.
‘Typical heart attack pain presents like an ache or pressure in the chest, like a tightness or constricting sensation, which can radiate to the arm or the jaw.
‘This, coupled with breathlessness, sweating, nausea or generally feeling unwell, should ring alarm bells and they should call 999 immediately.’ Dr Patel adds: ‘Some people experience it as a gastric pain just below the diaphragm, but it’s persistent pain and/or these associated features that should make people think they should be seeking urgent medical help.
‘And people with diabetes – both Type 1 and Type 2 – should bear in mind that they tend not to experience a heart attack as a pain at all, but more typically as nausea.’
This may be due to diabetic neuropathy, or nerve disease, which can damage nerves that convey pain from the heart.
Research has suggested that women are more likely to suffer a so-called ‘silent’ heart attack, displaying non-specific and subtle symptoms such as indigestion or prolonged and excessive fatigue rather than the classic pain in the chest, back, jaw or arm. A study at Oslo University Hospital, in Norway, and published in the Journal of the American Heart Association last December, found a link between a high pain threshold and ‘silent’ or missed heart attacks, suggesting women’s pain tolerance might explain why so many don’t realise they are having a heart attack.
If you suspect a heart attack, a potentially life-saving piece of advice, says Dr Patel, is to chew -not swallow – 300mg of uncoated aspirin (a normal adult tablet) to help dissolve the clot which causes the blockage (provided you aren’t allergic or have been told not to take aspirin by a doctor).
Chewing an aspirin has been found to work faster against clots than swallowing or dissolving a tablet in water.
‘Taking aspirin quickly could buy you time, but it’s important to ring 999 first and not to waste time hunting in the medicine cabinet,’ advises Dr Patel.
‘If there’s someone with you who can look, or if you have them to hand, take one. If not, just rest and wait for the ambulance so as not to put undue pressure on the heart.’
It may well have been the aspirin given to Vikie by her GP when she reluctantly visited him in September that saved her life. ‘Because the episode outside the Tube station had been so severe, I decided I should get it checked out, although I was still convinced it was nothing serious,’ she remembers.
‘I know my GP well and I was laughing as I explained my symptoms, saying, “I know it sounds like a heart attack but it’s just indigestion, even though I didn’t normally suffer from it”.
‘I didn’t for one minute think it might actually be the truth.’
Vikie’s GP insisted she had an ECG – a test to check the electrical activity of the heart – and referred her to hospital immediately. ‘I still wasn’t convinced,’ adds Vikie, who campaigns for families affected by autism and whose life with her seven children, six of whom have autism, was made into a Netflix documentary.
‘I insisted on driving myself there when he wanted to call for an ambulance, because I just didn’t want to make a fuss.’
Once at hospital and in the cardiac ward, Vikie had another heart attack and was rushed straight into surgery.
Surgeons discovered Vikie’s left anterior descending artery – the most important of the three main coronary arteries – was blocked.
She had a procedure to fit two stents, small mesh tubes, to keep the blocked artery open.
‘I still haven’t got the all-clear,’ she says. ‘During surgery, they discovered I had a leaky heart valve, where it doesn’t close properly and can cause the blood to flow backwards, putting extra pressure on my heart to work harder.
‘No one can tell me if that was related to the blockage or if it was something I had anyway.
‘I also have an irregular heartbeat, so I need another heart scan and a 24-hour monitoring test to determine what will happen next.
‘I’m taking aspirin, statins and clopidogrel to prevent further blood clots and ramipril to lower my blood pressure, but I just feel incredibly lucky to be alive.’
She adds: ‘Anyone with a thread of conscience is programmed to think twice before visiting their GP for something trivial, let alone go to A&E.
‘But it’s important for people to realise that you don’t have to be clutching your chest in agony for it to be very significant indeed.’