Warning signs of a heart attack include: chest pain or pressure, pain spreading to the arms, jaw, neck, back, or upper abdomen, difficulty breathing, nausea, vomiting, sweating, dizziness, or sudden collapse. Symptoms can be less typical in women, older people, and people with diabetes.
A heart attack can begin as ordinary chest discomfort. Within minutes, a blocked artery can start starving the heart muscle of oxygen. The gap between survival and severe damage often depends on how quickly patients spot the warning signs and reach the hospital.
Doctors say chest pain should never be ignored or left to pass. Once a patient arrives, emergency staff should assess them and perform an electrocardiogram, or ECG (a test that records the heart’s electrical activity), within 10 minutes. That way, treatment to restore blood flow can begin without delay.
The stakes are high in Kenya. The Ministry of Health says cardiovascular diseases (illnesses of the heart and blood vessels) account for about 13 per cent of deaths and 25 per cent of hospital admissions. High blood pressure is a major driver and affects about one in four adults, yet only 15.6 per cent of those with it know they have it.
Dr Mzee Ngunga is a consultant interventional cardiologist (a heart specialist who treats blocked arteries using thin tubes called catheters) at Aga Khan University Hospital, Nairobi. “Chest pain or discomfort can be an indicator of serious and life-threatening conditions and should be evaluated promptly with minimal delay,” he says.
What happens during a heart attack?
A heart attack, medically known as myocardial infarction (death of heart muscle caused by lack of blood supply), happens when fatty deposits inside the coronary arteries (the vessels that feed the heart) rupture and a blood clot forms.
“This blockage slows or blocks blood flow to the area of heart muscle supplied by that artery. If prolonged, the muscle can become damaged or die,” Dr Ngunga explains.
How big is the problem?
Ischaemic heart disease (heart disease caused by narrowed or blocked arteries) is the world’s biggest killer. The World Health Organization (WHO) estimates it caused about nine million deaths in 2021, roughly 13 per cent of all deaths worldwide.
In Kenya, the Ministry of Health has made the prevention and management of cardiovascular diseases a national priority.
What are the warning signs?
The most recognisable sign is chest pain or discomfort, but it does not always stay in one place. Dr Ngunga says it may occur on the left side of the chest or anywhere between the neck and the umbilicus (the navel). Patients often describe squeezing, pressure or heaviness.
“The pain may sometimes be felt in either arm, the jaw, teeth, neck, upper abdomen or back,” he says. Other symptoms include difficulty breathing, nausea or vomiting, sweating, dizziness and collapse. WHO lists a similar set of warning signs.
Symptoms can be less typical in women, older people and people with diabetes. Waiting for the classic, crushing chest pain before seeking help can therefore be dangerous.
Who is most at risk?
High blood pressure is a major driver. The 2015 Kenya STEPwise survey (a national health survey run by the Ministry of Health using WHO methods) found that about one in four adults aged 18 to 69 had hypertension (persistently high blood pressure). The official age-standardised estimate was 24.5 per cent. A separate weighted analysis of the same data put the figure at 25.8 per cent, with men at 28.1 per cent and women at 23.6 per cent.
Only 15.6 per cent of those with hypertension knew they had it. Risk also climbs with age: people aged 60 to 69 were nearly four times as likely to be hypertensive as those aged 18 to 24.
Hypertension, smoking, diabetes, obesity (excess body fat that harms health), unhealthy diets, physical inactivity and harmful alcohol use can all speed up artery damage. Another analysis of the survey data found that residents of Nairobi, Central, Eastern and Coast regions had 40 to 50 per cent lower odds of ideal cardiovascular health than people in Rift Valley. Age, lifestyle, urbanisation and access to care all appear to play a part.
What should happen at the hospital?
For a suspected heart attack, every minute counts. Dr Ngunga says emergency staff should check blood pressure, pulse, oxygen saturation (the amount of oxygen carried in the blood) and temperature, take a history and perform an ECG. “All this should be done within 10 minutes of your arrival,” he says.
The ECG helps doctors tell apart two broad types of heart attack. In STEMI, or ST-elevation myocardial infarction (a heart attack caused by a completely blocked artery), treatment to restore blood flow should start immediately. In NSTE-ACS, or non-ST-elevation acute coronary syndrome (usually a partial blockage), doctors rely on symptoms, ECG findings, and blood tests for cardiac troponin (a protein released when heart muscle is damaged).
How is it treated?
For STEMI, the priority is to reopen the artery. The preferred treatment, where available, is primary percutaneous coronary intervention, or PCI (a procedure to open a blocked artery from the inside). Dr Ngunga calls it the gold standard. A catheter is guided through the wrist or groin to the heart. A balloon then opens the blockage, and a stent (a tiny mesh tube) keeps the artery open.
Another option is thrombolysis (clot-dissolving drugs). However, it can fail to reopen the artery and carries a significant bleeding risk, including bleeding in the brain.
What should you do if chest pain strikes?
Do not wait for the pain to pass. “Chest pain, especially if it develops within a few minutes to an hour, needs urgent evaluation to rule out potentially serious causes,” Dr Ngunga says.
He advises using the fastest available transport to an appropriate emergency department and telling staff at once that you have chest pain. Cardiologists sum it up as “time lost is heart muscle lost”.
Long-term prevention means controlling blood pressure, diabetes, cholesterol, tobacco use, and weight. Kenya’s 2024 cardiovascular guidelines aim to standardise this across the health system. But for someone with unexplained chest discomfort, the priority is reaching care quickly.
