Every two minutes a heart attack strikes someone somewhere in the UK. Clare Guy explains the signs and symptoms, and the implications for underwriters
The human heart is made up of cardiac muscle and its job is to pump blood throughout the body. It works constantly throughout its lifetime and, unlike other muscles in the body, it never tires.
The heart is made up of four hollow chambers, the left atrium and right atrium, which receive blood, and the left ventricle and right ventricle, which pump the blood out of the heart. The heart muscle requires more oxygen than any other organ in the body (except the brain), but the blood that flows through the heart does not provide it with oxygen. The heart has its own blood supply, provided by the left and right coronary arteries, and the blood vessels that wrap around the outside of the heart.
Causes of heart attack
A heart attack - also known as a 'myocardial infarction' or 'coronary thrombosis' - is the sudden death of a portion of the heart muscle. This occurs as a result of an abrupt coronary artery blockage that lasts for more than a few minutes and causes a portion of the cardiac muscle to be deprived of oxygen, which then causes the death of the heart muscle supplied by that artery. Usually, the blockage is a result of a blood clot, also known as thrombosis.
Although a heart attack is a sudden event, it is usually a result of the narrowing of the coronary arteries, which happens over many years. For example, a condition called 'atherosclerosis' causes layers (plaques) of cholesterol/fatty material (atheroma) to gradually build up inside the coronary arteries, causing them to narrow. The plaques can then rupture, which blocks the artery through a sudden formation of a blood clot (thrombosis) on the ruptured plaque.
Sometimes the blockage can be caused by a spasm of the coronary artery muscle walls, or by an abnormal or very fast heart rate, where the heart muscle demands more oxygen than the blood supply can provide.
Following a heart attack, it is often the case that there is enough undamaged heart muscle for the heart to continue to function satisfactorily. Factors that may increase the risk of a heart attack are:
Several lifestyle factors, such as smoking, physical inactivity, high blood pressure, high cholesterol, drinking too much alcohol, having too much salt/saturated fats in your diet and being overweight.
Family history of heart disease.
People who have been diagnosed with diabetes are more likely to get coronary heart disease, although the reason for this is not clear.
Men have an increased risk of having a heart attack compared to women.
Women have lower risk of heart disease than men until the menopause. The hormonal changes brought about by the menopause are believed to make women as vulnerable to heart disease as men.
Research has shown that women underestimate the risk of developing heart disease, and so may ignore advice to prevent it.
Sudden severe stress causing a fast heart rate - usually in someone who already has coronary artery disease - can increase the risk of a heart attack.
Age can increase the risk of developing coronary heart disease, as conditions such as atherosclerosis take a long time to develop, and arteries naturally become less elastic as we age.
Signs and symptoms
It should be noted that a heart attack could happen at any time, for example, either during exercise or at rest. If symptoms persist for more than 15 minutes, it is probably a heart attack.
The following are usually, but not always, symptoms of a heart attack:
Crushing central chest pain that may spread to both arms (particularly the left) and up into the throat and jaw.
Sweating, light-headedness, nausea or shortness of breath.
When these symptoms are not relieved by resting or by using a nitrate tablet/spray.
Not all heart attacks result in severe or even noticeable symptoms - it is possible for a 'silent myocardial infarction' to take place, during which pain may be absent and the heart attack may not be recognised by those affected.
When this kind of heart attack is diagnosed, it is usually on the basis of an ECG showing evidence of an old infarction.
Diagnosis of a heart attack
The diagnosis of a heart attack is usually made on the basis of ECG changes that will indicate which part of the heart muscle has been damaged; cardiac enzyme changes (molecules released into the circulation following cardiac injury); and a suggestive history.
There are, however, other diagnostic investigations that may be performed.
Clare Guy is a life and disability underwriter at Scottish Equitable Protect
Facts and figures
There are an estimated 268,000 heart attacks a
year in the UK.
The estimated number of people under 75 living in the UK who have had a heart attack is 826,000. That is 26,000 higher than last year's estimate.
Heart attacks occur in five out of 1,000 people in the UK each year. It occurs more often in men than in women, and mostly in people over 40-years old.
Myocardial infarction is the main cause of death in Western societies.
The mortality from myocardial infarction is 25% - half of those who die never reach hospital.
Myocardial infarction accounts for around one third of the mortality that can be attributed to coronary artery disease.
Half of those who die from a particular attack do so from heart stoppage (cardiac arrest) within three or four hours of onset.
Statistics from the Chest Heart Stroke Association (1998) reveal that every two minutes a heart attack strikes someone somewhere in the UK.
A British Heart Foundation survey found that most women believed that breast cancer was a bigger threat to their health, but statistics show that women are four times more likely to die from heart disease than breast cancer.
Every year, nearly one in every two women who dies will do so from heart and blood vessel disease.
Even though coronary heart disease (CHD) kills more women than breast cancer over time, most women still think CHD only affects men - and may not bring the subject up when talking to their GP. Young women, in particular, are more scared of dying from lung or breast cancer than are worried about the risk of CHD.
Studies have found that death from CHD is around 60% higher in smokers than in non-smokers.
It has been found that regular exposure to second-hand smoke increases CHD risk by around 25%.
Obesity is a major risk factor for coronary heart disease. It is associated with high blood pressure, heart attacks, heart failure and diabetes.
Underwriting implications
From an underwriting perspective, due to the medical implications of a heart attack, all benefits except life cover will generally be declined. Typically, life cover will not be considered until six months after the incidence of a heart attack, although there are situations where the postponement period may be longer than this.
In some cases, an application for life cover may be declined from the application form. For example, if the applicant who is disclosing a heart attack is under 40, or if it is felt that there are too many risk factors involved with a particular applicant (for example, an overweight person or smoker). Additionally, if the heart attack is disclosed in combination with diabetes, then life cover will be declined.
Usually, when assessing an application where a heart attack has been disclosed, an underwriter will request a GP report together with copies of any available cardiology reports, and possibly an additional GP questionnaire.
When underwriting for an applicant who has a history of a heart attack, the type of heart attack will be taken into account. There are different types of heart attack, depending on which portion of the heart muscle became deprived of oxygen, and this indicates the severity of the heart muscle damage. The classifications are as follows: anterior; antero-lateral; antero-septal; inferior; infero-apical; infero-lateral; posterior; postero-lateral; and subendocardial.
When underwriting for an applicant who has had a heart attack, the underwriter will also take into account factors such as date of last attack, frequency of attacks, results of all investigations, other risk factors (such as obesity/smoking/high cholesterol or blood pressure), treatment and the response to treatment, any complications and the effect on functional capacity.
If terms are available, the disclosure of a heart attack will always attract a rating for life cover, which will be based on the medical information received, and will be determined by the type of heart attack and the age of the applicant. The rating may then be increased if there are other risk factors, such as obesity, high blood pressure/high cholesterol, smoking or ongoing cardiac symptoms, such as angina or other heart abnormalities.
