FAQ

No, according to research, only 3% of chest pain that patients report to a doctor is actually a heart attack. A significant proportion of them (12%) is what we call chronic stable angina, and an overwhelming 85% of chest pains are non-cardiac in origin, meaning there are other causes like musculoskeletal (40%) or gastric (10-18%).

20% of chest pain admissions to the Emergency Department are proven to be heart attacks, and 80% have other causes. However, heart disease is the leading cause of death in Australia, exceeding all types of cancers put together or old age-related deaths (e.g. Dementia, falls, etc.)., even during the height of the COVID-19 pandemic.

All myths have been proven wrong. In my 25 years of treating heart disease patients, my youngest patient with a heart attack was 18 years old; females and males both have equal preponderance, and I have encountered many who had heart attacks while doing their regular workouts in gyms or climbing Castle Hill. ”Muscles’’ alone don’t always guarantee immunity for heart attacks, and there is a certain entity called the “Obesity Paradox”.

If we use biomarkers like Troponin, it is very common for approximately 18% of patients to suffer heart damage during major operations, and it is the leading cause of death after surgery in developed countries. There it is very important to get your heart checked before any major surgery, especially if you have risk factors for heart disease or are already known to have heart problems.

• Most often, it is not perceived as chest but pain, but patients feel a sensation of pressure, tightness or squeezing in the centre of the chest, especially on strenuous exertion like mowing the lawns, climbing stairs, running, etc
• Pain in other parts of the body – it can feel as if the pain is travelling from the chest to the arms (usually the left arm is affected, but it can affect both arms), jaw, neck, back, shoulder blades and abdomen
• Feeling lightheaded or dizzy or fainting with or without chest discomfort
• Profuse sweating.
• Short of breath, feeling excessively tired, unable to play sports or go to the gym. Many mistake it for getting old or being obese.
• Feeling sick (nausea) or being sick (vomiting) (sometimes mistaken for gastroenteritis).
• Overwhelming sense of anxiety (similar to having a panic attack)
• Upper abdominal or lower chest discomfort after a heavy meal. (usually mistaken for gastritis).
• In some cases, there may not be any chest pain at all, especially in women, elderly people and people with diabetes. Silent heart attack.

• Electrocardiogram (ECG or EKG).This is the first and most important test to perform when anyone complains of chest pain. Call 000 immediately if it is severe and occurring for the first time.
• Blood tests.Blood tests detect heart muscle damage (Troponin).
• Coronary catheterization (angiogram).It should be done as early as possible, for best results, within 90 minutes of having chest pain. Usually, one or rarely more than one of the three main arteries of the heart is completely blocked with clots, and it must be opened using balloons +/- stents.
• This procedure is called primary angioplasty, and Dr Udaya Prashant has been doing it for 20 years. He makes himself available at odd times, midnight, weekends, public holidays, etc., as part of a rigorous primary on-call team and has saved thousands of lives by immediately stenting heart attack patients.
• Nearly 50% of heart attack patients present > 6 hours before the onset of pain, and there is a risk of permanent heart damage. Sometimes, they form large clots, which are difficult to clear and lead to poor outcomes. Dr Udaya Prashant has developed a novel technique for rescuing heart attack patients with high clot burden.

1. This can be done by using Heart Health Checks or Cardiovascular (CV) Risk calculators.
2. CT Calcium scoring
3. Stress test. There are various stress tests. Ordinary stress tests done by recording ECG’s on a treadmill are not very useful in diagnosis. Stress MPS using nuclear radiation or Stress Echocardiogram (Available at Pulse Cardiac Care) integrating echocardiography and ECG is a better test for predicting heart attack risk.

Yes, if the stress test is stopped early because of poor exercise capacity. Stress tests have limitations, as they are only screening tools and do not have 100% sensitivity or specificity.

It is more complex than treating a heart attack. It involves lifestyle changes and developing healthy habits. For further information, book a cardiology consultation with Dr. Ponangi through the friendly staff of Pulse Cardiac Care. We use the ‘’Renpho” device to estimate viscera, subcutaneous fat, lean muscle mass and other parameters, send special lipid analyses, Apo A/ApoB ratios, Homo IR ratios, LpA etc, to tailor preventive strategies for individual patients.

Traditionally, HDL is called good cholesterol, and LDL is called bad cholesterol. To prevent heart attacks, LDL should be as low as possible (<1.8 mmol/l).

It is a type of cholesterol that is not affected by usual anti-cholesterol medications and can cause multiple heart attacks at a young age.

There are many causes of heart attacks that can occur when heart arteries are normal. High-stress levels cause Takatsubo cardiomyopathy or “Broken Heart Syndrome”, which is becoming increasingly common nowadays.

Even for an experienced operator, it isn’t easy to estimate just by looking at the angiograms. We need advanced testing called FFR during angiography. FFR records pressures before and after a narrowing; if there is a significant pressure drop, only those must be treated by stenting.

Dr Udaya Prashant Ponangi pioneered the novel technique of iFR co-registration in Townsville. This technique allows for precisely analysing several narrowing’s simultaneously in each vessel, which is otherwise not possible by conventional methods.

The presence of calcium in the heart arteries denotes that the vessels were damaged by cholesterol deposition, and patients are at risk of having heart attacks. Any score above 400 denotes high risk. Statins are highly recommended to minimise future heart attack risk. For those with serious intolerance to statins, there is another option of taking 6 monthly injections to reduce cholesterol levels. (Inclisiran or Leqvio).

Highly calcified arteries are technically challenging to stent, and normal balloons do not crush them. We need special devices called Rotational Atherectomy, where the tip of the catheter has a diamond-studded burr and spins at 160000-180000, drilling its way into the calcium. Dr Udaya Prashant Ponangi is an expert in these complex interventions, and one of his cases was published in BMJ.

Blood is normally pumped only forward across each chamber of the heart and is regulated by valves. If the valves are faulty, blood leaks backwards, putting a lot of strain on the heart to maintain normal blood pressure and blood circulation and can cause heart failure. Surgery is the solution for severe leaky valves, but not all patients require operation. Our experienced sonographers can perform regular heart scans and tell exactly when a patient requires surgery.

1-2% of the Australian population have heart failure. They are one of the sickest patients in the community.

The main cause is that after a heart attack, certain areas of the heart muscle stop functioning, and the heart becomes progressively weaker and bigger. (Dilated Cardiomyopathy).

Surprisingly, 50% of heart failure patients have normal heart function on heart scanning or echocardiogram (Ejection Fraction or EF >50%).

10 years ago, the five-year survival was similar to a cancer patient, but now, with modern medications, people are living much longer. The key is taking medications regularly and restricting fluids to <1.5- 2.0 litres/day.

Dr Udaya Prashant Ponangi has extensive experience managing heart failure patients, including post-heart transplants and those on artificial hearts (LVADS).

Excess alcohol consumption and many cancer drugs weaken the heart muscle, producing cardiomyopathy. 2D Echo can detect early damage before a person develops symptoms. Advanced techniques called Strain Rate Imaging (available at Pulse Cardiac Care) are sometimes utilised.

Only 32% of Australians with hypertension have reduced their blood pressure to within the healthy or ideal range, compared to 68% of people in Canada. Around half of Australians with hypertension are not even aware that they have high blood pressure.

When blood pressure readings at a health care provider’s office are higher than in other settings, such as at home, it is called White-Coat Hypertension. The main reason is the anxiety or stress of visiting doctors’ clinics. A 24-hour Ambulatory BP monitoring device (available at Pulse Cardiac Care) can be very useful in managing such cases. It automatically records blood pressure in preprogrammed time intervals for in-depth analysis.

The lifetime cumulative risk of developing syncope is 35% in the adult population. Despite being a very common problem, a staggering 40% remain undiagnosed.

ECG, 2D Echocardiogram, and 24-hour HOLTER studies are commonly performed if we think syncope is cardiac in origin. We use a very convenient, high-tech Walkfree Cardioline Holter device for monitoring, eliminating the messy cables used by previous-generation devices.

 A Tilt Table Test (coming soon) may be useful in certain cases. Dr Udaya Ponangi wrote a thesis on tilt table testing and published a book evaluating unexplained syncope.