A heart attack occurs when the blood flow to the heart is severely restricted or blocked. The obstruction is often brought on by the buildup of fat, cholesterol, and other substances in the heart's (coronary) arteries. The fatty, cholesterol-containing formations are known as plaques. The process of plaque accumulation is known as atherosclerosis. On rare occasions, a plaque may rupture, causing a clot to form and obstruct blood flow. A reduction in blood flow can damage or even destroy a portion of the heart muscle. Known also as a myocardial infarction, a heart attack.^1-4

Symptoms of a heart attack might vary. Some people experience mild symptoms. Others exhibit severe symptoms. Some people don't exhibit any symptoms. Common heart attack symptoms include aching, squeezing, pressure, or tightness in the chest. spreading to the upper belly, shoulder, arm, back, neck, jaw, and teeth, Sweating on the palms of your hands, exhaustion, heartburn or indigestion, abrupt lightheadedness or dizziness, nausea, shortness of breath, etc. Unusual symptoms in women can include sharp or abrupt neck, back, or arm pain. Sometimes the first sign of a heart attack is a sudden cardiac arrest. Heart attacks can strike without warning. Many people, however, exhibit warning signs and symptoms hours, days, or even weeks in advance. An early warning sign of angina is persistent chest pressure or pain that doesn't go away with rest. A brief reduction in blood flow to the heart is what causes angina.^3-7

Coronary artery disease is the most common cause of heart attacks. Coronary artery disease causes one or more of the heart's (coronary) arteries to become blocked. Typically, this is caused by plaques, which are deposits of cholesterol. Arteriosclerosis, which is brought on by plaques, can reduce cardiac blood flow. A blood clot in the heart could develop from a ruptured plaque. Not all heart attacks are caused by blocked arteries. Other causes include coronary artery spasm (SCAD), certain infections, and spontaneous coronary artery dissection.^4-8

Numerous medical factors, such as lifestyle, age, and family history, might increase the likelihood of developing heart disease and having a heart attack. They're known as risk factors. Nearly half of all patients have at least one of the three main heart disease risk factors: high blood pressure, smoking, and high cholesterol.^6-10

People may live longer and experience less morbidity and mortality if they are aware of the causes, warning signs, and symptoms of a heart attack. In order to gauge this knowledge among the general populace of Himachal Pradesh, the current study was carried out.

Objectives of the Study

To evaluate the Knowledge about symptoms and risk factors for Heart Attack among the general population of Himachal Pradesh

• Research Approach -Descriptive

• Research Design-  Cross-sectional survey design

• Study area:  Hilly state of Himachal Pradesh

• Study duration- between January 2023 to March 2023

• Study population: All adults above 18 years of age who were staying in the state of Himachal Pradesh for 12 months or more. 

• Sample size- 400 Adults  assuming 50%   have adequate knowledge regarding symptoms and risk factors for Heart Attack, 5% absolute error, 95% confidence level, and 5% non response rate.

• Sampling Technique- convenience & snowball Sampling technique

• Study tool: A google form questionnaire consisting of questions regarding socio-demography, symptoms and risk factors for Heart Attack was created. The questionnaire was initially pre-tested on a small number of people to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 20 structured questions regarding knowledge about symptoms and risk factors for Heart Attack (10 each) having three options i.e. Yes, No & Don’t Know.  The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 10 and minimum score was zero in each category. Scoring was done on the basis of marks as >80%(9-10)=very good,60-79%(7-8) =Good,41-59% ( 4-6 )=Fair,<40% (< 4)=poor

• Validity of tool - by the experts in this field

• Inclusive Criteria- who were willing to participate in the study.

• Exclusion Criteria: who were not willing to participate in the study

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin in both rural and urban area of Himachal Pradesh till the 400 responses were collected. Responses were then recorded in a Google Excel spreadsheet.

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations- Participants confidentiality and anonymity was maintained. 

The present study was cross sectional descriptive study carried out to evaluate knowledge of symptoms and risk factors for Heart Attack among general population of state of Himachal Pradesh . In the present study 42% (168) of the Patients fall were below 40 years of age while 58% (232) were above 40 years.  51% (204)of patients were male and 49% (196) were female. 

Table-1: Knowledge about Sign & Symptoms of Heart Attack among participants

Table-2: knowledge of participants towards risk factors of Heart Attack

Figure-1: Knowledge towards Symptoms and Risk Factor of Heart Attack among study participants

In the present study 57(14.25%) study participants had very good knowledge (9-10 marks) towards sign & symptoms of Heart Attack, 224(56%) had good knowledge  (7-8 marks), 70(17.5%) had fair knowledge  (4-6 marks) and 49(12.25%) had poor knowledge (<4 marks) towards risk factors for Heart Attack. Similarly, 52(13%) study participants had very good knowledge (9-10 marks) towards risk factors of Heart attack, 244(61%) had good knowledge (7-8 marks), 69(17.25%) had fair knowledge (4-6 marks) and 35 (8.75%) had poor knowledge (<4 marks) towards risk factors of heart attack.

People may live longer and experience less morbidity and mortality if they are aware of the causes, warning signs, and symptoms of a heart attack. In order to gauge this knowledge among the general populace of Himachal Pradesh, the current study was carried out.^3-5

The results of our study demonstrate the general ignorance of heart attack symptoms and risk factors among Himachal Pradesh citizens. Similar results were found by Zhan C et al⁴ and Hertz JT et al⁵ in their respective studies.

The prevention of heart attacks is essential. Many people have their first heart attack, which can be fatal or severely disabling. It is never too late to take preventative measures, even after a heart attack. Following are some methods to prevent having a heart attack: Maintain a healthy weight, give up smoking, live a balanced lifestyle, eat a heart-healthy diet, exercising regularly, controlling stress, managing diabetes, high cholesterol, and blood pressure and  Rest as often as possible.^8-10

Limitations

Since the study's sample size and time period are set at 400 participants and three months, respectively, the scope and extent of the conducted research may be minimized. This poll was only conducted in one state of India, hence its findings cannot be generalized to the entire nation.

According to the survey's results, most Himachal Pradesh residents are unaware of the warning signs, symptoms, and risk factors for heart attacks. There is a need for educational programming to raise community awareness of heart attacks because they are a severe issue and have been proved to be a significant cause of increased mortality and morbidity.

1. Clevelandclinic Available at:  https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction(Accessed on 4 April 2023)

2. CDC. Available at:  https://www.cdc.gov/heartdisease/heart_attack.htm(Accessed on 4 April 2023)

3. Mayoclinic. Available at:  https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106 (Accessed on 6 April 2023)

4. Zhan C, Shi M, Wu R, He H, Liu X, Shen B. MIRKB: a myocardial infarction risk knowledge base. Database (Oxford). 2019 Jan 1;2019:baz125. 

5. Hertz JT, Madut DB, Tesha RA, William G, Simmons RA, Galson SW, Sakita FM, Maro VP, Bloomfield GS, Crump JA, Rubach MP. Knowledge of myocardial infarction symptoms and perceptions of self-risk in Tanzania. Am Heart J. 2019 Apr;210:69-74. 

6. Heart. Available at:  https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack(Accessed on 7 April 2023)

7. Banharak S, Zahrli T, Matsuo H. Public Knowledge about Risk Factors, Symptoms, and First Decision-making in Response to Symptoms of Heart Attack among Lay People. PRIJNR. 2018 Jan;22(1):18-29. 

8. Hopkins medicine. Available at:  https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-attack(Accessed on 8 April 2023)

9. Medical news today. Available at:  https://www.medicalnewstoday. com/articles/ 151444#outlook (Accessed on 9 April 2023)

10. Medline plus. Available at:  https://medlineplus.gov/heartattack.html(Accessed on 10 April 2023  )