Rachel Low woke up one morning to a strange feeling: she was overly tired and had a nagging pain in her left arm, shoulder, neck and breast. Then, she began sweating profusely, as if 'I was having a major hot flush'.
She continued ignoring her symptoms, but incessant nagging from her husband led her to reluctantly pay a visit to the doctor. The doctor-in-charge diagnosed her as "an anxious new mother" and subsequently sent Low home with painkillers and muscle relaxants.
The symptoms persisted, and the next day, Low collapsed at the dinner table.
"I did not think that what was happening was a heart attack. At the hospital, I was shocked when the hospital staff told me I was having a heart attack."
On a bright sunny morning one month ago, 42-year-old Jason Tan didn't know his short drive to work would change his entire life. "I started to feel a burning sensation in my chest, as well as discomfort from arm to shoulder. I broke out into a sweat, felt nauseous, and my head was spinning."
He kept on driving, figuring he was just anxious. He had a big presentation to the company's president that morning, and he had pulled an all-nighter preparing for that.
"At the time, I was a smoker, so I lit up a cigarette, figuring that it would reduce my anxiety."
It didn't. He kept ignoring the symptoms, got to work, and felt worse.
"It felt like all my body functions were out of control. I experienced crushing chest pain, left arm numbness, pain in my left arm. It felt like an elephant was sitting on my chest.
"A colleague called an ambulance for me. I just remember sitting on the floor, and people gathering around and watching me have a heart attack," he recalls.
Low and Tan have both joined the largest club in the world, dubbed by American actor and comedian Robin Williams as the "brotherhood of the cracked chest".
According to the World Health Organisation (WHO), in 2008, coronary heart disease was responsible for 7.3 million deaths. Over 80 per cent of those deaths takes place in developing nations like Malaysia, and occur just about equally in both men and women.
In 2030, if the WHO's projection is right, 23.6 million people will die from heart disease. Not in the picture are the millions more who will suffer from the crippling effects of a "damaged" heart.
"I never added up the symptoms. Instead of saying I'm having a heart attack, I thought maybe it was indigestion or stress anxiety. It's like everything else; you just don't think it's going to happen to you. And I don't know if that's being ignorant or just really believing you're healthier than that," says Tan.
According to senior consultant cardiologist Datuk Dr Khoo Kah Lin, "Often, many patients think they just have heartburn. A lot of people think you're supposed to clutch your chest and collapse, much like a 'Hollywood heart attack'."
"Some people only get pain in their jaws, so they get a pressure, a heavy feeling, a tight feeling in their neck. Many people think it's pain, but actually, it's not pain. A heart attack is pressure, a heavy feeling. It's a tight feeling across the chest. This tight feeling is often misconstrued by patients, making them think that it can't be a heart attack because a heart attack has to really hurt. It doesn't have to hurt, it's a tight feeling," adds Prof Sim Kui Hian, head of the cardiac unit at Sarawak General Hospital.
Women have different symptoms
Women have different symptoms
According to Low, "I suffered significant heart muscle damage as a result of my heart attack, partially because I waited so long to go to the hospital, and partially because once I got there, it took the hospital casualty staff over two hours to realise what was going on.
"I feel so lost and confused about the whole experience. I am a mother of three children, and I am not ready to die."
Experts say for every minute the heart artery remains closed, the greater the heart muscle damage.
"Women need to accept that the threat of heart disease and stroke is very real. Heart disease is not a male-only disease," stresses Tan Sri Dr Robaayah Zambahari, senior consultant cardiologist and Women's Heart Health Organisation (WH2O) chairperson.
"Just as important is the fact that women who make lifestyle changes to improve their health can reduce their risk of premature heart disease and stroke by as much as 80 per cent."
According to a report published by WH2O, one in every four Malaysian women die each year from heart disease and stroke. Yet, stop a woman on the street and she is unlikely to list heart disease as a concern. The signs and symptoms in women can be subtle - nearly two-thirds of women who die suddenly of a heart attack had no prior symptoms. As a result, about 50 per cent of women who experience heart attacks die before they reach hospital.
Women are less likely to experience chest pain than men. Even if they do, the pain experienced is milder, and can be described as pressure, or an ache. This discomfort is usually felt in the centre of the chest, and lasts for more than a few minutes; the pain may come and go.
"Because women who develop heart attacks usually do not experience severe chest pains, they are often given lower priority than men, who would usually come in with chest pains at hospitals," notes Dr Robaayah. "Women with heart disease are often misdiagnosed or under-treated. Those who are correctly diagnosed often feel isolated and confused."
Markers for heart disease
Risk factors for coronary artery disease were not formally established until the initial findings of the Framingham Heart Study in the early 1960s.
It is now known that a number of protective lifestyle factors are associated with a marked decrease in risk of coronary heart disease, cerebrovascular disease, and overall mortality. Such lifestyle factors include dietary pattern, physical activity, alcohol intake, sleep, smoking status and body mass index.
Dr Khoo advises: "You have to keep an eye on your cholesterol level, so you'll need to be doing a lipid test every six months. Blood pressure is an issue, so watch your salt intake. Go on an exercise programme. And watch your stress, because we know stress is a really important risk factor."
Both Tan and Low know the drill. These days, lunch or dinner looks a lot different.
"I used to eat char kuay teow or mixed rice piled with meat. I'm not sure if there is anything worse for you," says Tan.
With a low-fat diet and medicine, his cholesterol level is now down.
For the first time in 10 years, Tan is exercising, and four days in the hospital helped him quit his pack-a-day habit. "It's all for the good. I'm still getting used to it."
He advises: "Stop smoking; that's the first and foremost thing. Along with diet and exercise, that's three things you have to do. It's key that you maintain a healthy diet, and you do get out and walk or run or swim or do some physical activity a few times a week."
For a guy who never thought he would have a heart attack, he now knows how to prevent another one. Tan knows he has a second chance, one he doesn't want to squander.
Once Low was discharged from the hospital, she asked herself repeatedly: "What can save me from another heart attack?"
Her cardiologist has this plain reply: "Simple lifestyle changes."
These lifestyle changes mean increasing your physical activity, a healthy diet, and giving up unhealthy habits like smoking or drinking excessive amounts of alcohol.
But that is the only solution.
"I work almost 12 to 14 hours a day. Deadlines have to be met, bosses have to be cajoled and pleased. Often, it is an unimaginable struggle just to keep afloat. I barely have time for proper meals - one or two meals in a day suffice for me," says Low.
"There are plenty of snacks and instant meals in the pantry, plus coffee and tea for hunger pangs. Call me an emotional eater, but that's how I keep sane.
"Cheap, convenient and easily accessible, that's usually the type of food my family goes for. Of course, we know the importance of healthy eating. But we can only afford to do what we can, given the circumstances. We try as much as possible to ask the waiter to use less oil or salt, and even call for kurang manis at the mamak.
"We have two young children to feed, and my husband is also working full-time, but still, we can barely make ends meet.
"My schedule for the day is so tight that I can't find the time to exercise. By the time I finish work, I am so drained that sleeping is all I can think about."
Low knows she is living on borrowed time, but for her and many others today, this is just the reality we are saddled with. Of course, we recognise that healthy diets and regular, adequate physical activity are major factors in the maintenance of good health; mainstream media, our parents, in-laws, have incessantly pounded that fact into us.
"Walk 10,000 steps a day," says one source. "Stress is bad for you. You must stay calm and practise meditation like a yogi," and "Eat a rainbow of vegetables every meal," say others.
We are also told that cardiovascular disease is the world's most vicious killer. People who have high blood pressure, high levels of cholesterol and glucose, overweight and obese, those who smoke, and those who rarely engage in physical activity, are all at high risk of cardiovascular diseases such as heart diseases and stroke.
Heart disease is a "lifestyle" disease that can be mitigated by changes to behaviour. In other words, victims "brought it upon themselves".
However, many argue that unsafe outdoor space, exacerbated by rapid development and decreased availability of green space for exercise and recreation forces individuals to a more sedentary lifestyle.
Such restrictions and influences "nudge" individuals into behaviours that predispose them to heart disease; for them, there is no option for a healthier lifestyle.
However, as Prof Sim puts it, there is no such thing as "I can't do this". Simple practices such as packing a fruit or two in your bag so that you have something to munch on when you get hungry in between meals, or drinking a glass of water prior to meals, are practical examples we Malaysians can adopt.
If your office is on the 10th floor, why not take the lift up to the 7th floor, and walk up the remaining distance via the stairs?
States Dr Robaayah: "If you have not exercised for many years, we are not expecting you to turn into a buffed-up fitness enthusiast overnight. Take time to gradually build your stamina by adopting a consistent exercise routine."
In fact, studies have shown that even 15 minutes a day or 90 minutes a week of moderate-intensity exercise may be beneficial.
At the end of the day, it's all up to us - give excuses for the lifestyle we live, or take the challenge and make positive changes that will benefit you in the long run.