Heart attacks rarely strike without warning —Doctors

Heart attacks are often portrayed dramatically in films—someone suddenly clutches the chest, gasps for breath and collapses. But cardiologists warn that in real life, the warning signs are frequently subtle, easily ignored and sometimes completely silent, especially among high-risk individuals.

Health experts say the real danger usually begins years before the actual cardiac event, through untreated risk factors such as high blood pressure, high cholesterol, diabetes, smoking and obesity.

A major study published in the Journal of the American College of Cardiology found that more than 99 per cent of people who suffered a heart attack had at least one major risk factor beforehand.

These included elevated blood pressure, high blood sugar, abnormal cholesterol levels or a history of tobacco use. Most of the patients had two or more of these risk factors, with hypertension emerging as the most common.

Hypertension has become one of the most pressing health challenges across Africa. A review published in Cardiovascular Research estimated the crude prevalence of hypertension on the continent between 2002 and 2023 at 28.5 per cent, although the rates vary widely between countries and regions.

World Hypertension League Regional Director, Professor Mayowa Owolabi, said the situation is more alarming than many people realise.

“Several years ago, almost one out of every two Africans aged 25 years and above had hypertension, and only about seven per cent had their blood pressure under control. The remaining 93 per cent are either undiagnosed, not on treatment or poorly controlled,” he said.

He warned that uncontrolled hypertension significantly increases the risk of heart failure, stroke, kidney failure and sudden death.

According to him, “Every minute, six Africans develop a stroke, and at least one Nigerian suffers a stroke.”

He also pointed to the growing influence of what he described as the “commercial determinants of health”—tobacco, alcohol and ultra-processed foods—which are driving obesity and cardiovascular disease across the continent. Obesity, he noted, doubles the risk of hypertension, while diets rich in vegetables help reduce it.

The study had involved more than nine million people in South Korea and about 7,000 in the United States, showed that over 93 per cent of those who later developed heart attacks or strokes had blood pressure readings above optimal levels—even if they had not yet been formally diagnosed with hypertension.

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Cardiologists say these findings underscore a critical point: heart attacks rarely occur without warning. Instead, they are usually the result of years of silent damage to the blood vessels and heart muscle.

Professor Adewole Adebiyi, a cardiologist at the University College Hospital (UCH), Ibadan, said up to 80 per cent of cardiovascular diseases can be prevented through simple lifestyle measures.

According to him, “Maintaining normal body weight, eating healthy meals, sleeping well, reducing stress, exercising regularly and avoiding tobacco and alcohol can prevent the majority of heart diseases.”

He added that strong social connections and healthy relationships also contribute to overall cardiovascular health.

Despite this, many people ignore early symptoms, especially persistent or sudden chest pain, which doctors say should always be treated as a medical emergency.

Consultant cardiologist at UCH, Dr Oladimeji Adebayo, warned that chest pain is one of the most important warning signs of a heart attack.

“Chest pain is not just chest pain to a cardiologist. It may be a sign of a life-threatening heart attack,” he said.

He explained that the classic symptom of heart attack is pain on the left side of the chest that may spread to the left arm, shoulder, back or jaw. The pain may also be accompanied by nausea, vomiting, sweating or a general feeling of discomfort.

Because cardiac pain is often “referred pain”, it may appear in areas other than the chest, leading many people to misinterpret it as muscle strain, indigestion or fatigue.

“Any unexplained chest pain, especially in an adult, should be investigated immediately,” he said.

Dr Adebayo noted that symptoms vary between individuals and are not limited by race. Men are more likely to describe the pain clearly, while women may present with less typical symptoms such as fatigue, shortness of breath, nausea or back pain.

People living with diabetes are at even greater risk because they may not feel chest pain at all.

“A diabetic patient can have a heart attack without feeling any chest pain. That is why regular check-ups are very important,” he explained.

According to him, the onset of pain during a heart attack is usually immediate, and delays in seeking medical care can be fatal. Some patients may collapse suddenly due to severe cardiac events.

Dr Adebayo stressed that basic tests such as an electrocardiogram (ECG) and chest X-ray are essential for anyone presenting with chest pain.

“ECG is a standard and essential test. It helps us quickly determine whether the pain is coming from the heart.”

He also warned against self-medication and misdiagnosis, noting that some patients with heart attacks are treated for unrelated conditions because their symptoms are dismissed.

Beyond heart attacks, chest pain can also indicate other serious cardiovascular conditions such as aortic dissection and pericarditis, both of which require urgent medical attention.

Professor Adebiyi said it is a misconception that heart attacks and heart failure occur suddenly without warning.

“Some people have had elevated blood pressure for years, silently damaging their organs. The first sign may be sudden collapse after years of ignored headaches or chest discomfort.”

Another important but often overlooked warning sign is heart palpitations—an unusual awareness of one’s heartbeat.

Professor Okechukwu Ogah, a consultant cardiologist at UCH and past president of the Nigerian Cardiac Society, said palpitations may indicate an underlying arrhythmia that could lead to sudden cardiac arrest.

He stated: “Palpitations are the heart asking for attention. They may signal that something is wrong.”

Palpitations can present as very fast heartbeats (tachycardia), unusually slow heartbeats (bradycardia) or irregular rhythms. They may be accompanied by dizziness, shortness of breath, chest discomfort or fatigue.

“Feeling unusually exhausted during routine activities like cooking or fetching water should be reported at the hospital,” he added.

Heart conditions linked to palpitations include coronary artery disease, heart failure, valve disorders and cardiomyopathy. In people with existing cardiovascular disease, palpitations may indicate worsening heart function.

Experts say maintaining heart health begins with knowing and monitoring key health indicators—blood pressure, blood sugar, cholesterol levels and body weight.

Regular medical check-ups are essential for detecting borderline or mildly elevated values before they progress to full-blown disease. Even small increases in blood pressure, glucose or cholesterol should prompt lifestyle changes or medical treatment.

Because most heart attack risk factors are modifiable, doctors say a large proportion of cases can be prevented.

A heart-friendly lifestyle includes reducing salt intake, maintaining a healthy weight, eating whole grains, fruits, vegetables and lean proteins, exercising regularly and avoiding processed foods, trans fats and smoking.

Quitting smoking is particularly important, as tobacco use is one of the leading causes of cardiovascular disease and many cancers.

Ultimately, experts say awareness is the most powerful tool in preventing heart attacks. Recognising early warning signs, managing risk factors and seeking prompt medical care can mean the difference between life and death.

“Early diagnosis saves lives,” Dr Adebayo said. “Prompt testing and treatment significantly improve survival rates.”

They urge Nigerians not to ignore persistent chest pain, unexplained fatigue, palpitations or shortness of breath, especially if they have high blood pressure, diabetes, high cholesterol or a family history of heart disease.

In many cases, the body sends warning signals long before a major cardiac event occurs. Listening to those signals—and acting quickly—remains the best defence against heart attacks.