Heart is located in the center of chest with its apex pointing towards left arm. This is why in heart attack mostly pain occurs in the center of chest spreading towards left arm or left shoulder.

Heart is made up of specialized muscles which keep contracting rhythmically resulting in heart pumping. Heart has four chambers, 2 on the right - Right atrium and right ventricle and 2 on the left - left atrium and left ventricle. It has four valves - 2 on right side - tricuspid valve and pulmonic valve and 2 on left side - mitral valve and aortic valve. It has a this covering called pericardium

Normal heart pumping is between 55 - 70%. If pumping is less than 50% it is a weak heart and it pumping is more than 70% it is a hyper contractile heart and possibly a stiff heart. Heart either weak or stiff is unhealthy.   

For a healthy adult who is physically and emotionally at rest, normal heart rate is between 60-100 beats per minute. During physical exertion or emotional or mental stress heart rate goes up which is absolutely normal. During exercise and while running or climbing stairs heart rate goes up. During sleep or meditation heart rate goes less than 60 or 50 beats per minute and that is also normal. People who do lot of hard work like laborers, farmers or athletes have lower heart rate at rest.

Atherosclerosis is also called hardening of the arteries. When the lining inside an artery is damaged, fat and plaque build up. This causes the artery walls to thicken, and the blood vessel narrows or sometimes gets blocked.

Coronary artery disease is a form of atherosclerosis. It’s when the arteries that supply blood to the heart narrow, which can lower the supply of oxygen-rich blood to the heart, especially when your heart beats faster, like during exercise. Extra strain on the heart may result in chest pain (called angina) and other symptoms.

There are some risk factors that you can't do anything about. These include:

• Being male
• Being a woman who is past menopause
• Being older
• Having a family history of heart attack or coronary artery disease

Other risk factors can be controlled. These include:

• Smoking
• High Cholesterol
• High blood pressure
• Lack of exercise
• Obesity
• Diabetes
• Unhealthy diet
• Stress

By improving your habits, you can cut your risk of heart attack or angina.

About 30% of deaths from heart disease are directly related to cigarette smoking. Smoking is a major cause of atherosclerosis, heart attack, hypertension, paralysis.

Among other things, the nicotine in smoke causes:

• Less oxygen to the heart
• Higher blood pressure and heart rate
• More blood clotting

Damage to cells that line coronary arteries and other blood vessels

You can do several things to cut your chances of heart disease. If your arteries are already clogged, you can slow the damage with a healthy diet, exercise, quitting smoking, and reducing stress, maintaining optimum weight. With lifestyle changes, you can stop or slow the progress or even reverse the narrowing of arteries. While this is important for those with risk factors for the disease, it is even more important if you have had a heart attack or  underwent angioplasty or bypass.  

Classical symptom of heart attack is chest discomfort. Patients complain of discomfort or heaviness or tightness in the center of chest, or on left side of chest or on both sides of chest which sometimes spreads to left shoulder, left arm, upper back, neck or lower jaw. Pain of heart attack can also happen in any one or more of the above areas. This discomfort may be associated with diffuse sweating (cold sweats) or breathing difficulty.

In silent attack patients do not complain of chest pain. They complain of other symptoms like sudden onset breathing difficulty, sudden heavy sweating, sudden onset weakness or fatigue. Silent attack is commonly seen in elderlies, females, obese, diabetic patients. 

Females do have unusual presentation like silent attack (no chest pain). They may have only sudden breathing difficulty, diffuse sweating or sudden weakness. Females tend to ignore their symptoms so many a times they present late with heart attack

Yes, lower jaw discomfort is a well known symptom of heart attack. If you are having lower jaw pain on walking or climbing stairs or after meals or if your jaw pain is associated with some chest discomfort or arm discomfort then you should definitely rule out a heart attack.

If you are having symptoms like heart attack, do not panic but do not waste time and try to reach nearest good hospital as soon as possible. Trying to self medicate or trying to take telephonic advice may prove fatally wrong. There was a practice of giving tab sorbitrate under tongue but it only causes pain relief, it does not save life. If you are on blood thinner you may take an extra tablet before reaching to emergency. In heart attack every minute matters so any unnecessary delay can be life threatening.

Angiography is a test to check your heart vessels. It shows the condition of your heart vessels, wether any blockages are there or not, if blockages are there what is the severity of blockages, what is the distribution and how many vessels are affected. It is the angiography which gives a clear picture in a heart patients with blockages that what should be the best line of treatment. Wether you can be managed with medicines alone or you need further treatment like angioplasty or bypass

Angiography can be done conventionally where we put a wire through your hand or it can be done by CT scan as well.

Angioplasty is procedure to remove blockages in the heart vessels with the help of balloon and stent. it is commonly done through your wrist, occasionally through your leg. It does not involve any surgery. There are neither incisions nor sutures. In a routine case it usually takes 30 minutes to one hour to complete the procedure and you can be discharged next day or after 2 days. It does not need any general anesthesia. It only needs a small dose of local anesthesia. During procedure you can actually see your procedure and you can talk with your doctor.

In a routine non emergency angiography, if your angiography reports are good and you are comfortable, you can start walking after 2-3 hours of procedure. We actually discharge you after 3 hours of angiography. That day if you are comfortable and your angiography reports were good, you can do all your routine personal activities. In a routine non emergency case you can join your office or can start your routine work from next day. In an emergency condition or if you have multiple other issues as well or if you are uncomfortable you should discuss with you doctor and follow his advice regarding work or rest. If your doctor has given you any specific instructions regarding precautions, rest, exercise you should follow it. 

In a routine case where there was no emergency, you are comfortable, your angiography reports were good and your doctor has allowed or has not advised you rest, you can join your work form next day

After a non emergency angioplasty, you are are usually discharged next day or after 2 days if there were no other issues. You start walking after few hours and allowed to walk more from next day. Post discharge you gradually need to build up your stamina over 3-4 days and if you are comfortably walking for 20-30 minutes, climbing stairs, not having any symptoms you can join your work after 5-7 days. If you had a heart attack, if there were other issues, if there was involvement of any other organ is there, if your heart pumping is weak then it may take little longer before you can start your work. In emergency aw well as non emergency angioplasty, discuss these issues with your doctor and follow his/her advice.

After angioplasty you have to take few medicines life long to prevent second heart attack and to prevent development of new blockages. In early few months after angioplasty number of medicines are more but after one year there will be only few medicines. Blood thinner and cholesterol medicine you need to take life long. If you have other issues like blood pressure, diabetes or weak heart there will be additional medicines to manage them.