A heart attack occurs when blood flow to the heart is severely reduced or blocked. The blockage is usually due to a buildup of fat, cholesterol and other substances in the heart (coronary) arteries. The fatty, cholesterol-containing deposits are called plaques. The process of plaque buildup is called atherosclerosis. Sometimes, a plaque can rupture, forming a clot that blocks blood flow. A lack of blood flow can damage or destroy part of the heart muscle. A heart attack is also called a myocardial infarction [1-4].

Symptoms of a heart attack vary. Some people have mild symptoms. Others have severe symptoms. Some people have no symptoms. Common heart attack symptoms include Chest pain that may feel like pressure, tightness, Pain, squeezing or aching, Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth, or sometimes the upper belly, Cold sweat, Fatigue, Heartburn or indigestion, Lightheadedness or sudden dizziness, Nausea, Shortness of breath, etc. Women may have atypical symptoms such as brief or sharp Pain felt in the neck, arm, or back. Sometimes, sudden cardiac arrest is the first symptom of a heart attack. Some heart attacks strike suddenly. But many people have warning signs and symptoms hours, days, or weeks in advance. Chest pain or pressure (angina) that keeps happening and doesn't go away with rest may be an early warning sign. Angina is caused by a temporary decrease in blood flow to the heart [3-7].

Coronary artery disease causes most heart attacks. One or more heart (coronary) arteries are blocked in coronary artery disease. This is usually due to cholesterol-containing deposits called plaques. Plaques can narrow the arteries, reducing blood flow to the heart. If a plaque breaks open, it can cause a blood clot in the heart. Blocked arteries cause not all heart attacks. Other causes include Coronary artery spasms, certain infections and Spontaneous Coronary Artery Dissection (SCAD) [4-8].

Health conditions like lifestyle, age and family history can increase heart disease and heart attack risk. These are called risk factors. About half of all sufferers have at least one of the three key risk factors for heart disease: high blood pressure, high blood cholesterol and smoking [6-10].

Knowing the risk factors, early signs and symptoms of Heart Attack could potentially prevent morbidity and mortality among people. Thus, the present study was carried out to evaluate this Knowledge among the general population of New Delhi.

Objectives of the Study

To evaluate the Knowledge about symptoms and risk factors for Heart Attacks among the general population of New Delhi.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study Area: New Delhi

• Study duration: Between June to July 2022

• Study Population: All adults above 18 years of age who stayed in New Delhi for 12 months or more

Sample Size

About 400 Adults assuming 50% have adequate Knowledge regarding symptoms and risk factors for Heart Attacks, 5% absolute error, 95% confidence level and 5% nonresponse rate.

Sampling technique convenience and snowball Sampling technique

Study Tool

A google form questionnaire consisting of questions regarding socio-demography, symptoms and risk factors for Heart Attacks 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

Demographic Data Survey Instrument: The demographic form elicited information on participants' backgrounds: age, gender, marital status, religion, employment, education and many more.

Questionnaire

 The questionnaire contains 20 structured questions regarding Knowledge about symptoms and risk factors for Heart Attacks (10 each) having three options, i.e., Yes, No and Don't Know. The participants have to choose the right one. One mark was given for each correct answer and zero for the incorrect answer. The maximum score was ten and the 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 email and social media platforms like WhatsApp groups, Facebook, Instagram and LinkedIn in both rural and urban areas of New Delhi till the 400 responses were collected. Responses were then recorded in a Google Excel spreadsheet.

Data analysis was collected and entered in a Microsoft Excel spreadsheet, cleaned for errors and analysed with Epi Info V7 Software with an appropriate statistical test for frequencies and percentages. 

The present study was a cross-sectional descriptive study carried out to evaluate Knowledge of symptoms and risk factors for Heart Attacks among the general population of New Delhi. In the present study, 38% (152) of the Patients fell below 40 years of age, while 62% (248) were above 40 years. 53% (212) of patients were male and 47% (188) were female (Table 1).

In the (Table 2) study 59(14.75%) study participants had very good knowledge (9-10 marks) towards sign & symptoms of Heart Attack, 221 (55.25%) had good knowledge (7-8 marks), 71(17.75%) had fair knowledge (4-6 marks) and 49(12.75%) had poor knowledge (<4 marks) towards risk factors for Heart Attack. Similarly, 42(10.5%) study participants had very good knowledge (9-10 marks) towards risk factors of Heart attack, 249(62.25%) had good knowledge (7-8 marks), 64(16.0%) had fair knowledge (4-6 marks) and 45 (11.25%) had poor knowledge (<4 marks) towards risk factors of heart attack (Table 3).

Table 1: Knowledge About Sign and Symptoms of Heart Attack Among Participants

Table 2: Knowledge of Participants Towards Risk Factors of Heart Attack

Table 3: Knowledge Towards Sign, Symptoms and Risk Factor of Heart Attack among Study Participants

Myocardial Infarction (MI) is a common cardiovascular disease and a leading cause of death worldwide. The etiology of MI is complicated and not completely understood. Many risk factors are reported to be important for the development of MI, including lifestyle factors, environmental factors, psychosocial factors, genetic factors, etc. [3-5].

The results of our study demonstrate that the general population of New Delhi is underinformed about heart attack symptoms and risk factors. Similar findings were reported in the studies done by Zhan et al. [1] and Hertz et al. [3].

Heart attack prevention is critical. It should begin early in life. For many people, their first heart attack is disabling or even fatal. It's never too late to take steps to prevent a heart attack, even if you've already had one. Here are ways to avoid a heart attack Follow a healthy lifestyle, don’t smoke, maintain a healthy weight with a heart-healthy diet, get regular exercise, manage stress, Control high blood pressure, high cholesterol and diabetes, Get good sleep, etc. [8-10].

We conclude from the survey results that the general populace of New Delhi is not well informed on the symptoms, risk factors and warning signs of a heart attack. There is a need for educational programming to raise community knowledge of heart attacks because this is a severe issue and has shown to be a substantial source of increased mortality and morbidity.

Limitations 

The sample size and duration of the study are restricted to 400 respondents and two months in time; thus, the scope and extent of the conducted research might be minimized. This survey was conducted only in one state of India; hence, these findings cannot be generalized all over India.

Ethical Approval

Participants' confidentiality and anonymity were maintained.

1. Mayo Clinic. “Heart Attack.” Mayo Clinic, www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106. Accessed July 2022.

2. Zhan, C. et al. “MIRKB: A Myocardial Infarction Risk Knowledge Base.” Database (Oxford), 2019, Article ID: baz125.

3. Cleveland Clinic. “Heart Attack (Myocardial Infarction).” Cleveland Clinic, my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction. Accessed July 2022.

4. Centers for Disease Control and Prevention. “Heart Attack.” CDC, www.cdc.gov/heartdisease/heart_attack.htm. Accessed July 2022.

5. Hertz, J.T. et al. “Knowledge of Myocardial Infarction Symptoms and Perceptions of Self-Risk in Tanzania.” American Heart Journal, vol. 210, 2019, pp. 69–74.

6. Johns Hopkins Medicine. “Heart Attack.” Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/heart-attack. Accessed July 2022.

7. Medical News Today. “Everything You Need to Know About Heart Attacks.” Medical News Today, www.medicalnewstoday.com/articles/151444#outlook. Accessed July 2022.

8. MedlinePlus. “Heart Attack.” MedlinePlus, medlineplus.gov/heartattack.html. Accessed July 2022.

9. American Heart Association. “Understand Your Risks to Prevent a Heart Attack.” Heart.org, www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack. Accessed July 2022.

10. Banharak, S. et al. “Public Knowledge about Risk Factors, Symptoms, and First Decision-Making in Response to Symptoms of Heart Attack among Lay People.” Pacific Rim International Journal of Nursing Research, vol. 22, no. 1, 2018, pp. 18–29.