The deadly heart disease that creeps up on you

An aviator died in an incident at the Ohakea base swimming pool, and a triathlete during the swim leg of an event in Tauranga. A couple died after their car ended up in a Rotorua Lake.

All these events were described in the news as being the result of a "medical event" - we won't know exactly what happened until the coroner investigates.

The deathly heart disease that creeps up on you

The Detail

But most of them will have been heart attacks.

The Detail talks to cardiologist Dr Cara Wasywich about how they can happen without people knowing that there was anything wrong beforehand, and the symptoms that shouldn't be shrugged off.

Wasywich works at Auckland City Hospital and is clinical director of the Green Lane Cardiovascular Service and co-lead of the National Cardiac Network.

She says that with many of these medical events that involve exercise, the first symptom that person has ever had of a cardiac issue is that which kills them, which is why the news of their death is so shocking.

"Some of these deaths we see reported where someone drops dead or is exercising and dies ... many of those are the first presentation of a patient's coronary artery disease problem," she says.

We know that if you are someone who exercises you have a much lower chance of having a heart attack - but that doesn't mean it can't happen.

"Always there's a small trickle of people who have an event while exercising," says Wasywich.

In her day-to-day cardiac practice, she sees lots of people who have chest pain, which is the most common symptom of a cardiac blood supply problem.

But it can feel different to different people.

"Often it's a heavy pressure in the chest or an uncomfortable tightness but it can be different to that.

"If I have a patient come to me who comes to me with chest discomfort or chest symptoms which are worse with exertion and better with rest, then I get quite concerned about the possibility of this being a heart blood supply problem.

"It's certainly true that patients may not recognise their symptoms as potentially being cardiac, it's common for people to think they have indigestion - and actually it's common for people with indigestion to think they have heart pain so untangling those two things is quite tricky sometimes."

Sometimes it's just breathlessness - if you're trying to get fit and still getting breathless, that also raises concerns.

"When you're exercising you should feel comfortable, and if you feel bad - if you feel like you need to stop or slow down - you should listen to your body because that potentially is a marker of there being a problem."

Women come in for a special mention as being worse than men for recognising the symptoms.

"The female caregivers are quite good at looking after everyone else and forgetting to look after themselves," she says.

New Zealanders in general don't seem to be great at heading to the doctor for seemingly small things, but Wasywich says doctors would much rather see someone and reassure them that there's nothing wrong, than have someone not be seen and have a bad outcome.

"That's what we're here for," she says. "Sure, we are resource and time-limited, but if you need us, we should be there for you."

For those shy about heading to the GP for fear of a lecture on their weight, Wasywich says the way we think about obesity and weight is in the process of changing.

"There is this narrative in the community that if you're overweight it's a personal failing, and that is incorrect. I think we have lots of data now that emphasises the fact that obesity and the problems that are associated with obesity is a metabolic, medical problem."

She says you can see with new medications that reduce body weight that they also, most importantly, reduce the rates of cardio-vascular disease, diabetes, blood pressure and metabolic liver disease.

"It is appalling that a patient would feel shamed by going to the GP and being labelled as being obese or overweight."

She would like to see more people on blood pressure and cholesterol medication.

"We undertreat hypertension and we undertreat high cholesterol - no question," she says.

"We could reduce the risk of the population by getting in and dealing with these problems in a more assertive manner."

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