For this edition of Q&A, Dr. Wattanaphol Phipathananunth, a board certified cardiologist, answers readers’ questions on a variety of heart health topics. 

Q: Chest pain is a well-known heart attack symptom. But heartburn can also cause chest pain. Is there a way to tell the difference when the pain occurs?
A: Chest pain can be frightening, but in many cases it is a symptom of something much less serious than a heart attack, including stomach ulcers, panic attacks, muscle problems, pneumonia and heartburn. Heartburn is a digestive disorder which typically occurs after eating a large meal, and it is often accompanied by the sensation of food or liquid coming up into the mouth or throat, or a bitter, acidic taste in the mouth.
It’s difficult to identify what’s causing your chest pain while it’s occurring, but spotting any accompanying symptoms will definitely help narrow down the possible causes. Heart attack symptoms can vary greatly from one person to another, but the most common signs to look for include:

• + Pressing-like pain or discomfort in the center of the chest; 
• + Shortness of breath;
• + Chest pain accompanied by dizziness, nausea and/or sweating;
• + Tightening of the chest during physical activities or when under stress.

If you believe you’re having a heart attack, get medical help immediately; a quick response can mean the difference between life and death.
 
Q: I’m very confused about fat and cholesterol. “Low cholesterol” has been the mantra for healthy eating. But not all fats are created equal. If my goal is to protect my heart, what’s okay to eat and what should I avoid?
A: The guiding principle is to follow a low fat, low cholesterol diet. Despite tremendous public awareness about healthy eating, the world’s obesity crisis continues to worsen.
What really matters is the type of fat we eat. Trans-fats and saturated fats raise the risk of certain diseases; mono-unsaturated and poly-unsaturated fats do the opposite. These so-called “good” fats are found in plant-based foods and oils, such as vegetable oil, nuts and seeds.
Red meat, full-cream dairy products and hydrogenated vegetable oils such as margarine, non-dairy creamer and shortening are major sources of bad fats. Most foods contain at least some fat, and the body needs fat to produce and store energy.
Cholesterol is another complicated concept. Though it’s a known contributor to heart disease, you don’t need to totally give up foods like eggs, lobster and shrimp. The truth is, our bodies produce most of our cholesterol, which it uses to produce estrogen, testosterone and vitamin D. A healthy diet can include a moderate amount of high-cholesterol foods, but limit your total daily intake of cholesterol to no more than 300 ml.
Bringing high triglyceride levels under control requires more exercise and a healthier diet avoid high-carbohydrate and sugary foods and snacks, and cut out alcoholic drinks. Include more complex carbohydrates like whole grains and whole wheat products, and eat more fruits and vegetables. Their high fiber content helps reduce triglyceride levels while also helping maintain a healthy body weight.


Q: Does taking an aspirin-a-day really prevent heart attacks and strokes? And is it safe for anyone to be taking one per day?
A: Taking an aspirin every day has long been associated with a reduction in heart attack risk thanks to aspirin’s anti-clotting properties. However, recent studies have cast some doubt on whether the benefits of the aspirin regimen truly outweigh the potential risks – especially internal bleeding – for patients with no history of cardiovascular problems. 
As with all medications, you should consult your doctor before starting the daily aspirin regimen. However, it’s worth discussing the daily aspirin option with your doctor if you have more than one of the following heart disease risk factors: a history of cardiovascular disease, age 50 or older, have diabetes, high blood pressure, high cholesterol, or are a smoker.
If you’re currently on the aspirin-a-day regimen and have questions or concerns about it, consult your doctor before making any changes to your medication routines.
 
Have a question? You can submit your question for possible inclusion in future issues of, by e-mail [email protected] or by mail to Editor, Magazine, Bumrungrad International Hospital, 33 Sukhumvit 3, Wattana, Bangkok 10110, Thailand.