Don’t miss a beat: Heart disease can hide in plain sight

For a family waiting outside an emergency department, time is measured in uncertainty. 

Each passing minute carries the hope that a loved one will survive, recover and return home. For the clinical team, the immediate task may be to restore blood flow to threatened heart muscle. 

For the family, the same intervention represents the possibility of preserving a shared future.

These clinical and human realities give World Heart Day its significance. Observed on September 29, the occasion should prompt an examination of how effectively health systems prevent cardiovascular disease, recognise acute illness and provide timely, affordable treatment.

The World Heart Federation’s 2026 campaign continues under the theme ‘Don’t Miss a Beat’, emphasising the recognition of overlooked symptoms, the protection of heart health and the need for effective national action. 

The accompanying message expressed in this article’s title — ‘Heart Disease Can Hide in Plain Sight’ — captures an important concern: symptoms may be present yet remain unrecognised or be attributed to less serious conditions. (world-heart-federation.org⁠)

For Bangladesh, translating this message into better outcomes requires a comprehensive approach. 

Public awareness must be connected to accessible primary care, reliable emergency pathways and continuity of treatment. A person’s ability to recognise danger is only the beginning; the health system must be capable of responding.

Cardiovascular education should distinguish between long-term risk reduction and the assessment of new symptoms. Healthy behaviour remains essential, but it does not remove the need to investigate a potentially serious clinical presentation. Equally, successful emergency treatment does not end the need for prevention.

Chest pressure, heaviness or discomfort; pain in the arm, jaw or back; breathlessness, sweating and nausea can indicate a heart attack. 

Women may also experience unusual fatigue, weakness or upper-back pressure. Symptoms that appear tolerable or unfamiliar should not automatically be considered harmless. Suspected symptoms require urgent medical assessment. (professional.heart.org⁠)

Public communication must convey this urgency without creating indiscriminate alarm. Its purpose should be to help people recognise situations that warrant assessment and understand how to obtain help. Advice is most useful when it is clear, practical and connected to services people can actually reach.

Delays in treatment should also be understood within their social and institutional context. Transport, financial constraints, uncertainty about hospital capabilities and the organisation of referrals can influence the course of an emergency. 

An effective response must address these barriers alongside public knowledge.

The 2025 joint American College of Cardiology and American Heart Association guideline, developed with partner organisations, and the European Society of Cardiology’s 2023 guideline provide major evidence-based frameworks for the management of acute coronary syndromes. 

They emphasise prompt assessment, risk-based treatment and coordinated care. Their implementation requires clinical expertise as well as organisational readiness. (professional.heart.org⁠, escardio.org⁠)

Early electrocardiography is a fundamental component of assessment. Hospitals should aim to obtain an ECG within 10 minutes of arrival in patients with suspected acute coronary syndrome. Achieving this standard requires equipment, trained personnel and timely interpretation. The relevant measure of performance is whether diagnostic information leads to appropriate action without avoidable delay. (heart.org⁠)

The expression ‘time is muscle’ reflects the biological urgency of restoring blood supply to threatened myocardium. In patients with ST-elevation myocardial infarction, or STEMI, primary percutaneous coronary intervention is the preferred reperfusion strategy when it can be delivered promptly.

European guidance recommends fibrinolytic treatment for eligible patients presenting within 12 hours of symptom onset when PCI-mediated reperfusion cannot be achieved within 120 minutes of STEMI diagnosis, provided there are no contraindications. Transfer to a PCI-capable centre should follow, with emergency rescue PCI when fibrinolysis fails.

These treatment pathways also help correct a persistent misconception: four hours is not an absolute limit beyond which treatment becomes futile. Patients presenting later may still require emergency intervention when there is ongoing ischaemia, shock or serious instability. Guideline time thresholds are intended to minimise delay, not to justify waiting. (academic.oup.com⁠)

Management must nevertheless remain individualised. Acute coronary syndromes encompass different clinical presentations, and treatment decisions require consideration of the patient’s condition, investigation results and competing risks. Appropriate care depends on selecting the right intervention for the right patient at the right time.

Procedural safety and precision are also important. The 2025 guideline favours radial artery access for PCI when appropriate, reducing bleeding and vascular complications. It recommends intravascular imaging to guide intervention in complex coronary lesions. Such techniques should be applied according to clinical indications and supported by the necessary expertise. (professional.heart.org⁠)

For Bangladesh, the policy implication is that investment in cardiac care must extend beyond equipment. A catheterisation laboratory requires trained teams, dependable supplies, maintenance, critical care support and effective coordination with emergency services. Infrastructure becomes a clinical service only when it is reliably available to patients.

Communication is another essential dimension of quality. Patients and families need understandable explanations of the diagnosis, the urgency of treatment, potential benefits, risks and alternatives. Informed decision-making requires an opportunity to ask questions and receive clear answers. Institutions must provide sufficient staffing and support to make such communication feasible, including during emergencies.

Accountability should likewise be evidence-based. Outcomes cannot be interpreted adequately without considering disease severity, baseline risk and the timing of treatment. Complaints require reliable documentation, independent clinical review and fair procedures. Respect for patients’ rights and protection of healthcare workers are both necessary for a system in which difficult decisions can be made responsibly.

The transition from hospital to home deserves equal attention. Recovery involves reducing the risk of further events, restoring functional capacity and addressing the uncertainty that often follows a major illness. Discharge planning should include clear medication instructions, follow-up arrangements and referral for rehabilitation.

The 2025 guideline recommends dual antiplatelet therapy for at least 12 months as the default strategy in patients without high bleeding risk, alongside high-intensity statin therapy. The regimen and its duration must be tailored to individual circumstances. Patients should understand the purpose of their medicines and the importance of seeking medical advice before stopping or changing them. (acc.org⁠)

Cardiac rehabilitation is a substantive component of treatment. Supervised physical activity, nutritional education, psychological support and assistance with adherence help patients return to daily life. Recovery should be assessed in terms of function and quality of life, as well as clinical stability. (professional.heart.org⁠)

A coordinated national network for emergency cardiac care could provide the organisational framework Bangladesh needs. Primary care facilities, upazila and district hospitals, ambulance services and PCI-capable centres should operate through agreed protocols and clearly defined responsibilities.

The network should support ECG transmission, consultation before transfer, early preparation of receiving teams and safe transport. Referral decisions should be guided by clinical need and the actual capabilities of receiving facilities. These arrangements should be established before an emergency occurs.

Implementation must be accompanied by measurement. Relevant indicators include time to ECG, transfer delays, access to appropriate reperfusion, complications and continuity of follow-up. Outcomes should be interpreted with attention to differences in patient risk. Data should inform service improvement, resource allocation and corrective action.

Financial protection is indispensable. Emergency treatment should not be delayed because a family cannot immediately mobilise funds. Long-term care must also remain affordable. Assistance for disadvantaged patients, transparent charges and sustainable financing should form part of service design. Equity should be assessed through the experience of those who face the greatest barriers to care.

Prevention must remain central to this agenda. Avoiding tobacco, maintaining a healthy diet, remaining physically active and adhering to necessary treatment are important elements of cardiovascular health. (professional.heart.org⁠) Public policy should support these measures through accessible primary care, effective health education and environments that make healthy choices practical.

World Heart Day should therefore lead to commitments that are specific and measurable. People should know when to seek help. Patients should reach suitable facilities promptly. Hospitals should be prepared to respond. Evidence-based treatment and rehabilitation should remain accessible after discharge.

The significance of these commitments is ultimately human. Restoring blood flow to an obstructed artery may preserve the possibility of another morning together, another conversation or a return to the responsibilities and relationships that give life meaning.

‘Don’t Miss a Beat’ is a call to recognise warning signs and respond effectively. Our responsibility is to build a health system in which that response is timely, evidence-based and available to all.

Professor Dr AKM Mohiuddin Bhuiyan Masum, MBBS (DMC), MD (Cardiology), is a clinical and interventional cardiologist and professor and head of the Department of Cardiology at Popular Medical College and Hospital, Dhaka.