By the time you finish reading this article, three Australians will have had a heart attack or a stroke.
One of them will die.
That may seem shocking, but cardiovascular disease — a group of disorders that can be described, in layman's terms, as matters of the heart — is a major cause of death and disability globally.
"The public picture of it is that it hits suddenly and quickly," cardiologist Clara Chow says.
"But it may be silently coming up over time without us realising it, and the only way we can realise it is to actually go and look for it."
A broken ticker
Part of what makes a heart attack or stroke seem so sudden are the immediately devastating symptoms, and potentially fatal consequence, that can strike at any moment.
For Wayne Heming, it happened on holiday at the beach.
"I was on the Gold Coast, just doing a bit of body surfing," he said.
"I came out of the surf feeling crap — I was lucky to make it out of the surf, I struggled up the beach.
"So we went back to the unit and I started getting a pain in the arm and broke out into chills.
"My mate drove me to Southport Hospital and I was diagnosed on the table."
Fortunately, the blockage wasn't too serious and Mr Heming walked away from the heart attack with his life and the new nickname "Ticker".
He was 34.
When to get your heart checked
At the time, Mr Heming didn't think what was happening to him was a heart attack.
"I did drink a lot and smoke, and wasn't terribly fit, and I was overweight," he said.
"It was unexpected from my point of view, a total shock with very little warning apart from being overweight."
There are several known risk factors that increase the risk of a heart attack including smoking tobacco, high blood pressure, abnormal cholesterol, diabetes, being overweight or physically inactive.
Mr Heming's heart attack was in 1984.
Today, it is recommended people aged 45 and over — or 35 for First Nations people — get their heart health checked.
Clara Chow, president of the Cardiac Society of Australia and New Zealand, said people with a family history of coronary disease should also get a check-up five years before that relative had an episode.
"If you had a relative who had a heart attack at age 45, you should probably get checked from 40," Professor Chow said.
There's no magic number that increases your risk of a heart attack — it can happen at any age.
But one number in Australia that's become associated with it is 52.
The Shane Warne effect
On March 4, cricketer Shane Warne died of a heart attack while on holiday on the Thai island of Koh Samui.
The 52-year-old sportsman experienced chest pains prior to his death and had recently seen a doctor about his heart, according to Thai Police.
Regardless, his death came as a huge shock to his family, friends and fans around the world.
Six days later, Victorian Labor Senator Kimberley Kitching died of a suspected heart attack while driving to a meeting.
The 52-year-old politician was reportedly being treated for a health issue prior to her death.
Two days later, former Essendon premiership player Dean Wallis, 52, was rushed to hospital for life-saving surgery after suffering a heart attack. He survived.
Garry Jennings, chief executive of the Heart Foundation, said the tragic series of events had raised awareness in the community about heart health.
He said GPs had seen a surge in people wanting to have checks, and visits to the Heart Foundation website doubled after Warne's death.
But Warne is not the only high-profile cricketer to have suffered a heart attack in the past two months.
Less than 24 hours before Shane Warne's death, fellow great Rod Marsh died in hospital aged 74, a week after a "major" heart attack.
A major heart attack, or STEMI, is when the artery is completely blocked and the heart muscle suffers extensive damage.
On April 19, former Australia ODI wicketkeeper Ryan Campbell suffered a heart attack in England while playing with his kids.
The 50-year-old spent almost a week sedated in intensive care but is expected to make a full recovery.
A spate of reports in the media might make it seem like these serious medical episodes are out of the ordinary, but that is not the case.
"It happens every four minutes."
Since you started reading this article, one Australian has had a heart attack or a stroke.
Don't wait, call triple-0
Similar to a heart attack, a stroke is caused by a blockage in an artery.
But instead of stopping blood flow to your heart, it stops the blood flow to your brain.
While heart attacks can present with obvious symptoms like a crushing chest pain, the signs of a stroke are less obvious.
If you suspect someone is having a stroke, remember F.A.S.T. and check for signs of:
- Face — is it drooping?
- Arms — can they lift them?
- Speech — is it slurred?
- Time — call triple-0
Time is also critical for heart attacks.
But don't rely on that classic symptom of chest pains to call an ambulance.
About a third of people that have a heart attack don't have that typical symptom, Professor Jennings said.
"They might have pain that's not the centre of the chest, they might have pain in the back or in the upper part of the tummy," he said.
"They might get cold and clammy and they might get an arrhythmia, which is the heart beating irregularly.
"The quicker we get onto that, the more likely we are to be able to unblock the artery, free up the muscle and let people go back to a normal healthy life.
"We would much rather we have people that turn out not to have a heart problem and get sent home from the emergency department, than miss one who delays their treatment because they waited to go to the GP or they waited to drive to hospital."
Mr Heming still recalls the crushing sensation he felt during his heart attack in 1984.
"The chest just completely tightens up and then you get those really bad pains," he said.
"Your chest sort of feels like it's caving in a bit."
The former sports journalist had another brush with cardiovascular disease in 2000.
A cardiologist had diagnosed him with angina and told him to "walk through it".
But one day at work the chest pain was so bad that his boss drove him to hospital.
"They did an angiogram (a scan of the blood vessels) and most of my arteries were 90 per cent blocked," Mr Heming said.
"The doctor said to me 'you're going to have to have a bypass'.
"That was on the Friday and I said, 'that's alright, I'll go home, talk to my wife about it'.
"He said 'you won't be leaving the bed here, son'."
At age 50, Mr Heming had a quadruple bypass.
Bypass surgery involves taking a healthy vein or artery from another part of your body and grafting it to your heart so it directs blood around the blockages.
Twenty-two years later and Mr Heming is still ticking along.
"I must admit I've been very slack and I don't see a cardiologist very much but I've had a few tests and things seem to be okay," he said.
This is not a man's disease
Chest pains are also not necessarily the warning sign you'll get that you are having a heart attack if you are a woman.
Professor Chow said women often perceive heart disease as something that happens to men and not them.
"I think women are good at getting breast screenings, pap smears, these sort of things," she said.
"They've got it into their psyche that this is part of what they do and get those things checked out.
"But they don't think that it's necessarily part of what they do to get their heart assessed."
While cardiovascular disease kills about 40 per cent more men than women, Professor Jennings said women tend to present for treatment later than men.
"Partly because there's a feeling out there that heart attacks are for men, not so much a women's issue, even though we know that's not true," he said.
"And partly because of the tendency we all have to say 'it's much more important to pick up the kids from school or finish what I'm doing before I go the hospital and see whether this is serious or not'."
Professor Chow said the most upsetting thing was knowing heart attacks could be prevented.
"In that mid-period of your life, heart disease can hit, strike and take everything away," she said.
"A lot of conditions come up on us slowly but it still seems that heart disease comes up suddenly in a lot of people's lives.
"We shouldn't be scared of heart disease, we should be trying to embrace and think about it more in our day-to-day life so we aren't so shocked."
Another Australian has had a heart attack or a stroke since you've been reading.
Serious concerns over impact of COVID-19 on heart
Despite 45 being the recommended age for a heart check, Professor Jennings has a stark warning for millions of Australians.
Major studies in the United States and United Kingdom have suggested a person's risk of heart disease almost doubles in the year after they've had COVID-19.
In the US study, it didn't matter what someone's age, race, sex or pre-existing health was — just having had the virus increased their risk.
The risk was still heightened for people who were not hospitalised while they had COVID-19.
"There's some data coming along to suggest that heart attack and stroke rates are much higher in a year after COVID, particularly in non-vaccinated people," Professor Jennings said.
"I think it's going to be a big thing in the next year or so."
Professor Chow said the pandemic had also resulted in fewer people getting check ups as people were in lockdown and stayed at home.
"A number of patients that I've know for a long time were less likely to present," she said.
"We tried to do things with telehealth, which was a lot harder, to keep a good eye on their health.
"We're starting to see the change again, a lot of those people are coming back out of the woodwork."
People aged 45 and over — 30 and over for First Nations people — who are not yet known to have cardiovascular disease can currently get a free Heart Health Check, a 20-minute consultation with GP or medical professional, that's covered by Medicare.
However, the subsidy is temporary and next year the federal government is due to consider whether it should remain.
"We hope it will be made more permanent," Professor Jennings said.
The good news is that due to research, medication and intervention, heart health in Australia has dramatically improved over time.
Since Mr Heming had his heart attack in the 80s, rates of cardiovascular disease have dropped about 80 per cent.
And while the deaths of people like Warne and Marsh are tragic, they profoundly influence people to reflect on their own health.
"I have no doubt that's trigged a lot of men in their 50s, 60s and 70s to go and get themselves checked out," Mr Heming said.
"I know just from going to the pub, a lot of my mates say, 'oh, you've had a heart attack, Tick, haven't you, what's it like? I'm going to go see my doctor and just get checked out in the next couple of weeks'.
"One of my close friends has done exactly that, not that he's had any symptoms.
"There are thousands upon thousands of people who have heart attacks and thousands of people who die, but they don't have Shane Warne's profile.
"So unless you're a family member, you don't tend to react to that, do you?".
In the next few seconds, another Australian will have a heart attack or a stroke.
Cardiovascular disease accounts for one in every four deaths in Australia.
That's 118 people every day.
One every 12 minutes.
That's now.
