The symptoms of my heart attack were so mild that I didn’t realize I was having one, and I had emergency surgery the next day.

As a former Secretary of State for Health, Norman Fowler thought he had enough knowledge to instantly recognise whether he was having a heart attack.

“I assumed that if I had it done it would be dramatic and painful and I would collapse in a heap, but that wasn’t the case at all,” says Lord Fowler, who spent six years as Health Secretary in the 1980s under Margaret Thatcher.

The tall, thin 86-year-old suffered a heart attack (where the blood supply to the heart is partially or completely blocked as a result of a clot in one of the main coronary arteries) at his west London flat in May.

He recalls collapsing into a chair in the hallway after “suddenly feeling a pressure on my chest”. His wife Fiona, 78, immediately realised something was wrong.

“His face was grey, but he was still conscious. I’d never seen him like that before,” she recalls.

‘At first I thought it might be indigestion because he could talk to me.’

Although a crushing pain in the middle of the chest, along with nausea and pain in one or both arms, are classic features of a heart attack, in some older people the signs are less obvious, says Professor Bryan Williams, medical director of the British Heart Foundation.

As he explains: “A family member may notice that they are a little upset; delirium can also be a symptom of a heart attack in an older person.”

In fact, for some older victims, confusion and weakness are the only telltale signs that they are suffering a life-threatening event.

Although she didn’t initially realise the seriousness of the situation, Fiona called 111. “If I’d known it was a heart attack I would have called 999, but I didn’t think it was that serious,” she says.

Two “very capable” paramedics were sent in to give Lord Fowler an electrocardiogram (an electrical tracing of the heart to look for signs of a heart attack) and assess him.

“They didn’t have long faces either, which would have made me think, ‘I’m done for!'” he says wryly.

At nearby Charing Cross Hospital, he was tested for levels of troponin, a protein released by the heart when it runs out of oxygen-rich blood. Three hours later, it was confirmed that he had indeed suffered a heart attack, caused by a partial blockage of an artery.

Later that day, he was transferred to Hammersmith Hospital’s world-class cardiac unit, where he was hooked up to a monitor and kept under observation ahead of emergency surgery to clear the blocked artery the following day.

“It’s vital to monitor the heart in the hours after a heart attack – it’s a vulnerable time,” said Professor Williams. To clear the blockage, surgeons inserted a thin, hollow tube, called a catheter, into an artery in Lord Fowler’s groin and advanced it to the blocked artery.

They then inserted a small mesh-like tube (a stent) through the catheter to open up the artery and restore blood flow to the heart. Every day, around 300 people are admitted to hospital with a suspected heart attack. Most attacks are triggered by a blockage of the arteries, caused by a build-up of fatty plaque. This is usually the result of high blood pressure, high cholesterol or type 2 diabetes.

The good news is that the number of heart attacks and strokes in the UK has fallen (by around 30 per cent between 2000 and 2019, according to a study published in the BMJ). Survival rates have also improved, says Professor Williams.

“When I started as an NHS doctor, about seven in ten people died from an acute heart attack. With new drugs and interventions, such as stents, seven in ten now survive.”

But about 20 percent of victims will be hospitalized for a second attack within the next five years, according to a report by the American Heart Association. Survivors are given counseling on how to modify their lifestyle and diet to prevent another attack.

Doctors were unable to say what had caused Lord Fowler’s heart attack as he did not have high blood pressure or was under any particular stress; it appears to have been age-related.

In fact, Lord Fowler thought he ate “quite healthily, but my diet is even more severe now and I no longer eat things like apple crumble, which is sad,” he says.

Instead, she focuses on a Mediterranean diet, with lots of salads and vegetables, and the occasional treat. Four months later, she has recovered well, but in addition to modifying her diet, she has had to make some pretty significant changes in her life.

Doctors have told him to take things more slowly to avoid straining his heart too much. “That’s easier said than done for someone who has been so politically engaged for the last 50 years,” says Lord Fowler, who was speaker of the House of Lords from 2016 to 2021 and recently published a memoir of his time in government, The Best Of Enemies: Diaries 1980-97.

She has also been instructed to do daily exercises such as knee and arm raises, leg extensions, toe touches and chest presses, which she says she does religiously, to improve her overall fitness. (Her duties in the House of Lords over the past few years meant she only did “moderate exercise, mainly gentle walks.”)

And he now takes a “daily cocktail of pills” to help manage his condition, including blood thinners (aspirin and clopidogrel) to reduce the risk of future blockages or clots, statins, ramipril and lansoprazole (a proton pump inhibitor that reduces stomach acid to counteract the impact of the other drugs on the stomach lining).

Professor Williams says this combination of drugs has “contributed enormously” to improving patients’ post-operative survival rates. “That’s why it’s very important that patients continue taking them,” he adds.

Having suffered a heart attack has changed Lord Fowler’s lifestyle. “It’s the first time I’ve come close to suffering an illness that could have serious consequences, including death,” he says. “It makes you think about your life in a different way and wonder if you’re taking on too much responsibility.”

He says he is now scaling back his parliamentary work and “concentrating on fewer things”, such as completing a second volume of diaries and campaigning “against the continuing stigma attached to AIDS in much of the world”.

As Health Secretary, he oversaw the launch of a hard-hitting advertising campaign to alert the public to the dangers of AIDS.

Meanwhile, his wife insists she will keep an eye on the pair “to make sure he follows his doctor’s orders, does his exercises, takes his pills and stays away from his beloved apple crumble.”