When the Heart Attacks

By James L. Marcum, MD FACC

A tear rolled gently down Michelle’s cheek as we talked.  At 39, she appeared healthy; however a heart attack had taken its toll.  A strong family history, a stressful job, and a high cholesterol level were contributors.  She was in denial.  A 39 year old female should not have had a heart attack.  As we prayed together, the slow process of healing had begun.  Today, a vibrant Michelle boldly speaks about heart disease, giving hope while emphasizing awareness and knowledge of the problem.  In the next few minutes, I want you to learn about a disease touching everyone, a disease that can be treated, prevented and yes, even reversed. 
Cardiovascular disease is unfortunately all too common and yet we do not hear in the media as much about this disease as the numbers would indicate.  Let me share some numbers.  Over the next 24 hours, 3,000 Americans will suffer a heart attack.  This is nearly the same number of persons who died in the tragedy of September 11, 2001.  In fact in women, cardiovascular disease poses a greater risk than cancer and all other diseases combined.  This is not just an American problem, but a growing worldwide problem.  Cardiovascular disease (heart attack, strokes, heart failure, rhythm problems) is now the leading cause of death in the world claiming approximately 13 million lives a year.  The numbers continue to rise. 

There are  many areas to explore in cardiovascular disease.  In Part I of this series, I want you to gain a more complete understanding of a heart attack.  Then in Part II, we will focus on lowering the risks of having a heart attack.  The heart attack is the battle, but preventing a heart attack and reversing the causes are the war. 

John is a 45 year old executive who exercises daily, took no medications and in general felt “great”.  One morning while preparing for the commute to work, John developed chest pressure, a new feeling for him.  He was having a heart attack, sometimes referred to as a myocardial infarction.  An artery supplying the heart with oxygenated blood was completely blocked.  Without its blood supply, the heart muscle began to die, producing the symptoms he was experiencing.

What is a Heart Attack?
A heart attack occurs when an artery supplying the heart muscle becomes blocked and blood filled with oxygen cannot reach the heart muscle.  The real enemy is obstruction of blood flow in the coronary arteries. This leads to muscle death—a heart attack.  If the artery is small, the heart attack can be small but if an abnormal rhythm develops, even a small heart attack could be fatal.  If the obstruction is in a large artery or in an important location, the heart attack can be devastating.   Sometimes the terms coronary artery disease or coronary arteriosclerosis are used to describe blockages.  These terms may include heart attacks as well as conditions where the arteries are partially blocked.  

Symptoms of a Heart Attack
A symptom is an abnormal feeling that tends to persist.  A symptom of a heart attack could be a pressure in the chest, chest pain, extreme sweating, a racing heart, extreme shortness of breath, discomfort in the arms, back, neck or jaw.  Sometimes a heart attack might feel like indigestion.  Some heart attacks present with a feeling of extreme fatigue.  The list could go on and on, but people experiencing a heart attack do not feel right.  If you don’t feel “right”, get help immediately. 

Diagnosis of a Heart Attack
The diagnosis of a heart attack is made by the symptoms and usually an electrocardiogram (EKG).  Blood work can detect the slightest injury to the heart and help in making a diagnosis.  Other tests used may include a sound wave picture of the heart called an echocardiogram or an angiogram where dye is injected into the arteries of the heart to detect blockages.

How do Arteries Become Blocked?
Cholesterol is a substance in the blood that is comprised of different types of lipids.  Lipids are fats and can gradually build up on the inside of blood vessels and become calcified or hardened.  Other chemical elements become involved making the blockage larger and larger.  Blood has a difficult time passing through the arteries and cannot reach its destination thus causing symptoms to develop.

What Causes the Heart Attack?
Different processes can disrupt the flow of blood.  Sometimes a small blockage called a plaque may become unstable.  If a plaque, which could be described as a pimple, “pops”, there could be major problems even if there is just a 30-40 % narrowing.  When the pimple pops or ruptures, the body sees this as an injury.  If you had a cut on your finger, your body would repair the damage by clotting.  Cells would be recruited to the area.  Inside the arteries, cells are summoned in an elaborate mechanism to repair the damage.  These cells mean to do their job, but in the process they can clog up the artery, stopping blood flow and thus causing a heart attack.  This is the type of heart attack John experienced. 

Sometimes a coronary artery becomes clogged with lipids over years and years and gradually becomes blocked until no blood can pass through; this is another type of heart attack.  A heart attack can also occur when an artery spasms.  There may be no blockages at all.  The artery just closes.  Two possible causes of spasm are high altitudes when the oxygen content is lower and certain chemicals such as cocaine and cigarettes.  A final type of heart attack is when a clot from elsewhere in the body can float into the artery and jeopardize blood flow.  The most common type of heart attack is when the small blockages become unstable and rupture.

Unfortunately, there are no diagnostic tests to predict which plaque will rupture.  If such a test existed, it would be possible to predict heart attacks.  When John’s plaque ruptured, the recruited cells helping with the damage formed a clot resulting in a loss of blood flow causing severe pain. 

I know this is not light reading but what could be more important than learning about a disease which could directly affect you, your family or friends.  I hope I have piqued your interest to learn more. 

What Can Go Wrong?
There are several adverse things which can happen if blood flow to the heart is not restored quickly.   Because of the lack of blood flow to the heart, the electrical system could be damaged, causing dangerous fast or slow heart rhythms.  When these rhythms occur, the heart might be beating so fast or slow that it is unable to pump blood to the body.  Sometimes the muscle itself will be too weak and unable to pump oxygenated blood.  Without oxygenated blood the organs of the body cannot function.  The heart valves controlling the direction of blood flow depend on muscles that may be damaged during a heart attack.  Blood flow might move in the wrong direction because the valve is not working properly.  This presents a problem.  During a heart attack, it is even possible that a dead muscle may break open or rupture.  This problem is usually fatal.  As you can see, getting immediate treatment could save your life. 

John’s problem was diagnosed quickly and treatment was initiated.  The cornerstone in the treatment of a heart attack is to first restore blood flow to the heart and then help prevent development of problems related to the lack of blood flow.  The quicker the better.  Long-term treatment includes trying to halt or even reverse the disease process.  This is called regression. 

Treatment During a Heart Attack
The good news is that modern medicine has many methods to restore blood flow during a heart attack.  These may include angioiplasty with stents or the use of clot busting medications.  When dangerous fast rhythms develop, the heart can be shocked.  Pacemakers are useful in treating dangerously slow rhythms.  Sometimes surgery is needed to bring extra blood to the heart or repair damage to the heart.  Many medications are available which can lower the work load of the heart; thin the blood and lower cholesterol levels.  Treatment must be initiated as soon as possible.  It is estimated that one in three, who suffer a heart attack, does not make it to modern medicine in time. 
Remember treating a heart attack is the initial battle, but winning the war requires altering the body chemistry to prevent cardiovascular disease from developing in the first place.  In Part II, I will focus on methods to lower your risk of having a heart attack.  I want to convince you that preventing a heart attack is preferable to experiencing one . . .