A heart attack is an event that results in permanent heart damage or death. It is also known as a myocardial infarction, because part of the heart muscle (myocardium) may literally die (infarct). A heart attack occurs when one of the coronary arteries becomes severely or totally blocked, usually by a blood clot. When the heart muscle does not receive the oxygen-rich blood that it needs, it will begin to die. The severity of a heart attack usually depends on how much of the heart muscle is injured or dies during the heart attack.
The signs of a heart attack include chest pain that may extend to a patient's neck, shoulder or arms. Heart attack victims also may develop other symptoms including shortness of breath, nausea, vomiting or dizziness. In some cases, there may be no symptoms prior to a heart attack.
Immediate treatment for a heart attack should always include professional emergency medical intervention, including a call to 911 if the patient lives in an area with such access. While waiting for help to arrive or on the way to the hospital, patients are often instructed to chew aspirin, which has been shown to inhibit blood clots. A person's chance of surviving a heart attack depends on the treatment that is given within the first hour of the event.
After a heart attack, people may need from two weeks to more than six weeks of recovery time, depending the severity of the attack. Patients are strongly advised to use cardiac rehabilitation programs to recover quickly and safely from a heart attack. Lifestyle changes (e.g., diet, exercise) and medications may also be part of long-term treatment for heart attack patients.
Coronary artery disease is the leading cause of heart attacks in the United States. There are a number of risk factors associated with heart disease and heart attacks. Being overweight, smoking and not participating in regular physical exercise raises a person's risk of having heart-related problems, including a heart attack.
The American Heart Association estimates that in 2007, about 700,000 Americans will suffer a new heart attack and about 500,000 will have a recurrent attack. Additionally, another 175,000 silent first heart attacks will occur. The average age for a first heart attack is 65.8 years for men and 70.4 years for women.
About heart attacks
A heart attack occurs when the supply of oxygen-rich blood to the heart is disrupted, usually by a blood clot in one of the coronary arteries that supply the heart with blood. The heart is composed of a special type of muscle that never rests and therefore has high oxygen requirements. When the heart muscle is deprived of oxygen for even a brief period of time, the myocardial tissue begins to die (infarct). Medically, heart attacks are known as myocardial infarctions.
Coronary artery disease is the leading cause of heart attacks in the United States, accounting for more than half of all cardiovascular events in men and women under the age of 75. Atherosclerosis is the leading cause of coronary artery disease. Sometimes called "hardening of the arteries," atherosclerosis is characterized by fatty plaque deposits that gradually block arteries, causing them to lose their suppleness. A blood clot can form after such a plaque deposit ruptures.
Heart attacks can occur both with and without warning signs. Many people experience episodes of cardiac ischemia before a heart attack. Ischemia describes a lack of oxygen-rich blood. Ischemia may have no symptoms (silent ischemia) or it may be accompanied by a type of chest pain known as angina. In many cases, angina occurs at predictable times, usually during periods of activity when the heart's oxygen requirements are increased, such as after exercise. If the angina occurs at irregular or unpredictable times, and is not associated with exertion, it is known as unstable angina. This is a dangerous warning sign that a heart attack may be imminent.
Depending upon the severity of the attack and of the subsequent scarring, as well as how rapidly the person gets access to medical service, a heart attack can lead to:
Full recovery, occurring in the majority of patients
Heart failure, a chronic condition in which at least one chamber of the heart is not pumping well enough to meet the body’s demands
Electrical instability of the heart, which can cause a potentially dangerous abnormal heart rhythm (arrhythmia)
Cardiac arrest, in which the heart stops beating altogether, resulting in sudden cardiac death in the absence of immediate medical attention
Cardiogenic shock, a condition in which damaged heart muscle cannot pump normally and enters a shock-like state that is often fatal
Death
The location of the damage in the heart muscle is also important. Different coronary arteries supply different areas of the heart, thus the severity of the damage depends upon which artery was blocked, the extent of the blockage and how much of the heart muscle depended on that blocked artery.
A heart attack is not the same thing as cardiac arrest, even though many people use the terms interchangeably. Cardiac arrest occurs when the heart actually stops beating and pumping blood. It is usually caused by an abnormal heart rhythm that causes the heart's main pumping chambers (e.g., ventricles) to quiver and contract irregularly (ventricular fibrillation). The term “massive heart attack” is also mistakenly used to describe cardiac arrest, but they are not the same thing. A heart attack may lead to cardiac arrest, but these are separate events.
Role of atherosclerosis in heart attacks
Atherosclerosis is the single most deadly disease in the United States. At one time, researchers used to think of arteries as roughly analogous to plumbing pipes. In recent years, however, our understanding of arteries, and arterial disease, has been greatly enhanced. In fact, arteries are muscular organs that contract along with the heart to enhance blood flow and help maintain blood pressure.
Arteries are highly sensitive to a number of chemicals and hormones that help regulate their function. These chemicals act upon, and are sometimes excreted by, the inner lining of the artery, or the endothelium. Researchers have learned that long before atherosclerosis becomes clinically apparent, this thin layer of cells has already been damaged and the earliest plaque deposits have already formed. Indeed, atherosclerosis often begins in early childhood, and it rarely is limited to the coronary arteries. In most cases, if a person has atherosclerotic plaque deposits in their coronary arteries, other arteries are also affected.
The underlying defect, or cause, of atherosclerosis often remains unknown. However, researches have made great strides forward in understanding the process by which damage to the endothelial cells early in life can later evolve into a heart attack as an adult. It is now thought that the atherosclerotic process is mediated by immune-related inflammation. LDL cholesterol molecules also play an important role in the development of atherosclerosis.
According to this theory, arteries are damaged, which provokes a local immune response at the site of the injury. White blood cells gather at the site of the injury and begin to secrete chemical messengers that cause inflammation. This is a normal immune system reaction that occurs in an inappropriate place. At the same time, the protective endothelial layer has been compromised, allowing LDL "bad" cholesterol cells to migrate into the inner layer of the artery. This further aggravates the injury, which causes more white blood cells to gather. Other fatty materials in the bloodstream (e.g., triglycerides) also begin to gather at the injury. Together, these materials combine to form a lipid foam. This foam forms fatty streaks.
Over time, these fatty streaks grow larger, eventually attracting circulating blood platelets and evolving into plaque deposits on the inside of the artery wall. Not all plaque deposits pose the same threat. Some plaque deposits develop a relatively hard "shell" of minerals in a process called calcification. These types of plaque are considered to be stable plaques. They are less likely to rupture and cause a heart attack. Other types of plaque are known as unstable plaques, which, in comparison to stable plaques, have the following:
A larger fatty core
More white blood cells encased within
A thinner, softer, more unpredictable coating that might be stripped off without warning
The exact trigger of a plaque rupture is unknown. However, it can occur as a result of a strong, fast blood flow, especially during heavy exertion or emotional stress, when the coating is thin and the core of fat/white blood cells is particularly full.
During a plaque rupture, the fatty core of the plaque deposit is exposed to circulating blood, while pieces of the plaque travel downstream into the artery. At this point, several different events might occur. The site of the plaque rupture might attract platelets, which start a clotting cascade and form a blood clot (thrombosis). This blood clot may grow big enough to obstruct blood flow. Alternatively, it may break off and travel down the artery until it becomes lodged in a smaller artery. Finally, the pieces of the plaque may themselves become trapped in an artery, blocking blood flow. Any of these scenarios results in a heart attack. The severity of the attack will depend on which coronary artery is blocked, how dependent the heart muscle was on that source of blood supply and the extent of the blockage.
Researchers have found that almost 80 percent of first-time heart attack patients had ruptured plaque located both where the heart attack occurred and at other, distant sites. Researchers concluded that a heart attack is often not the result of one, discrete area of plaque damage. It may be separate areas of plaque rupture that combine to make the heart less stable and therefore vulnerable to a heart attack, a concept known as (pancoronaritis).
Heart attacks may also be caused by a coronary artery spasm, a temporary constriction of an artery in the heart.
Measuring inflammation
As atherosclerosis has been redefined as an inflammatory disease, many researchers have pursued strategies to either prevent atherosclerosis by reducing inflammation or to diagnose and measure atherosclerosis by tracking inflammatory blood markers. Two such inflammatory markers are C-reactive protein (CRP) and interleukin-6 (IL-6).
CRP is produced in response to inflammation. Studies have shown that higher CRP levels correspond with increasing age, body mass index, blood pressure and smoking status. There is also some evidence to suggest that CRP actually damages arterial walls by itself.
New studies have found that high levels of CRP in women with high blood pressure may be correlated with increased risk of heart attack. Data from the Women’s Health Study, an ongoing trial of nearly 30,000 women in the United States, has shown that when a woman has both high blood pressure and high levels of CRP, her risk of having a heart attack increases by as much as eightfold. Additional studies have shown that elderly people who have elevated CRP levels (above 3 milligram/liter, or 3 mg/L) have about a 45 percent increase in the risk of developing coronary artery disease.
There are, however, limitations to measuring CRP. The most important drawback is CRP's lack of specificity. In other words, CRP is produced in response to inflammation anywhere in the body, not just heart disease. Therefore, CRP levels may be elevated in response to any injury or autoimmune, inflammatory disease. Currently, the U.S. Centers for Disease Control and Prevention (CDC) support limited use of a new test to check for CRP. The highly sensitive C-reactive protein (hs-CRP) test is not recommended for general screening, but may be helpful in certain situations. In people with a history of coronary disease, for example, the test may be useful in assessing the likelihood of recurrent heart attacks.
Similarly to CRP, high levels of IL-6 are associated with excess alcohol intake, diabetes and lack of exercise. High levels of interleukin-18, an immune system protein, have been shown to signal inflammation and risk for heart attack and stroke.
Risk factors and causes of heart attacks
The American Heart Association (AHA) estimates that in 2007, approximately 700,000 people in the United States will have a heart attack for the first time. According to the AHA, episodes of angina based on age, gender and race are as follows:
Age
Gender/Race
Annual Rates of New
Heart Attacks* per 1,000
65-74
Male, non black
28.3
Male, black
22.4
Female, non black
14.1
Female, black
15.3
75–84
Male, non black
36.3
Male, black
33.8
Female, non black
20.0
Female, black
23.6
85+
Male, non black
33.0
Male, black
39.5
Female, non black
22.9
Female, black
35.9
*Source: AHA’s 2007 Heart and Stroke Statistical Update
Beyond genetics, a number of other risk factors may serve to either promote atherosclerosis or interrupt the disease process. Risk factors can be either controllable (e.g., diet, exercise and smoking) or uncontrollable (e.g., age, gender). To date, researchers have found that:
Patients with unstable plaque deposits are at greater risk for a heart attack than those with compact, calcified plaque deposits. Some researchers have tried to develop methods to determine the degree of calcification, which may help predict the risk of heart attack.
The risk of plaque rupture appears to increase in the morning hours, which may explain why more heart attacks occur between 6 a.m. and noon.
People with chronic kidney disease tend to have high blood pressure, which places added stress on waste-removing filters in the kidney (nephrons). Uncontrolled high blood pressure also contributes to heart disease through a process known as remodeling, where there is enlargement and weakening of the heart’s left ventricle (left ventricular hypertrophy) and increased risk of heart attack. Research has found that heart attack survival decreases even with mild to moderate kidney disease.
People with high levels of a certain type of lipoprotein called Lp(a) in the blood may be at increased risk of heart attack. Research has found that high Lp(a) levels may increase a person’s risk of heart attack over a 10-year period by as much as 70 percent.
People with metabolic syndrome have been found to have double the risk for heart attack and stroke when compared to people without the syndrome. The characteristics of metabolic syndrome are elevated fasting blood glucose levels, abdominal obesity, high LDL (“bad”) cholesterol levels, high triglyceride levels and high blood pressure.
Researchers have found a connection between infection and increased risk of heart attack. Infectious diseases, such as influenza, destabilize plaque and increase risk of plaque rupture. In some studies, influenza vaccines have been shown to reduce the risk of plaque rupture among the elderly, thus reducing the risk of heart attack and stroke.
The role of race in heart disease is currently being explored. In 2000, the Jackson (Mississippi) Heart Study was launched to better understand why black Americans have a higher mortality from heart disease than white Americans. Sponsored by the National Institutes of Health, it is modeled after the famed Framingham Heart Study. More than 6,000 black American men and women (ages 35 to 84) in Jackson, Mississippi, are being studied. A combination of physical examinations and questionnaires are being used to document and establish risk factors for cardiovascular disease in black Americans.
Totally vs. partially blocked arteries
Studies have indicated that a totally blocked artery is generally considered less of a threat in terms of a future heart attack than a partially or almost totally blocked artery. This is because there is less potential for further damage with the totally blocked vessel. The areas of the heart formerly supplied by that vessel are permanently scarred or “dead,” with no need for an oxygen-rich blood supply.
However, it is possible in some cases that the area served by the artery has collateral blood flow (i.e., blood flow through smaller caliber vessels) from another artery. In such cases, if it can be proven that the muscle is alive, opening or bypassing the artery may be of some benefit. Surgical bypass of a totally blocked artery that supplies a “dead” area of the heart may serve little or no purpose. Instead, the goal of the physician and the patient is to prevent further damage in those areas in which good or partial function still exists.
Signs and symptoms of heart attacks
Just as some people experience no symptoms during silent ischemia, some people can have a silent heart attack without knowing it. Up to 25 percent of heart attacks are symptom-free. The absence of symptoms, however, does not mean the absence of damage to the heart muscle. Unfortunately, people having a silent heart attack are unaware that they need to seek proper treatment immediately, and additional heart-related events or damage may occur.
The majority of people who suffer a heart attack experience symptoms that are often severe and frightening. Recognizing these symptoms and realizing their importance is crucial. The vast majority (90 percent or more) of heart attack-related deaths in patients under age 55 occur outside of the hospital. Medical experts believe this is often due to the patient's lack of recognition of the situation. Younger people tend to ignore symptoms, whereas an older person may be more willing to call 911 at the first sign of trouble. Whatever the case, the sooner the symptoms of a heart attack are recognized and appropriate treatment is administered, the better the outlook for survival – both in the near future and over the long term. Symptoms of a heart attack may include:
Chest pain that is unrelieved by rest and often spreads or radiates through the upper body to the arms, neck, shoulders or jaw
Chest-area pressure, discomfort or squeezing sensation that may be either constant or intermittent
Shortness of breath or shallow breathing
Heart palpitations, in which the heartbeat is fast, strong or obviously irregular
Abnormally weak and/or fast pulse
Fainting (syncope) or loss of consciousness
Feeling tired or fatigued
Sweating, often with heavy chills
Nausea or upset stomach
Gray facial color
Women tend to have different heart attack symptoms than men. Although they may experience shortness of breath, weakness, unusual fatigue and cold sweats, they may not experience chest pain. They may instead feel pain high in the abdomen or chest, or in the back, neck or jaw. They may also experience dizziness. Many women have reported symptoms of unusual fatigue, sleep disturbances, shortness of breath, indigestion and anxiety in the weeks leading up to their heart attack.
Although one or a combination of these symptoms may indicate the onset of a heart attack, they may be due to other conditions as well. As a general rule, it is better to be safe than sorry. If a heart attack is suspected and any of these symptoms are present, this may indeed be a sign of a serious lack of oxygen-rich blood supply to the heart. Emergency medical help should be sought immediately. Physicians usually advise stricken individuals to first call 911, then to chew an aspirin (“regular” aspirin, not non-aspirin pain relievers such as acetaminophen) and wash it down with a glass of water while waiting for help to arrive.
Diagnosis methods for heart attacks
When a patient has symptoms of a heart attack, the physician will promptly evaluate the patient’s medical history and run tests such as:
Electrocardiogram (EKG). A recording of the heart’s electrical activity as a graph, or series of wave lines, on a moving strip of paper or video monitor. The highly sensitive electrocardiograph machine helps detect heart irregularities, disease and damage by measuring the heart’s rhythms and electrical impulses.
Blood tests. These can be used to detect the presence of certain markers that are released following a heart attack. These include troponin, myoglobin, creatine phosphokinase (CPK) and creatine kinase MB.
Once the patient is stabilized, the final diagnosis of whether the patient actually had a heart attack can take several days. Tests that may be run during this time include:
Radionuclide imaging. A branch of nuclear medicine that introduces small, harmless amounts of radioactive materials (“tracers”) into the body. A special gamma camera is then used to scan the radioactive tracers and create visual images of the heart.
Echocardiogram of the heart. This test uses sound waves to track the structure and function of the heart. A moving image of the patient’s beating heart is played on a video monitor, allowing the physician to study the heart’s thickness, size and function. The image also shows the motion pattern and structure of the four heart valves. During this test, a Doppler ultrasound may also be done to evaluate blood flow within the heart, revealing any potential leakage (regurgitation) or narrowing (stenosis) of the heart valves.
Treatment options for heart attacks
A heart attack is not a one-time, one-moment occurrence. It is a process that occurs over a period of a few hours. With each minute that goes by, less oxygen reaches the surrounding heart muscle and the risk of permanent damage rises. Therefore, someone’s chance of surviving a heart attack depends on the treatment that is given within the first hour of the heart attack. The vast majority (about 90 percent) of heart attack patients who reach the hospital alive survive the event.
Immediate treatment for a heart attack should always include professional emergency medical intervention, including a call to 911 if possible. If the person goes into cardiac arrest, immediate death may be avoided if someone on the scene can administer CPR (cardiopulmonary resuscitation) within the first five minutes following the attack. CPR does not restart a heart in cardiac arrest, but it can keep a victim alive until help arrives. It is important to remember that CPR is not a substitute for emergency paramedic or hospital treatment.
People who believe they are experiencing a heart attack are urged to use an ambulance or friend/family member to take them to the hospital, rather than driving themselves. However, it is also recommended that someone call 911 immediately due to the risk of experiencing a ventricular arrhythmia and having a cardiac arrest on the way to the hospital.
While waiting for help to arrive or on the way to the hospital, patients are often told to begin chewing aspirin, which inhibits blood clots. Aspirin use at the time of a heart attack has been shown to reduce the risk of death and the degree of damage associated with the event.
Information has circulated around the Internet about the use of repeated coughing as an aid during a heart attack. With some life-threatening arrhythmias, which could be caused by a heart attack, frequent, recurrent and vigorous coughing may help to maintain the circulation of the blood and stabilize the heartbeat. Therefore, it may be useful during a heart attack if a patient begins to feel faint and may pass out. However, this would not be helpful in the absence of a life-threatening arrhythmia and should not be routinely used.
Upon arrival at a hospital or other emergency care facility, someone experiencing a heart attack may be given medications to prevent further blood clots and to take the strain off the heart. These medications include beta blockers, calcium channel blockers, anticoagulants and nitrates. The patient may also be given medications known as clot busters, the only medications able to dissolve an existing blood clot. Clot busters have been hailed by patients and physicians as somewhat of a miracle drug when given in time and in the right amounts. All clot busters must only be given to carefully selected patients following very specific guidelines.
Treatment for a heart attack may also include one or more procedures to open any blocked coronary arteries, including:
Balloon angioplasty. A catheter-based procedure in which a balloon-tipped catheter is inserted into coronary artery and rapidly inflated in order to press plaque back against the vessel wall.
Stenting. A procedure in which a wire-mesh tube is inserted through a catheter and permanently implanted in an artery to hold it open. Stenting is usually performed right after a balloon angioplasty, while the catheter is still in place.
Coronary artery bypass graft (CABG). A surgery that increases blood flow to the heart by re-routing the blood flow around the blocked portion of an artery with a bypass graft. A section of a blood vessel from another part of the body (e.g., the leg or chest) is relocated and grafted above and below the damaged portion of the coronary artery to form an open channel around the blockage. Traditional bypass surgery requires the use of a heart-lung machine. However, alternative strategies are becoming more widely available.
Physicians determine the type of necessary treatment needed based on the patient’s current condition and the underlying cause of his or her heart attack.
After a heart attack, patients typically remain in the hospital for several days. During this time, they are closely monitored for any abnormalities in heartbeat or other functions, as well as for signs of other heart-related trauma (e.g., chest pain or shortness of breath). Additional blood tests are taken to confirm the diagnosis and monitor the patient's progress. Patients will most likely be educated about the need for lifestyle modifications, including the need for a heart-healthy diet, exercise and stress management. These have been shown to lower the risk of additional damage to the heart.
After a few days in the hospital, most patients are sent home if there are no serious after-effects. Specific recovery times vary from patient to patient, but a general guideline is offered for patients whose heart attacks are classified as mild, moderate or severe, based on the amount of damage that was done. This guideline is as follows:
Severity of
Heart Attack
Time Before Returning to Work or Engaging
in Strenuous Activity (including having sex)
Mild
Two weeks
Moderate
Up to four weeks
Severe
Six weeks or longer
Other after-effects of a heart attack may be emotional in nature. Fear of a future attack, fear of physical activity (including having sex), and even mild or moderate depression are all normal and common feelings following the trauma of a heart attack. Patients are encouraged to discuss their concerns with their physician, and to also discuss their sex-related fears with their spouse/partner. Appropriate treatment and suggestions vary from patient to patient.
Patients are often referred to a cardiac rehabilitation program to help them cope with their physical and emotional concerns. It is important to remember that feelings of anger, depression, resentment and fear are not uncommon. Sharing these concerns with a physician or other trained health professionals (e.g., a therapist) can be a very important step on the road to recovery from a heart attack.
There are a number of medications that a physician may prescribe for someone who has had a heart attack. These medications include:
Antiplatelets (e.g., aspirin and clopidogrel). Drugs that help prevent the formation of blood clots. They are almost always prescribed, unless the patient has a history of gastrointestinal bleeding, peptic ulcer disease or allergy to that drug. Oftentimes, aspirin and clopidogrel will be prescribed for up to 12 months, after which time, aspirin alone will be continued, possibly for life.
Beta blockers. Drugs that reduce pulse rate, lower blood pressure and allow the heart to pump less vigorously while still meeting the body’s needs. Research suggests these drugs can help maintain a normal heart rhythm and reduce the risk of further cardiac events or sudden cardiac death. Once prescribed, the drugs are taken for life. They might not be prescribed for patients who have a history of asthma, insulin-dependent diabetes, severe peripheral vascular disease or a very slow heart rate (bradycardia). There has been concern that prolonged use of beta blockers may impair sexual function and bring on symptoms of depression. However, studies have found no greater incidence of sexual dysfunction and depression in people taking beta blockers when compared to people given an inactive pill, or placebo.
ACE inhibitors. Drugs that reduce vascular resistance of the arteries and relieve some of the strain on the heart, allowing the heart to pump more efficiently. Because they help the left ventricle to pump out oxygen-rich blood, they are often prescribed if the left ventricle was damaged during the heart attack and is no longer functioning normally. The drugs will continue to be taken for life.
Cholesterol-reducing drugs. Drugs that are prescribed if the heart attack survivor has high levels of lipids (e.g., cholesterol and triglycerides) to reduce the risk of another heart attack or other cardiovascular event. These drugs may be prescribed for life, or until there is evidence that the patient can maintain lower lipid levels with diet and exercise alone. Statins, for example, have shown benefit when given to heart attack patients before being released from the hospital, lowering the risk of mortality in the year following the attack.
All four of these types of drugs can safely be taken together, even over the long term. However, the use of multiple medications after a heart attack may not provide additional benefits.
Prevention methods for heart attacks
Risk factor modification is a major goal of prevention, both for first attacks and repeat heart attacks. Patients are urged to reduce behaviors that are associated with heart attack, such as smoking, and adopt healthy lifestyle habits that have been shown to prevent heart attacks, such as exercising and eating a heart-healthy diet. By altering these risk factors, it may be possible to slow the progression of atherosclerosis, which is the leading cause of heart attacks.
The American Heart Association (AHA) recommends that people have their blood pressure, body mass index (BMI), waist circumference and pulse checked at least every two years, beginning at age 20. Cholesterol tests and glucose tests are to be checked at least every five years. Such risk factors, according to the AHA, can be used to estimate the risk of developing heart disease within a 10-year period.
Specific recommended changes include:
Improving your cholesterol ratio. A person’s total cholesterol level (which includes LDL cholesterol, HDL cholesterol and triglycerides) should be no more than 200 milligrams per deciliter and no more than five times the HDL level. Key strategies for reducing levels of total cholesterol, LDL cholesterol and triglycerides are to eat a heart-healthy diet and to exercise regularly. If these strategies do not reduce total cholesterol levels, a physician may prescribe cholesterol-reducing drugs (e.g., statins). Strategies for increasing levels of HDL cholesterol include eating monounsaturated fats in moderation, decreasing the amount of saturated fat, limiting alcohol use and starting an exercise program.
Exercising regularly. Exercise can be an excellent tool in the both prevention of heart disease and improving quality of life for heart patients. Physically, it can slow or even reverse the process of atherosclerosis, as well as lower blood pressure and reduce cholesterol levels. Emotionally, it can reduce levels of stress and depression.
Achieving and maintaining a healthy weight. Obesity and being overweight are major risk factors for a host of serious health conditions, including coronary artery disease, high blood pressure, diabetes, heart attack and stroke. Some weight control methods include limiting calories, increasing activity, counseling, medication and surgical interventions.
Eating a heart-healthy diet. Modern research has consistently supported the idea that health is largely determined by what people choose to eat. Certain B-vitamins and minerals have been shown to be helpful to heart health. Omega-3 fatty acids found in certain fish (e.g., tuna, salmon and sardines) may keep arteries healthy and elastic. Saturated fats and tropical oils (palm and coconut oil), however, have been shown to be harmful, because they can speed up the development of coronary artery disease, atherosclerosis and obesity. Trans fat, in particular, has been linked to damage to the heart.
Quitting smoking and avoidnig all second–hand smoke. Tobacco smoking is a major cause of coronary artery disease and cardiac arrest. According to the United States Centers for Disease Control and Prevention (CDC), from 1995 to 1999, nearly 450,000 people in the United States died prematurely from smoking. Of these, nearly 150,000 deaths were attributed to cardiovascular diseases and nearly 125,000 were attributed to lung cancer. The CDC also estimates that second–hand smoke was responsible for more than 35,000 deaths from ischemic heart disease (and 3,000 deaths from lung cancer) annually during the same five-year period.
Controlling blood pressure. Individuals with high blood pressure (hypertension) are at greater risk of heart attack and other problems resulting from cardiovascular disease. Current research suggests that hypertension can bring on changes in genes involved in heart function. This contributes to a process known as remodeling, where there is enlargement and weakening of the heart’s left ventricle (left ventricular hypertrophy). Cells involved in heart muscle contraction become impaired and eventually self-destruct, leading to heart failure. Hypertension can be controlled through taking blood pressure medications, self-monitoring, eating a heart-healthy, low-salt diet, and engaging in regular exercise. People are also encouraged to have regular check-ups with their physician.
Controlling diabetes. People with diabetes may be more likely to develop heart-related diseases. Good glucose control is essential for all diabetics, as well as weight loss and a healthy diet. All type 1 diabetics will require insulin therapy, while type 2 diabetics can be treated with a number of additional medications that help control glucose levels. Non-insulin drugs used to treat type 2 diabetes include metformin and acarbose.
Learning and practicing stress management techniques. Stress, excessive anger and fatigue can lead to high-risk practices such as overeating, smoking, high blood pressure (hypertension) and a lack of exercise. In addition, chronic stress may be a direct contributor to poor heart health because it produces increases in blood pressure that could become permanent. Anxiety has also been linked to an increased risk for future health problems in men who have suffered a heart attack.
Avoiding high levels of homocysteine by getting enough B-vitamins. There is considerable debate over the role of homocysteine in heart disease. Homocysteine is an amino acid that is produced as a byproduct of other chemical reactions in the body. Numerous studies have shown that people with elevated homocysteine are at greater risk for heart attack, stroke and other cardiovascular problems. However, researchers have been unable to determine if elevated homocysteine levels are causedby heart disease, or if they cause heart disease. Also, two large, well-designed studies have recently shown that moderately lowering homocysteine among people with diabetes and existing heart disease had no effect on lowering risk for cardiovascular events.
At this point, the AHA has not identified elevated homocysteine as a major risk factor for heart disease and does not recommend widespread use of folic acid and vitamin B supplements to lower homocysteine. However, because of the association between homocysteine and heart disease, people are advised to obtain these important nutrients through a healthy diet that includes fruits, vegetables, whole grain and fortified grain products. Additionally, people who have a family history or personal history of heart disease but lack other well-defined risk factors, such as smoking or obesity, should consider monitoring their homocysteine levels. In the event of elevated homocysteine (above 15 mmol/L), supplementation to lower homocysteine should only be done under the supervision of a physician to ensure the patient's safety. Folate supplements, for example, may mask a true vitamin B-12 deficiency. In addition, studies find that these supplements may increase the risk of artery re-narrowing (restenosis) following revascularization procedures such as balloon angioplasty and stenting.
Recognizing and treating chronic depression. Depression has been linked with a higher risk of developing high blood pressure, heart disease and having a heart attack. Depression is associated with heart disease in several ways, including a risk of abnormal heart rhythms (arrhythmias), alteration of the amount of blood flowing to the coronary arteries, increased risk of blood clots (“sticky” platelets), and increased risk of sudden cardiac death. A recent study of the anti-depressant drug sertraline found that it was a safe and effective therapy in patients having a recent heart attack or unstable angina. It has also been shown to have anti-clotting properties.
There is a great deal of information in the media about different vitamins, mineral, nutrients and other substances and their supposed affect on heart health. For instance, there are conflicting reports on whether high doses of vitamin E can protect arteries and prevent heart attacks and strokes, or whether high doses of vitamin E can actually damage the heart. Aspirin therapy, which may be prescribed for a patient after a heart attack, has also been touted as way to prevent a first heart attack. While recent research supports the theory, there are risks to the regular use of aspirin, including gastrointestinal bleeding. Patients with no history or significant risk of heart disease should discuss with their physician if the risks associated with aspirin outweigh the potential benefits.
It is unfortunate that up to two-thirds of post-attack patients do not make lifestyle changes. It is estimated that up to one-third of fatal heart attacks could be prevented with the proper pre-attack medical treatments and lifestyle modifications. Even after one heart attack, the chances of avoiding future attacks can be increased with appropriate preventive care. People who have had a heart attack, or are at risk of having one, are encouraged to remember that their lifestyle choices can have a major impact on their heart health. Patients should always consult their physicians before making any changes to their diet or activity levels.
Much attention has also been given to the possible benefits of moderate alcohol consumption in lowering the risk of heart attacks and heart disease in general. At this point, medical experts do not recommend that non-drinkers begin drinking alcohol for better cardiovascular health. Research is still being done to clarify the relationship between alcohol and the heart. However, findings in recent years have suggested that moderate alcohol consumption may offer some people a degree of protection against heart disease. Moderate drinking is defined as no more than one drink per day for women and no more than two drinks per day for men. One drink is equal to the following: 12 ounces of beer or wine cooler, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
Patients should discuss alcohol consumption with their physicians. In general, patients should follow established, proven wellness strategies. The earlier in life a patient modifies his or her habits, the better the chances of lowering or even eliminating certain risk factors for heart attack.
Questions for your doctor about heart attacks
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about heart attacks:
Am I at high risk for having a heart attack?
What strategies should I use to lower my risk?
What tests can determine if I had a heart attack?
How serious was my heart attack and what was the damage?
Will I need any surgical procedures?
How long is my expected recovery?
What are my restrictions following my heart attack?
Will I need to take any medications? If so, which ones?
How long will I need to take the medications?
What are the side effects of these drugs?
How often will I need follow-up tests?
What are the chances of me having a second heart attack?
What signs will indicate the need for immediate medical attention?
