As Serious As A Heart Attack

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Providers are always warning you about preventable diseases. A heart attack is pretty preventable.
In the Korean War and Vietnam War the autopsies showed that some of the very young men had severe hardening of the arteries.

This was a surprise. That is why we recommend you get a cholesterol blood check in your late teens or early twenties just to make sure you are not at risk of a heart attack or stroke at an early age. These two problems are the result of atherosclerosis—hardening and blockage of the arteries. Since you and I and our friends and relatives have a great chance of having a heart attack or stroke in the future, I thought I’d review this subject for you.

The five major risk factors for atherosclerosis are:

Family History: if you have had a close relative with atherosclerosis starting before age 55 in males and 65 in females.

Cholesterol: mainly a low good cholesterol (which you can raise through more aerobic exercise) and a high bad cholesterol (which you can lower through better diet, sometimes with medication added).

Diabetes: This is defined by a fasting blood sugar above a certain level. If it gets high enough then you notice that you are losing weight even though you are eating a lot, along with fatigue, drinking and urinating a lot.

Tobacco use: This is probably from the nicotine (the tar causes cancer).

Hypertension: The silent killer. Most people do not have the morning pain in the back of their head. Check it; that’s the only way to diagnose it.

Minor risk factors are:

High Triglycerides: This is the other type of fat in the blood besides cholesterol. It is best checked in a fasting state. After a meal with ice cream or another fatty food, the blood has a milky color. People with high triglycerides don’t process the fat well so that their blood is milky most of the time.

Obesity: You can go to a calculator to check your BMI (http://www.nhlbisupport.com/bmi ) and find out if you are under, overweight, normal, obese. There is even a super obese category!

You are labeled with the metabolic syndrome when you have a few of these: obesity (waist more than 40 inches, 35 in females), high triglycerides, low good cholesterol, high blood sugar (even mildly, less than the diabetes level), hypertension. People with metabolic syndrome have a very high risk of atherosclerosis.
But by far, tobacco carries more risk than any of the other risk factors. So quitting is the best thing you can do for your heart, brain, lungs, colon, esophagus, stomach, kidneys, erections, skin, feet…..

The signs of a heart attack can be chest pain or discomfort, or indigestion, or nothing! In women or diabetics this is less exact sometimes. The discomfort can be in the neck or go down an arm or two. There may be associated sweating, shortness of breath, palpitations, dizziness, or nausea.

In the emergency department or office we ask about the 5 risk factors and the symptoms to measure the chance of having a heart attack and then usually check an electrocardiogram; the tracing of the heart’s electricity shows a different pattern if it is an attack than when it is normal. There can be a reading in between that shows the heart is crying for more oxygen or the reading can be unclear—in the gray area of positive or negative. So we check 2 more ECGs about 8 hours apart. You may be in the hospital for more than 20 hours to get this clarified.

We also check cardiac enzymes. These are chemicals liberated by the heart. When there is a piece of dead tissue-an infarction-these chemicals are released by the dead cells into the blood.

A large piece of tissue has large findings on the ECG and enzymes, a small piece has less so. A large piece will mean that your heart will pump poorly in the future since there is now less functional muscle to do the pumping. Whether large or small, there is a risk of death from an incorrect rhythm starting from the dying tissue. This rhythm can make your heart pump very poorly. That is why we put wires on the chest and monitor the rhythm of everyone who might be having a heart attack so that the computer can call the staff to you quickly to stop the bad rhythm with medication to save your life—keeping blood flowing to your brain.

Speaking of brains…The signs of a stroke are weakness in an arm or leg or both, or trouble talking or thinking. Quick emergency evaluation to see if it is really a stroke, and treatment are just as important as with a heart attack. Time is tissue. The longer one waits for both these organs, the more damage. Through medication and mechanical procedures, we can limit the amount of damaged tissue.

We listen to the story, perform a good neurological exam, a head scan, and blood tests to determine if a stroke is happening and if so, treat it right away.

Most of us will have at least one of these problems before we are 120 years old. I hope you will take the steps to postpone it to as late in your life as possible. And if you are having symptoms, don’t delay in calling 911. Time is tissue.

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