Surviving a heart attack: timing is crucial
by Anita M. Harris
Is it indigestion or chest pain? Knowing the symptoms of a
heart attack can literally save your life.
John H., 46, a medical doctor, thought he had indigestion. He felt discomfort in his
abdomen on and off for about a month, took antacid tablets and went about his life. One
day, his wife came home to find him lying on the floor, clutching his chest in pain. She
called an ambulance and had him rushed to the emergency room. There, he learned he was
having a myocardial infarction (MI), or heart attack. If Dr. H. had
waited much longer to get to the hospital, doctors told him, it is quite likely he would
have died.
Every year, approximately 1.1 million people in the United States suffer heart attacks,
and about one third of that number die, according to the American Heart Association. In
fact, MI is the leading cause of death in the United States.
The death of heart cells
Most heart attacks are a result of atherosclerosis: deposits of lipids or fatty cells,
which build up and cause damage to the arterial walls. The body responds by creating
plaque, which forms a scar inside the artery. If the plaque ruptures, it releases its
contents and can cause blood clots that block the flow of blood to the heart. Without
blood, the heart does not receive the oxygen it needs, and cells of the heart muscle begin
to die.
While a "heart attack" may describe several possible conditions,
"myocardial infarction" refers strictly to the death of heart cells. The longer
the heart muscle goes without blood, the more severe the damage, and the greater the risk
of ongoing heart muscle weakness, or even death. MIs can also be caused by drug use,
particularly cocaine, which may lead to clotting or to spasms of the arteries, and
decreased blood flow to the heart.
Immediate treatment is essential
Heart damage caused by MIs can often be minimized or averted by immediate treatment.
But "too many people wait too long to go to the hospital," says Robert P.
Giugliano, M.D., S.M., a member of the Thrombolysis in Myocardial Infarction Study Group
at Brigham and Women's Hospital in Boston. According to a 1997 report by the National
Institutes of Health (NIH), some studies show that as few as 3% of people suffering heart
attacks receive treatment within an hour after symptoms begin; the median time delay in
seeking care after the first symptoms ranges from 2 to 6.4 hours. "By then,"
Giugliano says, "a lot of damage may have been done."
Why people delay
There are many reasons why people having heart attacks delay getting medical help. Some
are fearful or "in denial," according to Giugliano. Others are put off by
complications or costs of the medical system, have trouble reaching their doctors, run
into language or cultural barriers, or don't have access to care. But many people simply
don't realize that they are having a heart attack. That is because the warning signs vary
widely, and the symptoms can be unclear.
The symptoms
The classic symptom of a myocardial infarction is intense, central chest pressure.
Other common systems include: pain or heaviness in the left arm, nausea, shortness of
breath, increased perspiration, and a feeling of impending doom. But many people who have
had an MI describe chest "discomfort," or pain in the jaw, teeth, arm, or
abdomen. Women are more likely than men to feel pain in their backs. Often, symptoms come
on gradually and are intermittent or vague. A quarter of patients—more often women
and people with diabetes—experience
no symptoms at all.
If you have symptoms that last for twenty to thirty minutes or more, or if you are
having frequent shorter episodes associated with physical exertion, you should contact a
doctor, Giugliano says. By asking questions about your symptoms and what precipitates
them, your doctor may determine that the problem is minor; it might be indigestion or a
pulled muscle. If your doctor suspects a heart attack, he or she will send you to the
hospital for an electrocardiogram and blood tests to determine if your heart has been
damaged.
Are you at risk?
Because heart attack symptoms can be difficult to recognize, it is important to know if
you are at risk. You may be at risk if you:
Population groups at greatest risk include the elderly, people with diabetes, men, and
smokers. Post-menopausal women are also at risk, but many observational studies show a
consistent lower risk of heart disease in women taking estrogen
after menopause,
compared with women not taking estrogen. However, other reasons besides estrogen may
explain the link, such as more education, better access to health care and fewer risk
factors among women who take estrogen.
Help from medical technology
Hospitals with cardiac catheterization laboratories can quickly determine whether an
artery is blocked, where, and to what extent. Drugs may be prescribed to break up clots,
and doctors may use a catheter device to open blocked arteries; they may even prop open an
artery, so blood can continue to flow freely. Some patients may undergo bypass surgery.
Today, most MI patients are treated and monitored in the hospital for five to seven
days. Upon leaving the hospital, many will live full, rich lives. But that does not mean
they are home free. "Once you have had one heart attack, you are at a higher risk for
having a second one," Dr. Giugliano says. "So it is important to reduce your
risks."
Life after a heart attack
To minimize the risk of a future MI, doctors usually prescribe aspirin to prevent blood
clots, and drugs called beta blockers. Many MI patients will receive prescriptions for a
cholesterol-lowering drug to prevent the buildup of cholesterol in the blood. Doctors also
recommend a low-fat diet high in fiber, a
regular program of aerobic exercise, smoking cessation, diabetes control, and weight
management.
About six weeks after leaving the hospital, many post-MI patients undergo a stress
test, which involves being monitored while walking on a treadmill
or riding a stationary
bike to determine readiness for more strenuous exercise. Your exercise program will
depend on the extent of damage to your heart, your age and other health issues. "If
you are 40 and have suffered a first, small heart attack, you may be able to resume
vigorous exercise almost immediately," Dr. Giugliano says. "But an 80-year-old
who has had a third attack may be limited to slow walking."
Patients should ask their doctors specific questions about what sort of activity is
appropriate, he adds.
Some physicians advise reducing stress,
which can help lower blood pressure. But, because stress levels are difficult to define
and measure on an individual basis, according to Giugliano, scientific research on the
relationship between stress and heart attacks requires further study.
Resources
American Heart Association
http://www.americanheart.org/
Heart Information Network
http://www.heartinfo.com/
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/
 Back
December 23, 1999
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