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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 (infarction). 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 obtain
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.
Someone's chance of surviving a heart attack depends on the
treatment that is given within the first hour of the heart
attack. Immediate treatment for a heart attack should always
include professional emergency medical intervention. While
waiting for help to arrive or on the way to the hospital,
patients are often told to begin chewing aspirin, a known
blood clot inhibitor. It is thought that taking aspirin while
experiencing a heart attack can decrease the risk of death
by about 25 percent.
After a heart attack, people will need from two weeks to more
than six weeks of recovery time, depending on how severe the
heart attack was. Cardiac rehabilitation programs are strongly
recommended to help people get back on their feet quickly
and safely.
What is a heart attack?
A heart attack is an event that results in permanent damage
or death to part of the heart muscle. It is also known as
a myocardial infarction, because areas of the heart muscle
may literally die (infarction).
 Although
a heart attack is usually the result of a number of chronic
heart conditions (e.g., coronary artery disease), the trigger
for a heart attack is often a blood clot that has blocked
the flow of blood through a coronary artery. If the artery
has already been narrowed by fatty plaque (a disease called
atherosclerosis), the blood clot may be large enough to block
the blood flow severely or completely. The person will experience
an episode of cardiac ischemia, which is a condition in which
the heart is not getting enough oxygen-rich blood. This is
often accompanied by angina (a type of chest pain, pressure
or discomfort), although silent ischemia shows no signs at
all. Severe or lengthy episodes of cardiac ischemia can trigger
a heart attack.
Depending upon the severity of both the attack and of the
subsequent scarring, a heart attack can lead to the following:
- 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 could 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
Whether or not the heart muscle will continue to function
after a heart attack depends on how much of it was damaged
or how much of it died before the patient could get medical
treatment. The location of the damage in the heart muscle
is also important. Because different coronary arteries supply
different areas of the heart, the severity of the damage will
depend upon the degree to which the artery was blocked and
the amount and area of the heart muscle that depended on that
blocked artery.
How is cardiac arrest different from a
heart attack?
While many people use the two terms interchangeably, cardiac
arrest is not the same as a heart attack. Cardiac arrest occurs
when the heart actually stops beating and pumping blood, usually
due to a malfunction in the heart's electrical system (ventricular
fibrillation). The term "massive heart attack" is
also mistakenly used to describe cardiac arrest, as they are
not the same thing. A heart attack may lead to cardiac arrest,
but these are separate events.
Who is at risk for a heart attack?
More than 12 million people alive today have a history of
heart attack or angina. A coronary event occurs every 29 seconds
and every minute someone dies from one. While age and genetics
play a role in heart attack risk, so do lifestyle factors
such as diet, activity levels and smoking (for more information,
see Can heart attacks be prevented?). However, these factors
cannot explain all heart attack occurrences, so scientists
are continuously researching potential new risk factors. Recent
findings include:
- Patients with coronary artery disease whose arteries are
clogged with fatty plaque – which tends to rupture
– may be at higher risk of heart attack than patients
with calcification, a process that makes plaque harder and
more brittle, forming a crust over plaque formations.
- Patients 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. A 2002 study found that
heart attack survival decreases even with mild to moderate
kidney disease.
- High levels of a certain type of lipoprotein called Lp(a)
in the blood may indicate an increased risk of heart attack.
- Patients whose parents have had a heart attack before
age 60 have a higher risk for developing coronary artery
disease at a young age. Studies find that patients (average
age 19) whose parents had early heart attacks can have thicker
artery walls and worse artery function than is normal for
their age. Researchers suggest that a genetic cause may
be responsible, stressing the need for healthy lifestyle
changes for patients with a family history of early heart
attack.
- Studies are also exploring the link between infectious
disease, inflammation and heart conditions.
What causes a heart attack?
In order to learn about the most common cause of heart
attacks, one must first have a basic understanding of plaque
formation.
 LDL
(“bad”) cholesterol produces poisons (toxins) that
damage the lining (endothelial cells) of the inside wall of
an artery. This damage contributes to the formation of tiny
wounds or lesions on that inside wall. Other fatty materials
in the bloodstream (e.g., triglycerides) are attracted to
those lesions and begin to build up there. White blood cells
rush to the site of the irritation to devour harmful substances,
but only cause the lining of the artery to become sticky,
attracting even more LDL molecules. Clot-producing platelets
begin to collect over the site, releasing still more irritating
substances and trapping more fatty particles and white blood
cells. This gradual build-up of fatty materials and toxins
is known as plaque.
As the plaque continues to build up, some of the plaque formations
develop a relatively thick covering (due to calcification).
These types of plaque are considered to be stable plaques
and are a primary cause of hardened and narrowed arteries
(atherosclerosis). 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 at any time without warning
If the coating of an unstable plaque is stripped off, this
is known as a plaque rupture. 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.
If the coating of the unstable plaque is torn off, the fatty
core will be exposed. Small fatty particles are then released
into the bloodstream. The site of the plaque rupture could
seal over with additional blood cells and fibrin deposits,
creating an even larger blockage (thrombosis) in that part
of the artery. The severity of the ensuing heart attack depends
on the duration of the blockage and the oxygen deprivation
it causes, as well as the amount and location of the heart
muscle tissues that are affected.
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. This concept is known as (pancoronaritis).
Aiding the researchers was their use of intravascular ultrasound,
which provided high-resolution, three-dimensional images of
the lining of the coronary arteries.
Other causes of heart attacks include coronary artery spasm.
What is the link between inflammation
and heart attack?
Researchers increasingly see the heart not merely as
a pump that becomes damaged on its own. Rather, there are
chemicals, hormones and other molecules released in the
body that contribute to a steady process of inflammation
within and around the heart. Research has found a link between
heart disease risk and high blood levels of inflammatory
markers – substances released by the body in response
to inflammation. Two such markers are C-reactive protein
(CRP) and interleukin-6 (IL-6). Studies show higher levels
of both CRP and IL-6 with increasing age, body mass index,
blood pressure and exposure to tobacco smoke. CRP may actually
damage blood vessel walls and increase plaque formation.
High levels of IL-6 alone 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. Blood clots may also
occur in response to inflammation caused by the rupture
of unstable, fatty plaque. Blood clots can block arteries
and increase the risk for heart attack.
The anti-inflammatory actions of some antibiotics have been
tested. New research has found promising results with clarithromycin,
an antibiotic medication often prescribed for respiratory
infections. In fighting infections and inflammation, the
drug might also reduce the risk of another heart attack.
Results on a small number of heart patients so far have
shown that clarithromycin significantly lowered the risk
of heart attack or other cardiovascular event.
In another example, studies have explored the possible effects
of inflammation brought on by a bout with the flu. It had
been thought that heart patients receiving a flu vaccination
had a lowered risk of a second heart attack. However, a
new study involving more than 1,300 first-time heart attack
patients showed that the flu vaccine did not alter the incidence
of a subsequent heart attack.
What are the symptoms of a heart attack?
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.
Of course, the absence of symptoms 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 do 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 younger patients (below age 55) occur outside
of the hospital, and medical experts believe this is often
due to their not understanding the situation. Younger people
tend to brush off the symptoms and ignore them, whereas
an older person may be more cautious. 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 include the
following:
-
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 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 heavy and often cold
-
-
Women are less likely to experience chest
pain that is heart attack-related. They are more likely
to feel fatigue or nausea prior to a heart attack. They
also feel pain high in the abdomen and chest, and even in
the back, neck or jaw. Whatever the nature of the pain,
it does not have to be jarring or obvious for it to signal
an impending heart attack. In fact, obvious pain is a better
signal of an impending heart attack than discomfort or heartburn-like
symptoms, which can be easily ignored or mistaken for indigestion.
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 chew an aspirin (“regular”
aspirin, and not non-aspirin pain relievers, such as acetaminophen)
and wash it down with a glass of water, while waiting for
help to arrive.
How is a heart attack diagnosed?
When a patient has symptoms of a heart attack, the physician
will promptly evaluate the patient's medical history and
quickly run tests such as the following:
-
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 chemicals that are released following a heart
attack. These include troponin, myoglobin, creatine phosphokinase
(CPK), aspartate aminotransferase (AST) and lactate dehydrogenase
(LDH).
Once the patient is stabilized, the final diagnosis of
whether the patient actually had a heart attack can take
the physician several days. Tests that may be run during
this time include the following:
-
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.
What treatments are given to a heart
attack patient?
A heart attack is not a one-time, one-moment occurrence.
It is a process that builds up over a period of a few hours.
With each minute that goes by, less oxygen is reaching the
surrounding heart muscle and the risk of permanent damage
is rising. 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, if the patient
lives in an area with such access. 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. Of course, CPR is NOT
a substitute for emergency paramedic or hospital treatment.
People who believe that they are experiencing a heart attack
are urged to let an ambulance or friend/family member take
them to the hospital, rather than driving themselves. While
waiting for help to arrive or on the way to the hospital,
patients are often told to begin chewing aspirin, a known
blood clot inhibitor. It is thought that taking aspirin
while experiencing a heart attack can decrease the risk
of death by about 25 percent.
Information has been circulating around the Internet about
the use of repeated coughing 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 a useful aid during
a heart attack when 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 formation and to take the
strain off the heart. These medications include beta blockers,
ACE inhibitors, 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 be given according
to a rigid protocol to carefully selected patients.
Treatment may also include one or more procedures to open
any blocked coronary arteries, including:
Physicians will determine the type of treatment needed
based on the patient's current condition and the underlying
cause of his or her heart attack.
What happens after a heart attack?
Post-heart attack patients will be hospitalized for
a few days following the attack. During this time, they
will be 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 will be 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 will be
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 |
Amount of Time before Returning to Work
or Engaging in Strenuous Activity (including having
sex) |
| Mild |
2 weeks |
| Moderate |
Up to 4 weeks |
| Severe |
6 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 all
their concerns with their physician, and to discuss their
sex-related fears with their spouse/partner. Appropriate
treatment and suggestions vary from patient to patient.
One excellent strategy for feeling more comfortable with
physical activity is to join a cardiac rehabilitation program.
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 professional (e.g.,
a therapist) is a very important step on the road to recovery
from a heart attack.
What drugs might be prescribed for
a heart attack survivor?
There are a number of medications that a physician may
prescribe for someone who has had a heart attack. These
medications include the following:
-
Antiplatelets (e.g., aspirin). 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 (e.g., aspirin allergy). The patient
will continue to take these medications 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 that
they 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 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.
- Antilipemic agents. 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.
Can heart attacks be prevented?
It is possible to reduce one's risk of developing atherosclerosis
(hardened arteries) in one or more coronary arteries, thus
eliminating a major risk factor in heart attacks. In fact,
it is easier to prevent future damage than it is to heal
damage that has already been done, such as plaque deposits
in the arteries. 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.
Although people cannot change their age or family medical
history, there are risk factors that people can change.
Because it has been proven that the build up of plaque is
sped up by certain behaviors, recommended changes include
the following:
-
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 fat in a patient's
diet, increase activity levels, counseling, medication and
surgical interventions.
- Eating a heart-healthy diet. Modern research has consistently
supported the idea that the health of people’s bodies
is largely determined by what they 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 particularly
harmful, because they can speed up the development of coronary
artery disease, atherosclerosis and obesity.
- Quitting smoking and staying away from all second-hand
smoke. Tobacco smoking is a major cause of coronary artery
disease and cardiac arrest. A 1990 study by the Centers
for Disease Control and Prevention (CDC) shows heart disease
as the leading smoking-related cause of death in the United
States among men and women. The CDC also suggests that the
average smoker dies nearly seven years before a nonsmoker.
And there is no safe minimum. Heart attack risk has been
shown to double with smoking as few as three cigarettes
per day (Journal of Epidemiology and Community Health; August
2002). Other studies continue to demonstrate adverse effects
of environmental (“second-hand”) tobacco smoke
on the heart and lungs of nonsmokers. The CDC estimates
that second-hand smoke is responsible for 62,000 deaths
from coronary artery disease (and 3,000 lung cancer deaths)
each year in nonsmokers.
- Controlling blood pressure (hypertension). Individuals
with high blood pressure 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 cf_tag_DisplayDef
glossId=1946 Glossary_Topics="" Display="left
ventricular hypertrophy">(remodeling). 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. Persons with diabetes may be more
likely to develop heart-related diseases. It is believed
that up to one-third of heart failure patients have Type
2 (non-insulin dependent) diabetes. There is also a strong
association between Type 2 diabetes and high blood pressure.
Type 2 diabetes has been linked to obesity, inactivity and
being over 40 years old. Preventative care is crucial to
the overall health and heart function of diabetic patients.
This includes exercise, to keep off extra weight and to
lower blood pressure. Even moderate exercise has been shown
to improve left ventricular diastolic dysfunction (LVDD),
a defect of the left ventricle in between contractions.
Researchers feel that LVDD is an early manifestation of
heart damage due to diabetes. Patients are advised to adopt
an exercise program under the supervision of their physician.
- 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.
- Avoiding high levels of homocysteine by getting enough
B-vitamins. Homocysteine is an amino acid produced as a
normal byproduct of the breakdown of methionine, which is
an essential (dietary) amino acid acquired mostly from eating
meat and other proteins. High homocysteine levels have been
linked to damage of the arteries, which may increase the
risk of heart attack, stroke or other cardiovascular problems.
Researchers are currently trying to determine whether high
homocysteine levels are an actual cause of those conditions,
or are simply associated with them for some other reason.
Homocysteine can be kept at moderate, healthy levels if
the body has adequate levels of three important B-vitamins:
vitamin B-6, vitamin B-12 and folic acid (the synthetic
and more easily absorbed version of folate). Therefore people
are encouraged to make sure they get enough B-vitamins every
day.
- 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 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.
Patients should always consult their physicians before making
any changes to their diet or activity levels.
It is unfortunate that up to two-thirds of post-attack patients
do not make these lifestyle changes, because research has
shown them to be so helpful. 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 one,
are encouraged to remember that their lifestyle choices
can have a major impact on their heart health.
Can moderate alcohol use lower heart
attack risk?
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. Studies have
shown that one or two drinks a day may have a protective
effect by lowering blood pressure; by having anti-clotting
properties (making platelets less “sticky”); and
by helping to raise levels of high-density lipoproteins
(HDLs), the so-called good cholesterol. A drink is generally
defined as 4 ounces of wine, 12 ounces of beer, or 1.5 ounces
of liquor (vodka, gin, scotch, etc.). A recent study of
male heart attack survivors found a lower risk of a second
heart attack with moderate wine consumption.
But the alcohol-heart question is still debated:
Whether or not to drink is something patients should discuss
with their physicians. More important, however, is following
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.
The risk of totally vs. partially blocked
arteries
It is interesting to note that a totally blocked artery
(in the absence of any new blood vessels called collaterals
that the body may create through angiogenesis) is generally
considered less of a threat in terms of a future heart attack
than is a partially or almost totally blocked artery. Why?
Because there is no 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. A bypass of
a totally blocked artery that supplies a "dead"
area of the heart serves 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.
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