Unhealthy lifestyles are a factor
The exact medical term is myocardial infarction.
It comes from Greek and Latin meaning heart (cardio) and muscle (myo). Infarction is derived from the word farcire — meaning to plug up — and refers to the death of tissue due to lack of blood supply.
In plain English, myocardial infarction is a heart attack.
In more cases than not, it is caused by a blockage of one or more arteries leading to the heart. Those arteries transport much needed oxygen and other nutrients to the heart, and if blocked, the heart muscle begins to die.
As a cardiologist at Brigham and Women’s Hospital and Chief of the Division of Women’s Health, Dr. Paula Johnson has seen her share of heart attacks and discusses that painful condition within the larger context of coronary heart disease.
Heart disease is the leading cause of death for both men and women in this country. It doesn’t discriminate by race and accounts for roughly 30 percent of all deaths in a given year. Heart attacks alone account for one out of every five of those deaths.
The exact number of heart attacks is not known since a percentage goes undetected — reasonable estimates hover around a million each year. What is known is that an estimated 300,000 people die each year before seeking medical help. What is also known is that heart attacks are a major cause of sudden death in adults.
Heart attacks are not necessarily fatal. Clot-busting drugs and other procedures used to open the arteries, such as angioplasty, can stop a heart attack and minimize the damage. But time is a factor. These treatments work better if performed within one hour of the start of symptoms.
The key is to recognize the symptoms of an attack and seek immediate medical attention.
Dr. Johnson has two bits of advice, especially for those with well-known risk factors such as high blood pressure, diabetes, high cholesterol and obesity. Smokers are particularly vulnerable. Family history and aging also play a role.
Perhaps the first, and arguably the more important, is to see a doctor immediately to learn how to minimize the impact of the risk factors and avoid a heart attack. The second is for patients to remain eternally vigilant about their condition and ongoing treatment.
“We as doctors really can’t cure the disease,” Dr. Johnson said. “It’s a matter of treating it, and a lot of it depends on whether a patient is able to make the necessary changes in their lifestyles to remain as healthy as possible.”
The culprit is atherosclerosis — fatty deposits, or plaque — that clog the arteries of the heart. In some instances, the plaque grows large enough to narrow the artery, reducing the flow of blood. An even more serious condition occurs when the plaque ruptures, causing the formation of blood clots that can partially or completely block blood flow. Clots can also break off and travel to other parts of the body. If a clot reaches the brain, for instance, it can cause a stroke.
The impact of atherosclerosis is great. It is the most frequent cause of myocardial infarction and angina, another word with Greek roots. Back then it meant “strangling.” But it is now used to describe the condition in which spasmodic attacks of pain occur, usually as a result of the lack of oxygen to the heart muscle.
Stable angina, the most common type of chest pain, results from physical exertion or extreme emotion during which the heart pumps faster and harder, thus requiring a greater supply of blood. Rest and medication can typically relieve stable angina.
Unstable angina, on the other hand, is more serious. It can occur even at rest, and does not respond to medication. Unstable angina poses a medical emergency, and is a sign that a heart attack could occur soon.
Not all heart attacks are alike. Some are sudden and intense. People have likened it to a herd of elephants stampeding on their chests. Heart attacks can be deceiving, however. Some start as a mild pain in the middle of the chest; in others, the symptoms may come and go. In still others, the attack is silent and without warning.
The typical signs of a heart attack include shortness of breath, uncomfortable chest pain, and discomfort in other parts of the upper body — one or both arms, back, neck, jaw and stomach. Less common signs are nausea, sweating, or lightheadedness.
There are gender differences as well. “Women can have atypical symptoms that are difficult to diagnose,” Dr. Johnson explained. “It can be overwhelming fatigue or a feeling similar to indigestion that can’t be relieved with an antacid.”
Dr. Johnson further explained that standard diagnostic tests, such as x-rays of the arteries of the heart and stress tests, have often failed to reveal heart disease in women. Part of the reason is that some women experience microvascular dysfunction in which the smaller vessels of the heart become obstructed.
Although largely considered a man’s disease, heart disease is the leading cause of death in women, and increases in incidence after menopause.
To a large extent, coronary heart disease is preventable. Some factors, such as age, gender, and family history, including race, are not changeable. But several other risk factors can be modified and controlled through proper screening, lifestyle changes and medications.
Dr. Johnson has seen countless patients who are willing to make changes in their lifestyles but are unable to because of other physical ailments or lack of money.
Take exercise for one. It’s a well-known fact that 30 minutes of exercise a day can help speed up the heart rate and increase the flow of blood throughout the body. But what happens if a person has arthritis or a recent hip replacement? In those cases, Dr. Johnson suggests consulting with a patient’s primary care physician and possibly seeing a physical therapist.
More troublesome is nutrition. “Many people really want to eat in a healthier way,” Dr. Johnson said. “And even when people do understand the importance of nutrition, they might not be able to afford to eat a generous diet of fruits and vegetables, which really can be expensive. What we must do as medical professionals is work with patients to improve their diets on a tight budget.”
When it comes to heart disease, Dr. Johnson adds, “Everything is interrelated.”
The most common controllable risk factors are diabetes, high blood cholesterol, high blood pressure, obesity, cigarette smoking and physical inactivity.
Although each factor by itself increases the risk of heart disease, factors often occur in clusters, further increasing the risk. The metabolic syndrome — a combination of moderately elevated blood pressure, abnormal cholesterol levels, and obesity, especially excess fat around the waist — is felt to be a strong indicator of heart disease. According to a recent study in the American Heart Journal, roughly 25 percent of the American population have the metabolic syndrome.
Screening plays a pivotal role in controlling or preventing heart disease. All the risk factors that make up the metabolic syndrome can be detected by simple and painless examinations. A mild pinprick can obtain enough blood to test for diabetes and total cholesterol — although a more sophisticated blood test is required to determine specific cholesterol levels, including HDL (“good”) and LDL (“bad”) cholesterol, and triglycerides. A blood pressure cuff reveals blood pressure. A body mass index chart, using your height and weight, can determine obesity. And a common tape measure can reveal waist size.
Dr. Johnson was adamant about reducing the risks factors. She said she understands the difficulty in quitting smoking, for instance. She said she also understands just how busy many people are these days and the tendency to ignore medical problems.
But heart disease is very serious and requires a long-term commitment — even if many of the medical terms really are Greek.
“If anyone is diagnosed with the disease, they should be as aggressive as possible with the appropriate treatments,” Dr. Johnson said. “That means knowing your blood pressure and cholesterol levels, controlling diabetes, and exercising, for example. It is important to have tangible goals to reduce your risk of heart disease.”
“Most important,” Dr. Johnson said, “it means being vigilant about one’s health.” |
Paula A. Johnson, M.D., M.P.H.
Chief, Division of Women’s Health
Executive Director, Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital |
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