Are you ready for a heart attack?
At this time of year as the weather cools down and the nights get longer, the holidays begin rapidly approaching until the next thing we know, they are right upon us. Thanksgiving, Christmas and New Years Day are supposed to be filled with love and joy with our family and friends. These days are supposed to be full of good times and cheer. A time of fellowship, a time of gift giving, a time to eat, drink and be merry. And for most of us, the holidays are exactly that. But, for anyone with heart disease—or who is at an increased risk of heart disease, the holidays instead may be a time of special risk. A joyful day may easily turn into a day of great tragedy.
Several studies have shown that during the winter holidays not only are heart problems more likely to occur but when they do, they are more likely to be fatal. The months of December and January are especially risky for people with heart disease. (1)
Imagine if you will, over the years you have been putting on weight and you have ignored your doctors admonition to lose weight simply because you feel like you are carrying it well for someone your size. You have not had any major health issues, so why worry about a little bulge at the belly, after all, you have more important things to worry about such as taking care of your family over your own needs.
It’s your life, who the hell is that doctor to tell you how to live when they are not the one paying your bills. All they need to do is shut up and give you your medicines to fix your ailments. All you wanted was medicine and not a judgmental opinion about your obesity. It’s your life, you will live it any way you see fit. That is until you cannot…
Now imagine if you will, you have been working hard since sunrise, preparing to give your family a wonderful Thanksgiving or Christmas Day meal. Your adult kids and the grandchildren have arrived a few hours ago to a warm home full of love and the aroma of a baking turkey in the oven. The smells that bring back happy memories of the past when you were a young child visiting your own grand parents. The kids are all catching up with each other in the living room while the grandchildren are running all around the house bringing joy to your heart despite the fact you are feeling a bit tired now and have a case of heartburn that you have not been able to kill with antacids. And for some odd reason, your jaw aches too. But regardless of this, nothing is going to ruin your day.
You have worked hard all day in preparation of your family gathering. You awoke to a heavy, wet snow coming down, covering the ground in a thick, cold blanket. Once you got the turkey into the oven, you pulled on your snow boots, put on your heavy coat and shoveled the drive for your loved ones. And the snow kept coming down, covering the drive about as fast as you could clear it. Once you finally removed the snow and spread your ice melt, you return to the kitchen and finish the final meal preparation.
What a joyous day, surrounded by loved ones. The table has been set, the delicious and hearty food has all been put out and as you begin to carve the turkey with your youngest grand daughter at your side waiting in anticipation, as you slice into the turkey, you all of a sudden feel a crushing pain in your chest and everything goes black…
My friends, if this scenario ever happens to you, if you are lucky, you will be able to go home from the hospital after a few days of tests and observations. If you are not so lucky, this may be the last day of your life.
Are your personal affairs in order?
Did you get a final chance to tell your family how much you loved them before you passed on?
Is your family going to ever live with guilt or regret that they signed a Do Not Resuscitate (DNR) order?
If you spend a few days in ICU, is your family going to go bankrupt trying to save your life? Even if you die, they could still go bankrupt…
Tightness, pressure, squeezing, stabbing, or dull pain, most often in the center of the chest
Pain that spreads to the shoulders, neck, or arms
Irregular or rapid heartbeat
Cold sweat or clammy skin
Lightheadedness, weakness, or dizziness
Shortness of breath
Nausea, indigestion, and sometimes vomiting
Exposure to cold weather
Exposure to sudden and unusual levels of exertion, such as shoveling snow
Exposure to emotional stress, which is very common and is often fairly severe during the holidays
Becoming sedentary over the winter months
Exposure to illness, especially influenza, which can produce inflammatory changes in the blood vessels
Over-indulging in food, alcohol and/or tobacco
Exposure to indoor pollution, such as cigarette smoke, or even a poorly-drafted log-burning fireplace
Reluctance to seek medical help during the holidays
Decreased exposure to light
What to Expect
For starters, always call 911 to be transported via ambulance rather than going by car. Contrary to what you might assume, speed isn’t the only rationale. “If you’re having a heart attack, there are two reasons why you want to be in an ambulance,” says Dr. Joshua Kosowsky, assistant professor of emergency medicine at Harvard Medical School. One is that in the unlikely event of cardiac arrest, the ambulance has the equipment and trained personnel to restart your heart. Cardiac arrest, which results from an electrical malfunction that stops the heart’s pumping ability, is fatal without prompt treatment. However, most heart attacks do not cause cardiac arrest, Dr. Kosowsky stresses. “It’s rare, but it’s certainly not a risk you want to take while you’re driving or riding in a car.” (2)
The other reason to travel via ambulance is that in many places in the United States, if a person calls 911 complaining of chest pain, the dispatcher will send paramedics who are trained to perform an electrocardiogram (ECG). This simple, painless test records your heart’s electrical activity through 12 small electrodes placed on your chest, arms, and legs. A six-second recording can then be transmitted to the receiving emergency department, which can help speed up the process of getting you the care you need.
Some people don’t experience the typical symptom of crushing chest pain during a heart attack, however, so they may hesitate to call 911. People with pain that waxes and wanes or who have subtler symptoms (such as jaw pain or shortness of breath) may show up at the emergency room on their own. Even if you do this, you’re still likely to get rapid care. The person who greets you might be a receptionist rather than a doctor or nurse, but most emergency departments follow a specific protocol for a suspected heart attack. “If you mention any symptom that sounds like it might be a heart attack, the first thing they’ll do is to get you an ECG, ideally within 10 minutes of your arrival,” says Dr. Kosowsky.
A doctor then interprets the ECG, which will reveal if you’re having a major heart attack, in which an artery feeding your heart is blocked, choking off the blood supply to part of your heart muscle. This usually creates a distinct signature on the ECG and means you’ll quickly receive treatment to open the blocked artery. (2)
But not all heart attacks show up on the first ECG. So even if it looks normal, you’re still not out of the woods, says Dr. Kosowsky. The next step is an evaluation by a doctor or other clinician, who will ask about your medical history and details about the location, duration, and intensity of your symptoms. You’ll also have a blood test to measure troponin, a protein that rises in response to heart muscle damage. This blood test is very sensitive. But keep in mind that elevated levels don’t always show up right away. That’s why doctors sometimes have people stay for several hours to get a follow-up troponin measurement.
Other possible tests include a chest x-ray to look for alternative causes of chest discomfort, such as pneumonia or heart failure. A doctor also might give you a trial of medication to see whether it relieves your symptoms, and additional ECGs may be performed over time.
Often, if several troponin tests come back normal, the doctor may want to check your risk of a future heart attack with an exercise stress test. This test can reveal how your heart responds to the demands of increased blood flow needed during exercise. During a standard exercise test, you walk on a treadmill at progressively faster speeds, while trained staff monitors your heart’s electrical activity, your heart rate, and your blood pressure.
An imaging test may also be performed to quantify the degree of blood flow to the heart. One option is an echocardiogram, a noninvasive test that involves placing an ultrasound probe on your chest to create a moving image of your beating heart. Restricted blood flow in the heart’s arteries changes the movement of the heart, which an experienced echocardiographer can detect.
Another option is a nuclear perfusion test, which entails injecting a radioactive substance called a tracer into a vein. The tracer then travels through your blood to your heart. A special camera that records the radioactive particles emitted from the tracer circles around the heart, taking images from multiple angles. A computer then combines these images to create a detailed picture of the blood flow to the heart.
In certain situations, if the source of your symptoms remains unclear, a physician might order a computed tomography angiography (CTA) scan. For this test, you receive an injection of a contrast dye into your arm or hand. The dye “lights up” in an image to reveal a three-dimensional view of your heart’s arteries, courtesy of multiple rapid-fire x-rays taken during the scan.
Sometimes, even after all the testing, doctors don’t know for certain what’s causing your chest pain. “If that’s the case, it’s still worth asking the doctor what his or her best guess is, because that will help you determine what next steps to take,” says Dr. Kosowsky. (2)
Common Treatment Procedures.
Angioplasty: Special tubing with an attached deflated balloon is threaded up to the coronary arteries.
Angioplasty, Laser: Similar to angioplasty except that the catheter has a laser tip that opens the blocked artery.
Artificial heart valve surgery: Replaces an abnormal or diseased heart valve with a healthy one.
Atherectomy: Similar to angioplasty except that the catheter has a rotating shaver on its tip to cut away plaque from the artery.
Bypass surgery: Treats blocked heart arteries by creating new passages for blood to flow to your heart muscle.
Cardiomyoplasty: An experimental procedure in which skeletal muscles are taken from a patient’s back or abdomen.
Heart transplant: Removes a diseased heart and replaces it with a donated healthy human heart.
Minimally invasive heart surgery: An alternative to standard bypass surgery.
Radiofrequency ablation: A catheter with an electrode at its tip is guided through the veins to the heart muscle to destroy carefully selected heart muscle cells in a very small area.
Stent procedure: A stent is a wire mesh tube used to prop open an artery during angioplasty.
Transmyocardial revascularization (TMR): A laser is used to drill a series of holes from the outside of the heart into the heart’s pumping chamber.
Reduce your risk of heart attack through healthy nutritional practices coupled with exercise that is approved by your doctor. Do it for yourself, do it for your loved ones. You might believe that your life is yours to live as you see fit. However, never forget that someone is going to have to pick up the broken pieces behind you when your health fails or when you pass on. Taking care of your health is only the right thing to do. Doing otherwise is a selfish act that only serves to cause pain and hurt in your loved ones at a later time and place. Be well, embrace your loved ones and love them like there is no tomorrow. You never know, there may be no tomorrow for you.