Heart attack presentation, intervention and prevention

• Heart • Jun 04, 10

You might think you know a lot about heart attack warning signs and symptoms – crushing chest pain, left arm numbness, a family history of heart disease. “Most people have the basic understanding of these things,” explained Matthews resident Dr. James Roberts of Mid Carolina Cardiology Monroe. “Probably the most confusing thing is pain that may not be that altogether-crushing kind of fatalistic chest pain everyone assumes is a heart attack. Most people think the pain is like an elephant sitting on their chest and it can be very different.

“It doesn’t even have to be in the anterior part of the chest. It can be in the back, the side or even jaw or neck pain. Educating people about those things is very useful.”

Roberts attested that avoidance is, however, a common occurrence. “People will go on for four, five, six hours trying home remedies like Goody’s powder or TUMS that don’t seem to work and not pursuing medical attention,” he said. “The second most common error is people deciding to drive themselves to the hospital once they finally go. It’s not the best idea – you can endanger your life and someone else’s if something happens on the way there.

“If you have pain lasting more than 15 to 20 minutes and you have potential cardiac risk factors – high cholesterol, high blood pressure, diabetes, smoking, family members with a history of heart attack – you need to go to the hospital and it’s best to call an ambulance and let them do what they need to en route.”

Particularly today, when medic teams can perform electrocardiograms in living rooms before transport, decisions about patients’ care can be made sooner, which better informs decisions, saving time and lives.

“Time is muscle,” Roberts said. “The sooner we can get the artery open, the less damage there is to the heart muscle.”

Prevention over intervention
That education needs to continue, Roberts said. “Heart disease still is the No. 1 cause of death for men and women,” he explained. “As far as the number of people yearly who get diagnosed with coronary disease, that’s well over 2 million. That’s just new diagnoses. The prevalence of coronary disease in the U.S. is very, very high – probably well over 20 million cases.”

Roberts said that while the greatest strides have been made in the past 20 years with the development of angioplasty procedures and stents to clear and keep open blockages, more needs to be done to treat the underlying problem. “We know the risk factors – hypertension, diabetes, smoking, cholesterol, family history. You can’t change your family much but we can do more about the other four,” he said.

“The overall prevalence of heart disease in men has been flat and the incidence in women has been going up. We’re not doing well at the primary prevention level at preventing the disease. Although we can do exciting things to prolong life, the coronary death rates are flat over time. In the long term, people die at about the same rate. That’s still a little bit frustrating.”

Roberts is passionate about prevention. He stressed that screenings for hypertension, diabetes and cholesterol are imperative. People who have a strong family history of heart disease should see a cardiologist, Roberst said. Cardiologists can perform advanced lipid test, among other screenings, to gauge risk. “People can have a normal-looking cholesterol panel and very high cholesterol risk,” he said.

Stress tests and advanced imaging also are critical to proper testing, Roberts said, adding that carotid artery ultrasound imaging has become so precise it can measure early development of plaque in the inner lining of the artery. “That allows us to stratify people and I think it helps motivate people,” he explained. “If you’re 40 but you’re told you have a vascular age of 65, they’ll quit smoking, take cholesterol meds and eat better, as opposed to someone who’s told their stress test is normal.”

Take responsibility

Roberts stressed that simply taking responsibility and adopting healthy habits actually is the best medicine. “That really gets underemphasized. We know that just eating well does some really fantastic things for you,” he said, citing studies that have shown a 70 percent reduction in future cardiac events for people placed on Mediterranean-French-style diets versus a mere 30 percent reduction in future cardiac events for people who rely on medication and medical intervention alone.

“If you just eat right, you’ll do better than being on medication,” Roberts said. “We’re born with an LDL cholesterol of 25. We’re treating people to get them below 100. It’s really important to realize normal cholesterol is very, very low. If you eat well and keep it low, it’s likely you won’t get into trouble.”

The same is true for exercise, he said. “If you look at aboriginal cultures, people who hunt and eat nuts and berries don’t develop coronary artery disease. If we chased our food down and pulled it off the trees, we wouldn’t have much (coronary artery disease) either,” Roberts said. “If we get out and exercise and try not to eat too much burnt meat, we’ll probably be OK.”

Most important, Roberts stressed it’s never too late to make a change. “Very often people say to me, ‘Doc, are you going to put me on medicine?’ I say, ‘The first thing I’m going to do is try to get you to make a change in your lifestyle – get you to lose 15-20 pounds, eat well, exercise.’

“Your ideal body weight is what you weighed when you were 21 (if healthy). Everything else is 99 percent fat. Not too many people put on muscle after 21.” He admitted not many people can get back down to their 21-year-old physique, but it gives a frame of reference for where they should be.

“Get a plate; put mostly colorful things on it in small portion sizes and get exercise – that goes a long way,” he added. “If you start having chest pain, if it’s anywhere in the neck to the waist, you need to take it seriously – particularly if you have metabolic syndrome or other risk factors. You need to get to a hospital. There’s nothing wrong with saying, ‘I want to see a cardiologist. I need to be taken to hospital x or y.’ People can take control of their own health and their own health care.”

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by Regan White