Heart Smart

By Matthew Devane

John Wiley & Sons

ISBN: 0-471-74692-4

Chapter One

Heart Attack!

Know the Warning Signs to Save Your Life

Robert was only fifty-two years old when he died. His wife was still in shock shortly after his death when she told me what had happened.

I knew something was wrong when Robert came inside after cutting the grass. He was pale, sweating like crazy, and had left the lawn mower running outside. He just plopped down on the couch and asked me to get him a glass of water.

Those were his last words to me. By the time I came back just a few minutes later he was dead.

Robert's tragic story is by no means unique. Three hundred thousand Americans die within the first hour of the onset of a heart attack each year.

But many deaths could be prevented if the victims knew what to do and immediately took action. If Robert was anything like most of my patients in their fifties, he probably kept mowing the lawn for another five, ten, or even fifteen minutes after his chest pain started. If he had recognized the early warning signs of a heart attack and called 911 immediately, there is a good chance the paramedics would have gotten to his house in time to save his life.

What Exactly Is a Heart Attack?

A heart attack, or myocardial infarction, occurs when the supply of blood and oxygen to a part of your heart muscle becomes blocked. The blockage is caused by a combination of clot and cholesterol inside your heart artery. Since your heart muscle requires a constant supply of fresh blood and oxygen to keep pumping blood to every part of your body, a heart attack is a life-threatening event.

When blood and oxygen are abruptly cut off during a heart attack, the heart reacts badly. In fact, if it goes without blood and oxygen for more than about ten or fifteen minutes, the heart muscle begins to die. If the blocked heart artery is not treated and opened quickly, the affected part of the heart muscle dies and is permanently replaced by scar tissue, preventing it from functioning fully.

Heart attacks can lead to dangerous arrhythmias and congestive heart failure, and can even result in sudden cardiac death.

Small vs. Large Heart Attack

When it comes to heart attacks, size matters. The size and extent of your heart attack help determine your prognosis.

Two major factors decide whether you had a large heart attack or a small one: the location of the blockage and the duration of the blockage.

Location, Location, Location

The location of the clot plays a big role in determining the size and severity of a heart attack. Clots that occur in larger vessels and clots that occur farther upstream in your heart artery lead to a larger heart attack and more damage. If the blockage takes place in a smaller branch vessel, only a small part of the heart muscle will be affected.

Blockage Duration

The second factor that determines the size and severity of your heart attack is how long the artery is blocked. The longer the artery remains choked off, the more heart damage is done. This is the reason you must act so quickly at the first sign of trouble.

Each additional minute your heart artery remains blocked increases your chances of sustaining life-threatening heart arrhythmias and becoming chronically disabled. The heart is not at all forgiving.

The best way to minimize heart attack damage is to call 911 as soon as you have chest pain.

What Are the Warning Signs?

One of my patients summed it up best when he said: "It was really strange, I never felt any of the severe pain I expected during my heart attack. There was clearly an uncomfortable crushing feeling across my chest and I felt a little sweaty, but that's about it. There was no pain at all."

Almost one in four heart attack victims misinterprets his or her heart attack symptoms as being caused by something else. This is a costly, often fatal mistake that you can avoid by knowing what to look for.

While many heart attack symptoms vary from person to person, there are some that most people share. Not every person will suffer these classic symptoms, but the vast majority of heart attack victims feel at least one of them.

Chest Pain (or Chest "Discomfort")

The most common symptom caused by a heart attack is chest pain. But different patients feel the pain differently. Chest pain has been experienced by heart attack victims as

Heaviness, tightness, squeezing, or pressure

Pain that is located in the left side of the chest but that may radiate to the left or right shoulder and arm, neck, jaw, teeth, ear, or back

Pain that starts suddenly, while you're at rest or with exertion

Chest discomfort that is constant and lasts for more than ten to fifteen minutes

Chest discomfort that is hard to pinpoint: it might be in the middle of the chest or "all over" the chest

In their own words, victims have described heart attacks in these ways:

"There is an elephant (or weight or brick) sitting on my chest."

"It feels like a band being tightened around my chest."

"I can't pinpoint the symptoms but it's just uncomfortable inside my chest rather than a pain."

"There is a tightness in my chest and around my heart."

"It feels like a heavy pressure on the chest."

"It feels like someone has a hand on my heart and is squeezing it."

Beyond Chest Pain

Chest pain or pressure may be your only warning sign of a heart attack, but it's more likely you'll feel a constellation of symptoms:

Shortness of breath

Difficulty breathing

Feeling cold and clammy


Extreme weakness, fatigue, or exhaustion

Nausea or vomiting

Palpitations or fluttering in the chest

Dizziness or light-headedness

The "Classic" Heart Attack

The following is a typical heart attack scenario. If you find yourself having a similar experience, call for help immediately.

You are sitting at the dinner table when all of a sudden you feel a pressure or heaviness in either the middle or the left side of your chest. It may be very difficult to pinpoint the exact location of the discomfort, but it feels heavy and uncomfortable "inside" your chest.

The pressure or heaviness quickly grows stronger as your heart muscle cells begin to die. The chest discomfort may start to spread to your jaw, neck, teeth, ear, or either arm. The pain in those areas has a similar "heaviness" to the chest discomfort you feel.

You begin to feel weak and break out in a cold sweat. A touch of nausea creeps in. Now you start to think that something is dreadfully wrong. You even begin to think that maybe you really are having a heart attack. But then you tell yourself "It can't be" because you have never had any symptoms before. Still, the feeling is different from the acid reflux symptoms you've had and any other discomfort or pain you have experienced. You go back and forth in your mind as to what could be causing this heaviness and pressure in your chest. While you are trying to figure out what is going on, your wife (or husband) tells you that you look pale and clammy. Your spouse wants to know what is wrong. At this point you must make a decision. Either you lie and say, "Nothing," that you just need to rest for a while, or you do the right thing and say you are having a heart attack and that 911 should be called.

Calling 911 can save your life.

Heart Attack Survival Guide

The scenario above, and others very much like it, take place more than a million times a year across the United States. Familiarizing yourself with the symptoms and the progression of a heart attack will enable you to act correctly and immediately if you experience one.

But what is the right thing to do?

How you react to heart attack symptoms is just as important as recognizing them. If you have any of the above symptoms or even consider that you might be having a heart attack, you need to act immediately. Fear, hesitation, and doubt lead to fatal delays in treatment.

Six Steps to Take Instantly

1. Stop what you are doing and lie down.

2. Don't panic.

3. Direct someone to call 911 and to say that you are having a heart attack.

4. If they're available, chew a full-strength aspirin or two "baby" aspirin.

5. If one is available, place a nitroglycerine tablet under your tongue.

6. If you can, ask someone near you if an automatic external defibrillator (AED) is available (these are now found in many public places). If not, ask if anyone nearby knows CPR-just in case.

Six Mistakes to Avoid

1. Downplay or ignore your symptoms.

2. Delay seeking help because of fear or embarrassment that your symptoms might not mean you're having a heart attack.

3. Try driving yourself to the emergency room.

4. Think you're too young or too healthy to have a heart attack.

5. Think that since you are a woman you could not be having a heart attack, that only men have heart attacks.

6. Delay medical care because you do not want to bother your spouse/parent/children/neighbors.

Don't Make Up Excuses

Evelyn lived alone on a quiet cul-de-sac surrounded by mostly elderly neighbors and friends. One night after dinner, she had a sudden onset of chest heaviness and pressure in her mid and upper chest.

Evelyn's initial instincts were right on target. She recognized that her symptoms were likely due to a heart attack and she thought she should call 911. But that's when her chest pain excuse kicked in. If she called 911 she feared her elderly neighbors would become very upset when they saw an ambulance come to her house, and she didn't want to upset them.

Evelyn never did call 911. Instead, after much consternation and many precious minutes, she called her daughter, who came right over and immediately called 911. But the twenty-five-minute delay was too long.

Evelyn died needlessly that night because her fear of upsetting her neighbors overrode her recognition of her symptoms and her correct instinct to call for help.

Making excuses or downplaying your symptoms is not a Heart Smart decision. I've heard all sorts of crazy reasons why patients didn't call for help as soon as they started having a heart attack-from not wanting to miss a business luncheon to not wanting to leave their dog home alone. These excuses all cost these patients precious time. Here are some excuses that should not keep you from calling 911 if you think you're having a heart attack:

It's probably just indigestion.

I don't want to spend the next three hours in the emergency room.

I don't want to call 911 if it's not really a heart attack.

I will be embarrassed if it turns out to be something other than my heart.

I don't want anyone to worry about me.

It can't be a heart attack because I've never had any other symptoms.

Heart Attack Survivor Secrets

Heart attack survivors get it right. They make the right decisions at the right times. There are major action differences between people who survive a heart attack and people who don't. Here are a few heart attack survivor secrets:

Heart attack survivors recognize the early warning signs and symptoms of a heart attack.

Heart attack survivors call 911 without delay.

Heart attack survivors get help first and worry about the consequences later.

Heart attack survivors don't make excuses or downplay symptoms.

Heart attack survivors always err on the side of caution.

Heart attack survivors would rather spend three hours in the emergency room and find out that their heart is fine than wish they had gone to the emergency room as they slip into unconsciousness.

Summing It Up

A heart attack is a life-threatening medical emergency that must be recognized as soon as symptoms develop. Delays in treating heart attacks lead to congestive heart failure, dangerous cardiac arrhythmias, and sudden cardiac death.

Become a chest pain expert. Being able to recognize the early warning signs and symptoms of a heart attack is your best bet for survival.

How Big Was Your Heart Attack?

If you've had a heart attack and don't know if it was a large or a small one, ask your doctor about your Ejection Fraction, or EF. The Ejection Fraction tells you the percentage of blood your heart pump ejects with each beat; in other words it is a measure of how strong your heart pump is. A normal EF is 55 to 70 percent. Your EF is one of the best ways to predict how well you will recover after a heart attack and learn how much damage the heart attack did to your heart. (Your doctor can determine your EF through a heart angiogram, a heart ultrasound, or a stress test.)

Heart Smart Chest Pain Alert!

Women, diabetics, and senior citizens often do not experience any of the classic heart attack symptoms. Fatigue, palpitations, and vague chest pain may be the only warning signs.


Excerpted from Heart Smart by Matthew Devane Excerpted by permission.
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