HEART ATTACK Q&A
by Jon Patrick Hyde
Every year about 785,000 Americans have a first coronary heart attack. Another 470,000 who have already had one or more coronary attacks have another attack.

In the past decade heart disease caused almost 25% of deaths—almost one in every four—in the United States.  This means that the World Health Organization's (WHO) states that CAD and CVD cause 1 in 6 in world population deaths; the rate of CAD and CVD related death in the USA is higher than the world average. 

Coronary heart disease alone is estimated to cost the United States over $110 billion each year. This total includes the cost of health care services, medications, and lost productivity.  CAD is the leading cause of early disability retirement in adults in the USA.
WHAT IS CAD?

CAD - Coronary Artery Disease - is a condition where fatty pockets of material become lodged inside of a wall of a coronary artery causing a narrowing of that wall and decreasing blood flow to the tissue serviced by that artery.  This narrowing is called STENOSIS

Your body's natural healing process in such a situation is to grow new artery wall over the lodged material.  This material then becomes part of the artery.  This is bad because it is a foreign material and it hardens over time - causing the artery wall to become less flexible.  Arteries stretch during blood flow and their walls are meant to be flexible. 

This lodged material causes a narrowing of the artery which can lead to increased blood pressure and stress on the artery itself.  Additionally it results in reduced blood flow to the tissue serviced by the artery. 

In time stenosis can worsen to the point that blood flow becomes so restricted that blood cells become lodged in the narrowed opening resulting in a complete blockage. 

Other times for reasons unknown the fatty pocket of material under the artery wall ruptures out.  This activates your body's natural immune response and platelet cells are sent to the rupture and a clot is formed.  This is very bad for it takes an area already restricted by stenosis and typically results in a complete blockage. 

In both cases the end result is a heart attack. 

WHAT IS A HEART ATTACK?

A heart attack is caused whenever the blood flow to cardiac muscle is reduced enough to cause the heart's beating functions to be reduced, affecting the delivery of oxygen rich blood to the organs and tissues of your body.

Also called a myocardial infarction (MI)
. The reduction of blood supply to heart muscle can rapidly damage and destroy heart tissue. This is most often caused when plaque or a blood clot reduces the space inside an artery lowering the amount of blood able to pass through.  This reduces blood volume flow and causes pain. 

Unlike other types of muscle and tissue in your body, heart tissue does not regenerate.  When it dies it remains dead.  This means that if enough heart tissue is destroyed during a heart attack the heart can no longer function.  This is why heart attacks are often deadly and treatment for a heart attack should be sought immediately. 

A STEMI heart attack is a complete blockage of a coronary artery and if untreated STEMI heart attacks are 100% fatal. 


WHAT IS A WIDOWMAKER HEART ATTACK?

There are heart attacks and there are STEMI heart attacks.  A heart attack is caused whenever the blood flow to cardiac muscle is reduced enough to cause the heart's beating functions to be reduced, affecting the delivery of oxygen rich blood to the organs and tissues of your body.

An ST Elevation Myocardial Infarction (STEMI) heart attack is a 100% blockage of a coronary artery.  The Widowmaker is a STEMI heart attack. 

There are two main arteries that supply blood to your heart, the Right Coronary Artery and the Left Coronary Artery.  Arteries are like the branches of trees.  They split off into smaller branches several times before reaching the cellular level where oxygen is provided to your body's cells.  The main branch of the Left Coronary Artery is the Left Anterior Descending Coronary Artery or LAD for short.  The LAD is responsible for delivering 65% of the oxygen rich blood needed to your heart muscle.  When the LAD blocks off, tissue death occurs across a larger section of your heart than if a smaller branch of the LAD or of another coronary artery was blocked. 

Widowmakers are 100% fatal if not treated.  Even when treated they have a 90% mortality rate (9 out of 10 people die from this type of heart attack).

In a STEMI heart attack there is sudden rupture of an unstable part of the wall in a heart artery. This leads to a build up of clot in an attempt to heal it however this clot formation results in total blockage of the artery. This total blockage leads to loss of blood supply to the heart beyond that point. The heart muscle stops working within minutes and soon dies unless the blockage can be cleared and the artery can be opened back up. For this reason every minute from the onset of a heart attack is absolutely critical. Often the patient doesn’t make it to hospital due to sudden death. For those who put off seeking medical attention too long or for those in whom the heart attack isn’t treated a STEMI heart attack is 100% fatal. 

For those who do seek medical attention and survive the initial event the damaged or dead heart tissue cannot be regenerated and they are left with a damaged heart; healthy, normally functioning heart tissue is replaced by a non beating scar.


ABOVE: These are Summit4CAD Founder Jon Patrick Hyde's Cardiac Cath Angiogram images.  In the left image (before treatment) you can see that when compared to the image on the right (after treatment) that a blockage has occurred (no blood is getting past the blockage and into the left side arteries of the heart).  The image on the right shows Jon's heart after the blockage has been removed and normal blood flow has been established.   
WHAT IS A CARDIAC CATH LAB?

The full name is Cardiac Catherization Laboratory - Cath Lab for short.  This is a specialized treatment facility used to diagnose and treat coronary artery disease.  The procedures conducted in the Cath Lab are an alternative to more traditional open heart surgery. 

Using x-ray machines which feed data to the cardiologist real-time, the cardiologist can diagnose and potentially treat CAD and CAD related complications without putting the patient through the stress of open heart surgery. 


WHAT IS AN ANGIOGRAM?

An angiogram is a non-emergency Cath Lab procedure used to determine and diagnose CAD.  A small catheter is inserted through the femoral artery in your leg and threaded up into the heart.  A dye that x-ray machines can see is injected into your the arteries of your heart so that the cardiologist can see if there are any blockages or stenosis (narrowing of the arteries due to plaque buildup).


WHAT IS AN ANGIOPLASTY?

During an angiogram the cardiologist may decide to treat stenosis if any is present by inserting a small balloon catheter into any artery showing signs of stenosis.  Once placed in the area of narrowed artery the cardiologist inflates the balloon and this stretches the artery back open.  This is called a "Balloon Angioplasty". 



If the stenosis is significant the cardiologist may be concerned that the widening of the artery done with the balloon catheter might not remain open and they may decide to insert a "STENT"
WHAT IS A STENT?

A stent is a small piece of medication coated platinum mesh that is inserted into a coronary artery showing signs of significant stenosis (narrowing).  It is placed on a balloon catheter.  When the balloon is inflated the stent stretches out and into the wall of the artery holding it open.  Eventually the artery wall grows over the stent and it becomes part of the artery structure. 

     
WHAT IS CCU?

CCU is the Coronary Care Unit - it is sometimes referred to as Cardiac Intensive Care Unit or Cardiac Critical Care Unit.  Think ICU (Intensive Care Unit) but for heart patients only.  CCU is an intensive care unit specifically designed and equipped to care for critically injured or sick heart (cardiac) patients.    

Patients do not typically require CCU stays after routine angiogram and/or angioplasty procedures.  If overnight hospitalization is required patients are typically sent to the PCU (Progressive Care Unit). 

CCU is reserved for patients experiencing life-threating conditions which require constant monitoring. 
 
WHAT IS CABG?

Pronounced "Cabbage" - this is open heart bypass surgery - called a Coronary Artery Bypass Graft (CABG)

Before angioplasty and stents this was the only surgical treatment option for a blocked coronary artery.  The procedure is much more dangerous and recovery takes much longer.  Additionally risk for restenosis is high, meaning that additional CABG procedures may be required in the future. 

A CABG procedure consists of placing a graft between the IMA (Internal Mammary Artery) and whatever coronary artery is affected by the stenosis or blockage.  The graft is placed on the side of the artery that is blocked - bypassing the clot or stenosis so that blood flow can resume to the affected tissue. 

Up to 4 grafts can be attached to the IMA - depending on how many coronary arteries are affected - a patient can have a single, double, triple or quadruple bypass procedure. 

WHAT ARE THE RISK FACTORS FOR CAD?

Risk factors for CAD include:

  • Heredity - parents, grandparents, uncles/aunts (blood related), siblings - if any of these people have CAD or a large number of risk factors for CAD you may also be at risk.
  • High Blood Pressure - If you have high blood pressure you are at greater risk for CAD.
  • High Cholesterol/Borderline High Cholesterol - high cholesterol has been associated with the building of plaque in coronary arteries - which is the cause of CAD. 
  • Diabetes - Diabetes causes high blood pressure and strain on every organ system in your body. 
  • Poor Diet - Foods high in trans or saturated fats, high in salt (sodium), or sugars, high in caffeine, high in cholesterol - all contribute to CAD.
  • Being Overweight or Obese - Obesity puts additional strain on your cardiovascular system and heart. 
  • Lack of Physical Activity - Regular exercise is vital to a healthy heart.  Lack of regular exercise can lead to worsening of risk factors such as high cholesterol, diabetes, high blood pressure and obesity.
     
  • Smoking - Smoking is associated with several deadly diseases. Smoking limits how much oxygen is absorbed into your blood stream, increases blood pressure, and can increase cholesterol levels. 
  • Stress - Research shows that the most commonly reported "trigger" for a heart attack is an emotionally stressful event, especially one involving anger.  Stress increases blood pressure.
  • Alcohol Consumption - Heavy alcohol use can lead to high blood pressure and can damage heart tissue. 
  • Sleep Apnea - Sleep apnea is a common disorder in which a person has pauses in breathing while they are sleeping or they breath shallow, reducing the amount of oxygen absorbed into the blood stream.  Untreated sleep apnea can lead to high blood pressure, diabetes, stroke, and heart attack. 
I THINK I AM HAVING A HEART ATTACK, WHAT SHOULD I DO?

Call 911 or contact emergency services in the area where you live immediately.  Do NOT drive yourself to the hospital. 

Most importantly - REMAIN CALM!  Many heart attack victims suffer from elevated stress or a panic attack as they are experiencing their heart attack.  It's hard to not panic because frankly, it's probably the most painful thing you'll ever experience.  It was for me.  Even if you are not in tremendous pain, it is a very scary situation and it's VITAL that you not give into panic or fear.  Focus on something that keeps you calm and keeps you thinking. 

**Panic causes your body to produce adrenaline - which makes your heart beat faster.  If you are experiencing a heart attack, making your heart beat faster may very well cause your heart to fail completely. 


I cannot stress enough - stay calm and stay focused on getting through your ordeal and being alive and healthy when it is over.  Doing this will greatly improve your chances for survival and recovery. 

WHAT ARE THE SYMPTOMS OF A HEART ATTACK?

It's important to remember that symptoms of a heart attack vary from person to person.  Just because you don't have shooting pain running down your arm doesn't mean that the heavy, crushing feeling you are experiencing in your chest isn't a heart attack.  My pain was all the way across my chest - both sides not just the left.  And I had no pain in my jaw or neck or back or arms.  I did have a tingling/numb sensation in my fingertips and wrists.  But the pain was limited to my chest and never travelled anywhere else.  I certainly didn't have the typical heart attack symptoms - but the pain was beyond anything I'd ever felt.  So I knew it was something very serious.  If I had waited to get treatment I'd probably not survived another couple of hours. 

Symptoms can be different between men and women.  Likewise, women generally have higher pain tolerances than men so their symptoms may be much less severe. 


Here is a list of the most common symptoms experienced by heart attack patients:

  • Chest Discomfort - Pressure, squeezing, crushing sensation, dull but intense pain.  This pain can be located towards the left side of the chest, the center of the chest, or across the entire chest.  Chest discomfort is the most common symptom for both men and women. 
    This was the primary symptom that I experienced. 

  • Shortness of Breath - with or without chest discomfort.  This is much more common in men that in women. 
    I want to note that I never experienced shortness of breath. 

  • Pain in Other Areas of The Upper Body - Pain in your left arm or both arms, pain in your jaw, back, or stomach.  This is less common in women.  
    I want to note that I never experienced any of these symptoms.

  • Diaphoresis (Cold Sweats) - This is when you feel cold but you are sweating uncontrollably. 
    I DID experience this symptom.

  • Nausea - Many heart attack victims mistake their symptoms for food poisoning or the flu because symptoms such as diaphoresis when accompanied by nausea with stomach pain and chest pain mask the true underlying cause. 
    I never experienced nausea or stomach distress. 

  • Lightheadedness - A large amount of blood is pumped into your head each heartbeat to keep oxygen flowing to your brain.  If your heart is compromised and not pumping correctly a loss of blood volume into your head will cause you to feel lightheaded, dizzy, or even cause you to black out. 
    I did not feel lightheaded during my heart attack but did experience it as a symptom a couple of hours before my heart attack started in full. 

  • Numbness in Extremities - Tingling fingers, numb hands or feet, numbness in your wrists or arms. 
    It was this symptom that actually convinced me that I was experiencing a heart attack. 
I'VE RECENTLY HAD A HEART ATTACK AND SURVIVED, DOES THIS MEAN MY LIFE AS AN ACTIVE PERSON IS OVER?

This is really a difficult question.  The truth is that depending on the severity of your heart attack and the amount of damage caused to your heart tissue; you may be looking at a greatly diminished quality of life.  CAD is the leading cause of early disability retirement in adults in the United States

The reason that surviving a heart attack may mean a significant change in your ability to be active is simple :  If your heart has been damaged (meaning there are areas of dead tissue that will not regenerate) - your heart's ability to pump blood is greatly affected IN THE AREA that your heart was damaged, but the rest of your heart will continue to function as before.  THE DANGER IN THIS IS: that if the damaged area(s) get out of sync with the parts of your heart that are functioning correctly (there are 4 chambers of your heart that have to function together to effectively pump blood) - your heart could loose the ability to pump blood.  LIKEWISE - there are "electrical nodes" placed in different areas around your heart that when activated cause your heart muscle to contract (this is what keeps everything working in order) - think about the firing sequence of spark plugs in your car's engine.  If the damaged/dead area of your heart contains one of these very important nodes - your heart can easily get out of sync because the "firing order" of the electrical impulses that cause your heart to function correctly can get out of order.  This is called an "Arrhythmia" and it is VERY DANGEROUS.  Arrhythmias can become deadly.  They are often caused when a damaged heart beats faster (regular activities can cause this in some post-heart attack patients if their heart damage is significant).   

I was facing this same possible reality when I was sent home after my hospital stay.  I did exactly what my doctor ordered (rest, relaxation, no stress, no getting my heart worked up, no strenuous activities, the AHA (American Heart Association) diet, and take the medication he prescribed to me which included a medication that slowed my heart rate so it could better heal. 

I did these things and when combined with the lifestyle and fitness choices I'd made during the course of my life I walked away from my widowmaker heart attack experience with no residual heart damage and a healthier, more active lifestyle. 

All of this will depend on what your doctor(s) find when they evaluate your heart post recovery.  This typically is done through a diagnostic test called an echocardiogram.  This test will give your doctor(s) the information they need to determine what activity level is safe for you. 
WHAT IS AN ECHOCARDIOGRAM?

An echocardiogram is a form of ultrasound diagnostic test that is painless and usually takes about 20 minutes to complete.  It offers an amazing array of diagnostic information from how effective your heart's chambers are in moving blood flow to how far your heart muscle is contracting as it beats.  It provides an enormous amount of data regarding the functions of your heart. 


WHAT ARE COLLATERAL ARTERIES?

Collateral Arteries are new artery structures (which includes blood vessels and smaller capillaries) that are grown as a result of pushing your heart into a zone beyond where it is getting adequate blood supply during exercise.  These new "remodeled branches" - the medical term for them - seem to be more common in people with existing coronary artery disease.  These vessels provide an alternative source of blood supply to the myocardium in cases of coronary artery disease or an acute (sudden) event such as a heart attack (where blood flow to heart muscle is stopped). Increasing evidence indicates that collateral arteries provide a relevant protective role in patients with coronary artery disease.

Harvard Medical School has released studies showing that patients with CAD should focus on the development of collateral arteries as a means of reducing the negative health effects of CAD and additionally minimize the chance of permanent heart damage in patients who experience a heart attack. 

https://www.health.harvard.edu/press_releases/do-it-yourself-cardiac-bypass-surgery
 
This website is not meant to diagnose or treat any medical condition nor is it meant to substitute or replace care provided by a qualified healthcare professional.  This information is provided for purely educational purposes and all information pertaining to your specific medical issues or concerns should be discussed with your doctor or a qualified healthcare professional.  If you are experiencing a medical emergency please contact the medical emergency services available at your location. 
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