"There have been studies that look at whole populations, and about half of heart attacks were unknown. You can find an episode when a patient, in retrospect, thought it was the flu."(DR. STEPHEN L. KOPECKY)
Stephen L. Kopecky, MD, specializes in cardiology and internal medicine in the cardiovascular diseases department at the Mayo Clinic in Rochester, Minn.
Q: Several of my family members have had heart attacks. What are the chances that I will too?
A: If there is an incidence of early-in-life heart attacks in your family, it should be a red-flag warning. If your uncle had a heart attack at age 48, you need to pay attention to your health. Go get your cholesterol checked and dont ignore health issues. If the genes are there and family members have had early heart attacks, you need to assume that you have the same genes. Dont assume youre any different, even if youre not obese or don't have high cholesterol.
Q: If I have high cholesterol, what are my risks of a heart attack?
A: Cholesterol is a big factor. What we used to call normal is now high, and high cholesterol is a huge problem in our country. We see metabolic syndrome, high triglycerides, low HDL, and high LDL—all causing heart disease in many of our patients. Then there are plenty of people with high cholesterol who dont have heart attacks. About 80% of people who have heart attacks have at least one of the main risk factors, such as cholesterol, high BMI, or diabetes. If you dont have any of these risk factors—high cholesterol, high blood pressure, current smoking, or diabetes—by age 50, there is only a 5% chance youll have a heart attack by age 90.
Q: I know the classic symptoms of a heart attack, such as chest pain. What are some less common symptoms?
A: About half of all heart attacks occur without significant symptoms. The attacks are only identified after or during the electrocardiogram. Most of the time, the first symptom of heart disease is the heart attack.
Chest pain doesnt happen in more than half the patients. For patients older than 65, there is increased shortness of breath when doing things that dont normally cause shortness of breath. Nausea is also associated with problems with the underside of the heart. Pain in the left arm is not uncommon. Sometimes patients feel it in the jaw or teeth, especially with problems in the left front artery of the heart. Pain between the shoulder blades tends to confuse us more than anything, but it is usually associated with a tear in the aorta.
[ pagebreak ] Q: What steps can I take to make sure I get the best care at the hospital?
A: First, get there quickly. The ambulance should take you to the nearest hospital that treats heart attacks. Stay informed. If you have heart problems, know your symptoms, have a list of medications you take, and look up every doctor in the area so you know where to go if you have trouble. Be honest with your doctor. When talking about symptoms, dont leave out any details. Lastly, write everything down. Dont be afraid to ask for a written copy—which medications you need to take, what food you should be eating, anything you think youll need to know.
Q: What are some heart attack myths?
A: One is "Im too young." Unfortunately, we are seeing an increase in heart attacks in young women. Another is "I cant be having one." It can happen to anyone. A third is "Exercise causes heart attacks." People think that heart attacks are caused by exercise, but in active, healthy individuals, its usually not due to the exercise, its due to other problems. Lack of exercise is actually a bigger issue.
Q: I've heard of someone having a heart attack without even knowing it. How is this possible?
A: Its because of nonspecific responses. If I take your hand, tell you to close your eyes, and then hit your pinkie with a hammer, prick your index finger with a pin, or burn your middle finger with a match, you could tell me what I did without opening your eyes. If I did the same things to your heart and to your lungs, you couldnt differentiate. With your heart, you would only feel a burning pressure in your chest. The nerves in our insides are not as sensitive as those on the skin. There have been studies that look at whole populations, and about half of heart attacks were unknown. You can find an episode when a patient, in retrospect, thought it was the flu.
Q: Do heart attack symptoms differ for men and women?
A: Women dont get the classic symptoms. Women also tend to have heart attacks 10 years later than men; the average woman is 65, while the average man is 55.
[ pagebreak ] Q: What are the most important steps to take if I think I'm having a heart attack?
A: Put your heart at rest as soon as possible. Dont wait. Lie down and dont try to walk anywhere. Take one nitroglycerin if you have it available. If the pain does not go away immediately, call 911. Chew aspirin. If you chew (rather than swallow) it takes effect more quickly.
Q: What are the triggers for a heart attack?
A: Overexertion—if a person isnt physically active and really exerts himself past his usual level of activity, this can cause an attack. Infection—getting the flu vaccine decreases incidence of heart attack by half. The flu causes inflammation in the body, which can inflame the lining of different organs and tear it, even just a few days after an infection. Lastly, stress—it isnt as common as people think, but being emotionally upset ups adrenaline and blood pressure.
Q: How long is the recovery time for heart attack patients?
A: Older patients have a harder time with recovery. Usually victims are out of here in three or four days. It is rare if someone stays more than six.
Q: How can I reduce the likelihood of having a second or third heart attack?
A: Dont smoke. If you are a smoker, quit. Try to get your BMI to 25 or below. Eat five servings of fruits and vegetables a day. Get 150 minutes of exercise a week. If youve been getting that amount of exercise, it will reduce your chance of heart attack by 90%. If you start today, it will reduce it by 40% in four years.
[ pagebreak ] Q: How are diabetics affected by heart disease? What about older adults?
A: We consider diabetes an equivalent of heart disease. Diabetes is one of the worst factors, and about half of diabetics have heart disease. A lot of diabetics dont feel the heart attack, because they often think the symptoms of nausea and sweating mean theyre having a diabetic episode. Older people have a lot fewer specific symptoms.
Q: In your experience, what are the most important predictors of heart attack survival?
A: Its multifactorial, but there are better outcomes in hospitals that are equipped for heart attacks. One easy answer is how quickly you get to the hospital. Most of the deaths will occur in the first hour.
Interestingly, once youre at the hospital, it matters if anyone or anything—even a cat or a dog—cares if you die. Your chances of dying increase if you think no one cares if you live.
Q: I have heard that it is "better" to have a heart attack during the week. So what should I do if I have chest pain on Sunday?
A: People who have heart attacks at work are more likely to go to the hospital than those who are at home. Its not clear if people at work just dont want you to die or if people at home are lazy and dont want to drive to the hospital. When in doubt, go to the hospital.
Q: If I think I am having a heart attack, should I call EMS or have a friend, spouse, or coworker drive me to the hospital?
A: Call EMS. This is one reason you pay taxes—so that trained professionals can come and get you and take you to the hospital.