Heart Attack Archive

New imaging techniques that use light or sound waves to create images of the inside of coronary arteries have helped researchers better understand the fat-laden plaque that builds up inside artery walls (atherosclerosis). Most heart attacks happen when small, inflamed areas of fatty plaque rupture suddenly, causing a clot that blocks blood flow. This may explain why treating large, obstructive plaques with stents or bypass surgery does not seem to prevent heart attacks or help people live longer.

Ask the doctor

Q. My doctor says I'm at risk for a heart attack because a test shows inflammation. I know about high cholesterol and blood pressure, but how does inflammation increase the risk for heart attacks?

A. I can understand why you're puzzled. In medical school I learned that there is a simple road to a heart attack. First, cholesterol starts building up in the wall of a coronary artery carrying blood to the heart muscle. Over many years, the plaque of cholesterol slowly grows bigger. When it grows large enough that the heart can't get the blood it needs to work hard, the heart cries out in pain — chest pain, a condition called angina. Finally, when the plaque grows large enough, it blocks the flow of blood completely, causing a heart attack. It was a beautifully simple explanation.

Exposure to microscopic particles called PM_2.5 in air pollution may increase a person’s risk of heart attack, stroke, and heart rhythm disorders. The tiny particles pass from the lungs into the bloodstream, triggering inflammation and other cell-damaging processes. Air pollution comes mainly from coal-fired power plants, industrial factories, and motor vehicles. To limit exposure, people should try to avoid exercising outdoors near busy roads or industrial areas.

People who’ve never experienced wooziness should call 911 if the symptom comes on suddenly or severely, especially if it’s accompanied by other symptoms. However, a person who has experienced wooziness before or been unwell recently should sit down, have a drink of water or juice, and rest for 10 to 15 minutes. If the feeling of wooziness persists, if other symptoms develop, or if it’s hard to get up without feeling faint, one should call 911.

Peripheral artery disease (PAD), which occurs when fatty deposits clog arteries outside the heart, is underrecognized and potentially dangerous. The hallmark symptom is leg pain that occurs with exercise, called intermittent claudication. PAD is more common among people who are older, who smoke, and who have diabetes. The recommended treatment involves short periods of walking interspersed with rest periods when pain occurs. Walking increases blood flow in the leg's smaller arteries and helps create new channels to move blood around the blockages; it also helps discourage new blockages.

Heart attack symptoms can differ between men and women, but not as much as you might think.

Thanks to national campaigns to boost awareness, more people now recognize that heart disease is the leading cause of death in women as well as in men. For both sexes, cardiovascular disease is to blame for one of every three deaths in the United States.

Throughout the country, someone has a heart attack — the most common manifestation of this prevalent disease — about every 40 seconds, on average. Maybe you've heard that women are more likely to have "atypical" heart attack symptoms than men. But what does that really mean? A review article in the May 2020 Journal of the American Heart Association offers some perspective.

In the journals

Age may not be a factor when it comes to who can benefit from statins. A study published online July 7, 2020, by JAMA found that people who started taking the cholesterol-lowering medication in their mid-70s or later had fewer heart-related problems and lived longer than non-users.

Researchers looked at 326,981 mostly male veterans, ages 75 and older, who were free of cardiovascular disease and did not take statins. Over the next 10 years, more than 57,000 began statin therapy.

For monitoring conditions that contribute to heart attack and stroke, virtual doctor visits are much more convenient than in-person appointments. Where is this trend headed?

Virtual doctor visits — when you talk to a physician on a video call instead of during an in-person office exam — have been available in certain places for years. But they never really caught on until the pandemic hit earlier this year. Almost overnight, virtual care became an indispensable tool for managing coronavirus infections and other health conditions during the crisis.

In 2019, virtual visits accounted for fewer than 1% of the appointments at Mass General Brigham, a large health care system founded by Harvard-affiliated Brigham and Women's Hospital and Massachusetts General Hospital (MGH). "But during the peak of the coronavirus surge in Boston, 80% of all visits were done virtually," says Dr. Lee Schwamm, director of the Center for TeleHealth at MGH and vice president of virtual care at Mass General Brigham.

Tofu may be good for the heart. A study published in March 2020 in the journal Circulation found that people who ate at least one weekly serving of tofu or another food containing isoflavones (a compound found in soybeans and other legumes) had an 18% lower risk of developing heart and blood vessel disease than people who ate these foods less than once a month. These foods appeared particularly beneficial to premenopausal women and women who had gone through menopause but weren't using hormone replacement therapy. Experts recommend substituting these foods for less healthy protein options such as red or processed meats.

Research we're watching

Ticagrelor (Brilinta), a drug that helps prevent blood clots, was approved in 2011 for treating people who had experienced a heart attack or acute coronary syndrome (a sudden loss of blood flow to the heart). Now, the drug can be prescribed to a broader group of people. In June 2020, the FDA expanded ticagrelor's approval to reduce the likelihood of first heart attack or stroke among high-risk people with coronary artery disease.

The expansion is based on results from a multiyear study of more than 19,000 people with coronary artery disease and diabetes at high risk for a heart attack. Participants who took aspirin plus ticagrelor were less likely to experience a heart attack, stroke, or death from heart disease compared with those who took aspirin alone.