Heart Attack Archive

Ask the doctor

Q. I just got a stent placed in my heart artery and feel great again. If it develops problems, can it be treated?

A. Stents, the tiny wire-mesh tubes used to prop open blocked arteries, are useful for treating heart attacks and chest pain that occurs with physical activity. They're placed during a coronary angioplasty and stenting procedure, which usually involves snaking a thin tube (catheter) through a vessel in the upper thigh or the wrist up to the heart. After more than two decades of use, today's stents are safer and more effective that the original versions. Problems can still arise, but they are uncommon and treatable.

Learn how to recognize and prevent this dangerous condition, known as venous thromboembolism, or VTE.

When a blood clot blocks an artery supplying the heart or the brain, the result is a heart attack or stroke. Most Americans are familiar with these two serious health threats. But they're probably less familiar with the dangers of venous thromboembolism, or VTE — a clot that forms in a vein.

A clot in the leg or arm, known as deep-vein thrombosis, can cause pain, swelling, and redness in the affected limb. But the real threat occurs if the clot breaks off and travels to the lungs, causing a pulmonary embolism.

In the journals

People who have had a heart attack or a stroke are routinely prescribed a statin to reduce the risk of a repeat event. But by also following a Mediterranean-style diet, they can improve their chance of living longer, suggests a study in the Feb. 1, 2019, issue of the International Journal of Cardiology.

The study looked at 1,180 people, average age 68, who had at least one previous heart attack or stroke, and recorded their statin use and diet intake at the study's beginning. The researchers identified the people who faithfully followed a Mediterranean-style diet. A Mediterranean-style diet involves consuming medium to high amounts of whole fruits and vegetables, whole grains, legumes and nuts, olive oil, and poultry and fish, with limited amounts of red meat, alcohol, and dairy.

Why do heart attack rates rise on Monday mornings and the week after daylight savings time begins?

Deep inside your brain is a small cluster of cells that serves as your body's master clock. These cells govern your circadian rhythm, the 24-hour internal clock that keeps your body in sync with the day-night cycle. But nearly all your cells also have their own clocks to ensure that each one performs its unique role — such as producing proteins or releasing hormones — at the right time.

These biological timekeepers are under genetic control. But what happens if our behavior or environment is out of sync with our internal clocks? Understanding the potential health consequences of that misalignment is the focus of the Medical Chronobiology Program at Harvard-affiliated Brigham and Women's Hospital, says Dr. Frank Scheer, who directs the program.

People with fluctuating numbers — like blood pressure, cholesterol, and weight — may be at higher risk of heart attack, stroke, and even death.

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Most people battle "yo-yoing" at some point, when their weight, blood pressure, or some other health number keeps going up and down.

On the surface, this may not seem like a problem if you routinely hit the healthy numbers. Yet new research suggests that fluctuations like this may pose a greater health risk than staying at a single level, even if it's not a perfect one.

In the journals

Vitamin D and omega-3 fatty acid supplements have had mixed results when it comes to preventing heart attacks, strokes, and cancer in people who have already developed these problems or are at high risk for them. Yet a new study published online Nov. 10, 2018, by The New England Journal of Medicine found they may actually prevent these conditions among people who have never had these problems before.

Researchers recruited almost 26,000 people, ages 50 and older, who had no history of heart disease or cancer. The participants were divided into four groups. People in one group were given daily doses of 2,000 international units of vitamin D (an amount found to be linked to lower disease risk in observational studies) and 1 gram of a drug called Lovaza, which contained 840 milligrams of omega-3s (two to four times the amount in two servings of fish per week). The second group took vitamin D and a placebo, the third group took the omega-3s and a placebo, and the final group took two placebos. After more than five years, the researchers found that those given omega-3s were 28% less likely to suffer a heart attack compared with those given a placebo. Those who ate fewer servings of fish (less than the average of 1.5 servings per week) appeared to have a greater benefit from the additional omega-3s while those with higher fish intake had minimal benefit.

Ask the doctors

Q. My partner recently had a heart attack. The doctor recommended exercise, but I wonder if it's better to take it easy. I feel like exercise might be dangerous or even cause another heart attack. Is exercising too risky?

A. As counterintuitive as it might seem, exercise is good medicine for heart attack survivors. Provided the doctor gives the green light, about two-and-a-half hours of moderate-intensity exercise each week can be beneficial — this is the amount recommended by the American Heart Association. Exercise can start as soon as the doctor gives the okay.

As many as half of all heart attacks go unrecognized — and their long-term consequences can be serious.

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Most people don't realize that they could have a heart attack without even knowing it. Although these are commonly referred to as "silent" heart attacks, a more accurate term may be "unrecognized" heart attack, says cardiologist Dr. David Morrow, director of the cardiac intensive care unit at Harvard-affiliated Brigham and Women's Hospital.

"Some people do have symptoms, so in that sense, their heart attack is not silent. They just don't recognize the sensations as coming from their heart," he explains. They may think it's just indigestion or muscle pain, when the real cause is actually reduced blood flow to the heart. People may also experience other atypical symptoms, such as nausea or excessive sweating during a heart attack (see "Heart attack symptoms").

A "type 2" heart attack caused by severely restricted blood flow can be just as serious as a heart attack caused by a sudden complete blockage.

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In TV shows and movies, a man having a heart attack typically clutches his chest and falls to the ground, but most heart attacks are not nearly as dramatic.

"No two heart attacks are the same, nor do they strike in similar fashion," says Dr. Krishna Aragam, a cardiologist with Harvard-affiliated Massachusetts General Hospital. "Some heart attacks are subtler in their warnings, but can be just as serious and even deadly if they are not attended to."

Research we're watching

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A tendon that stretches between your heel and your calf may tell you something about your cardiovascular health. Researchers found that people with thicker Achilles tendons have more significant coronary artery disease and are at higher risk for a heart attack than those with thinner tendons.

The study, which was presented in November 2018 at the American Heart Association's Scientific Sessions meeting in Chicago, found that people with thicker Achilles tendons were more likely to have a blocked heart artery and left main coronary artery disease, which is associated with a high risk of heart disease and death. It's unclear, however, exactly why this artery was thicker in these individuals.