Heart Attack Archive

Doctors are rethinking how heart attacks are defined and diagnosed.

Every few years, an international task force revises the definition of heart attack to reflect new knowledge and diagnostic techniques. In late 2012, the task force updated the previous definition to specify six different types of heart attacks, how each one occurs, and how each one can be diagnosed.

Heart disease doesn't have to bring your love life to a halt.

Having heart disease—or a past heart attack—can disrupt your life in so many ways. For one thing, it can make you pause before doing activities you didn't think twice about in the past—including having sex.

For some, the stress of grief causes serious heart problems.

Love is such an intense emotion that losing someone you love can cause profound grief. All of us grieve differently, and in some people, the emotional and psychological impact of grief can manifest itself physically by triggering a heart attack or causing a serious—albeit temporary—disease of the heart muscle.

Yet "symptomless" does not mean "harmless."

In the movies, a heart attack victim often clutches his or her chest, falls to the floor, and dies on the spot. While this certainly can happen, symptoms can vary widely in type and intensity. In fact, up to 37% of people who have a heart attack never know it, because they never have symptoms. They find out they have had a heart attack when an electrocardiogram (ECG) is done for another reason.

A symptomless heart attack—often called a silent heart attack—is not harmless, however. A study published in the Sept. 5, 2012, issue of the Journal of the American Medical Association found that people with an unrecognized heart attack had the same risk of dying within five years as those who knew they'd had a heart attack. In both groups, the risk of dying during the five-year study was twice that of people who'd never had a heart attack.

Women may not be keeping pace with men when it comes to getting treated for heart attack symptoms, and this delay could be life-threatening, French researchers reported in October at the Acute Cardiac Care Congress in Turkey.

The study's authors looked at cases of a type of heart attack called STEMI (ST-elevation myocardial infarction) in 5,000 people over a six-year period. Nearly 1,200 of them were women.

Survival rates for people brought to the emergency department following an out-of-hospital cardiac arrest vary widely among hospitals, so quality of care was long assumed to be the determining factor. But research conducted by physicians at Harvard-affiliated Beth Israel Deaconess Medical Center (BIDMC) and two other medical centers suggests that health also plays a key role. The researchers examined 208 adults who survived a cardiac arrest and were admitted to two sophisticated urban teaching hospitals: BIDMC in Boston and Henry Ford Hospital in Detroit. All patients received state-of-the art care, yet those in Boston fared much better than those in Detroit.

Upon close examination, the Detroit patients were found to be much sicker than those in Boston, with significantly higher rates of end-stage kidney disease, hypertension, diabetes, heart failure, and lung disease. In addition, more patients in the Detroit group had an arrhythmia strongly associated with poor outcome. Additionally, after they started hospital treatment, the Detroit patients were significantly more likely to be critically ill.

Research finds most people skip the proven measure.

Aspirin or another type of antiplatelet medication is usually prescribed after a heart attack or a diagnosis of cardiovascular disease (CVD). But a recent report by the Centers for Disease Control and Prevention found that fewer than half of the people with CVD in the United States are prescribed antiplatelet therapy. Even when it's prescribed, that doesn't mean patients are taking it as directed. "It can have side effects, like stomach upset or nosebleeds. These side effects can lead people to stop taking it without telling the doctor," says Dr. Deepak Bhatt, a cardiologist with Brigham & Women's Hospital. "Also, many of the patients prescribed aspirin start to feel well once they've recovered after a heart attack, and mistakenly conclude they don't need to take aspirin."

How aspirin works

Aspirin helps prevent future heart attacks by helping to keep platelets in the blood from sticking together and forming clots that block blood flow in one of the heart's arteries—a process that can result in a heart attack. If you have CVD, you may be prescribed another type of antiplatelet medication, such as clopidogrel (Plavix), instead of or in addition to aspirin. However, some studies have shown that taking both medications is not significantly more effective than taking just one.

Chewing an aspirin tablet during the first symptoms of what could be a heart attack can save your life. But in order for it to work properly, you must understand which kind of aspirin to take, and how to take it.

Why?

A heart attack is usually the result of a blood clot in a coronary artery that blocks blood flow. Aspirin inhibits the formation of a clot and helps restore blood flow.

High LDL cholesterol levels are known to increase the risk of heart attack, and lowering LDL levels has been proven to help protect against heart attack.

Both surgical and nonsurgical options can prevent stroke.

The same process that causes obstructions in the heart's arteries can block the carotid arteries in the neck, a disease known as carotid stenosis. If these interfere with blood flow, a stroke can occur.

Symptoms of pending stroke (see box) usually require treatment to reduce the risk. One option calls for opening the artery and removing the plaque—a surgical procedure known as endarterectomy. A less-invasive option, called carotid stenting, involves inserting a catheter into an artery in the groin, advancing it to the carotid artery, opening the blockage with a balloon, and leaving behind a wire cage (or stent) to hold the artery open.