Heart Attack Archive

By Richard Lee, M.D.
Associate editor, Harvard Heart Letter

When I was a newly minted cardiologist, heart attacks were feared far more than they are today. They terrified people who were having them, and their families, because they were known killers. Heart attacks made doctors nervous, too, since we were less certain about how to treat them and the therapies available to us were less effective than the ones we have at our disposal today.

Surviving a heart attack — A success story

Morbidity and Mortality Chart Book, National Heart, Lung, and Blood Institute, 2009.

Measuring blood pressure: Let a machine do it

Myers MG, Godwin M, Dawes M, et al. Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial. BMJ 2011; 342:d286.

Millions of women and men take calcium pills to strengthen their bones and ward off osteoporosis. Whether taking calcium is good, neutral, or bad for the heart is a matter of conflicting studies and lively debate. Australian researchers have sounded another note of caution in a controversial paper they published in the medical journal BMJ.

The Australian team took a fresh look at data from the Women's Health Initiative Calcium–Vitamin D Supplementation Study. It randomized 36,282 women to a calcium–vitamin D supplement or to a placebo. The results of the trial, published in 2006, showed a small improvement in hip bone density but no effect on hip fracture. The researchers reported that the numbers of heart attacks and other cardiovascular problems were the same in both groups.

These drugs may harm more than help after a stroke linked to a degenerative brain condition.

The drugs known as statins do many good things. They are the most powerful cholesterol-lowering agents discovered so far. They help prevent heart attacks in people who have had one, as well as in those at high risk for one. They lessen the risk of having an ischemic (clot-caused) stroke, the most common kind of stroke in the United States. Use of statins has been linked to stronger bones, better brain health in old age, and other noncardiovascular benefits.

Parents pass on many things to their children — genes, love, a taste for certain foods, some habits, and heart attack risk. Yet family history isn't included in the Framingham risk score, a widely used tool for gauging heart attack risk. Intriguing information from the global INTERHEART study suggests that family history — specifically if and at what age a parent had a heart attack — should be used to help calculate a person's chances of having a heart attack.

The INTERHEART investigators asked 12,000 heart attack survivors and an equal number of healthy men and women about their parents' cardiac health. The risk of having a heart attack increased with the number of parents who had one, especially before age 50 (see table). The relationship persisted even after the investigators made adjustments for age, gender, and other factors that are key contributors to cardiovascular risk. Having one parent who had a heart attack after age 50 slightly increased an individual's heart attack risk; having two parents who had attacks before age 50 substantially increased the risk.

Unnecessary blood transfusion can do more harm than good.

Blood transfusion deserves a prominent place in the pantheon of medical advances. It has saved countless lives on the battlefield and in hospital emergency departments. It is a life-prolonging treatment for people with conditions that prevent the body from making blood or blood components, from kidney disease and cancer to disorders such as hemophilia and sickle cell anemia. But whether blood should be routinely transfused during or after heart surgery is a question that more and more people are asking. The answer is tilting toward "no."

Rheumatoid arthritis begins in the joints, but it doesn't end there. The inflammation that causes swelling and pain in fingers, wrists, knees, and other joints can also affect the heart. A large study from Sweden suggests that a new diagnosis of rheumatoid arthritis should get you thinking about your heart, too.

In a group of 7,500 men and women with new rheumatoid arthritis whose health was followed for up to 12 years, more people than expected had a heart attack, developed chest pain with activity or stress (angina), or needed a procedure to open or bypass a blocked heart artery within five years of their diagnosis (Journal of Internal Medicine, December 2010).

The electrocardiogram (ECG) is one of the most common, enduring, and important tests in all of medicine. It's easy to perform, noninvasive, produces results right away, and is useful in diagnosing dozens of heart conditions. The ECG has taken on even more importance lately because a particular ECG pattern, called ST elevation, is a strong indication that a serious heart attack has occurred, and there's more emphasis than ever on treating heart attacks as soon as possible. An ECG isn't necessarily going to be part of a routine physical, but if you need medical attention because you have chest pain, sudden unexplained shortness of breath, or other symptoms that suggest a possible heart attack, you will almost certainly get an ECG.

The ECG is a reading of the electrical impulses in the heart that activate the heart muscle and its blood-pumping action. Twelve electrodes affixed to the skin on the chest, arms, and legs sense those impulses from various vantage points. Part of the reason the ECG has had such staying power is that the output is visual: a line graph with peaks and valleys, not a stream of numbers. As a result, reading an ECG is a matter of pattern recognition, not computation. There are many permutations, but someone can be trained to recognize the most common patterns relatively quickly.

Cough and ACE inhibitors. About one in nine people (11.5%) who take an ACE inhibitor such as enalapril or ramipril develops a dry cough. That's about 10 times higher than listed in the fine print of the drug's prescribing information or in the Physicians' Desk Reference, a commonly used resource for drug information (American Journal of Medicine, November 2010). For some people, the cough is a mild nuisance. For others, it is so aggravating they stop taking the drug. If you take an ACE inhibitor and are bothered by a dry cough, ask your doctor about switching to an angiotensin-receptor blocker or another medication.

Waist circumference and longevity. A bigger waist isn't a good sign for living to a healthy old age. Among 105,000 middle-aged men and women taking part in the Cancer Prevention Study II, the larger the waist, the greater the chances of dying over the nine-year study. As expected, the connection was seen among individuals who were overweight or obese. But it was also seen in those with healthy weights (Archives of Internal Medicine, Aug. 9/23, 2010). The increased risk of dying was most pronounced in men with waists greater than 43 inches and women with waists greater than 37 inches.

Hospitalization rates for heart attacks are going down, so maybe prevention efforts are paying off.

Two studies published in 2010 show that the American heart attack rate is continuing to decline. The first, published in Circulation, was based on Medicare data. The main finding was that hospitalization rates for heart attack dropped by about 23% between 2002 and 2007, which by the authors' calculations might have translated into 100,000 fewer hospitalizations a year for the 45 million Americans enrolled in the Medicare program.