A heart attack (also called “myocardial infarction”) occurs when a blood vessel supplying blood
to a part of the heart becomes blocked,
resulting in permanent damage to the heart muscle due to the
lack of blood flow. The blood vessel can become blocked from
advancing atherosclerotic plaque lesions, a sudden formation of a
blood clot, or from the spasming of a coronary artery - an artery that
supplies blood to the heart.
Most people believe that a heart attack is caused by a slow,
progressive build-up of plaque, comforting themselves that it
takes a lifetime to become completely clogged - but
this just isn't true for a majority of heart attacks.
Heart specialists now believe that
most heart attacks occur when
an unstable, atherosclerotic plaque lesion,
filled with cholesterol and fat,
suddenly breaks apart, thus forming an open wound within the
artery wall. Blood platelets and clotting proteins rush
to the wound and form a clot — called a thrombus. The clot can
enlarge in a matter of moments, causing obstruction of blood
flow to the heart with resultant angina (chest pain). If the blood flow
becomes completely obstructed, a heart attack ensues.
is the small plaques that can be the most lethal. A person with
a 50% blockage who suddenly becomes obstructed is at much greater
risk of having a large amount of heart damage than a person with
a slowly progressive blockage. A person with a 90% blockage that
was slow to progress has probably had a chance to develop
“collaterals”–– smaller blood vessels
that grow to take over the job of the big vessel that has been
gradually closing down.
Every Second Counts
A heart attack is a life–threatening event. With immediate
medical intervention — preferably within the first
hour of onset of symptoms – heart damage may be averted or
reduced. A new blood test measuring “troponin”
– a chemical released into the blood during a heart attack –
allows doctors to diagnose a heart
attack more quickly and accurately than ever before. Time equals
muscle is the theme that resounds in emergency rooms and
treatment is aimed at quickly restoring
blood flow to the heart muscle to prevent permanent damage.
Studies show the most common time for a heart attack to occur is
Monday morning. Saturday morning ranks second. Another common time
is during the early morning hours when the platelets are stickier.
Aspirin reduces platelet stickiness. Aspirin can
also reduce the amount of damage caused by a heart attack
in progress. Aspirin can have side-effects, however, and preventive “aspirin-a-day”
therapy is reserved for those at risk. Check with your doctor or healthcare
professional if regular aspirin may be of benefit to you.
In his book, The McDoughall
Program for a Healthy Heart , author John McDoughall, MD, outlines
the following key elements that can lead to a heart attack:
- The presence of high total cholesterol and LDL cholesterol
- The initial injury to the lining of the artery wall
- The formation of unstable, cholesterol–filled, fat–filled plaques
- The rupture of the plaque
- The formation of a clot over the open plaque
- The clot closing off blood flow to the heart or brain (or other major organ),
causing a heart attack or stroke.
What sets these elements in motion? Dr. Mehmet Oz, MD, heart
surgeon at Columbia Presbyterian Medical Center in New York City,
stated at a recent conference on the Mind-Body Connection
(Friends Connection, Mar,00, Moorestown, NJ) that
it is his observation that many heart attacks can be traced
back to a very stressful life event that occurred about four to
seven days prior. Dr. Oz says that there are still many unknowns
about what causes a disease state. In any case, something
happens to cause a turbulent blood flow and the platelets to become
very sticky. In his book, Healing from the Heart, Dr. Oz further
explains the biophysical changes that contribute to the unstable plaque
and rupture, also explaining why smaller lesions are the most dangerous.
of the plaque is very active and tends to be irritable. If a lot of
blood elements, including sticky platelets, adhere to this surface,
a fifty to sixty percent lesion can suddenly grow in size and close
off all passage of blood. The plaque, like a balloon, can also fill
itself with blood, expand and plug the vessel”.
Dr. Oz explains in his book that the physiological makeup of troubled arteries is an
important factor in evaluating heart disease.
To illustrate, Dr. Oz compares a very
elderly woman with a 50% blockage who has no chest pain and
slowly advancing atherosclerosis, to a young man with a 50% blockage
who has chest pain with minimal exertion. The etiology (cause) of heart
disease is different in these two persons. The treatment
will be different. “It all depends on how pliable— how
spasm-prone –a patient’s vessel walls are”.
Scenario of a Heart Attack
Below is a passage that describes a heart attack that occured to
a fictitious patient named “Frances” and represents
a composite of several women heart attack sufferers. It was adapted, in part,
from Dr. Oz's book, Healing from the Heart. The story illustrates how
heart disease can present in a woman, the nature of the disease, and
how a person's life hangs in the balance. It is important to note that heart
attack treatments vary from hospital to hospital, depending upon the technology
available at the institution. Hospitals that specialize in open-heart surgery are
able to offer some of the more advanced cardiac care services and procedures.
One Woman's Story - the story of Frances
Sixty-year-old Frances had been feeling poorly for the past two weeks with feeling run down. Symtpoms
worsened over that period and she was feeling extreme weakness and looking
especially pale. She figured
she must be coming down with the flu, but it didn't feel like the flu. By Sunday afternoon, however,
her symptoms became life-threatening. She developed a crushing, vise–like
pressure in her chest that took her breath away. The pain was shooting down
her left arm and through to her back. She could barely talk or breathe and she couldn't even lift
her arms to pick up a toothbrush, let alone a phone to call 9-1-1.
Frances lived alone and she was paralyzed with fear. She didn't want to go
to the hospital by ambulance and she didn't want to disturb her friends on a Sunday
evening because “they were busy with their own
lives and had their own set of problems”. She convinced herself that if she took two
aspirin and went to bed, she would be better in the morning... but that's not what
happened. Her sleep was interrupted with recurrent chest pain.
At dawn, Frances called her best friend, Anne, who immediately
came to her rescue and drove her to the nearest hospital emergency room.
By the time Frances reached the hospital,
precious minutes had been lost while the affected part of her heart
muscle was dying. An electrocardiogram was completed, a potent pain medicine administered,
an intravenous line started and a blood test taken. Immediately after the
emergency room doctor made a diagnosis of heart attack,
Frances received a potent blood thinner to try and dislodge the clot.
When this failed, a dye was injected into her heart arteries through a catheter
inserted into her groin's large femerol artery. A moving X-ray image on film—an
angiogram— was then made of Fran's heart in full, crippled action, showing one
major and several smaller blockages. The first–line doctors
decided against angioplasty due to the location of the blockages. Angioplasty is
a procedure whereby a tiny balloon near
the end of a catheter is placed into the blocked artery and inflated,
flattening the clot and the plaque and opening the vessel.
With angioplasty no longer considered an option, open-heart bypass surgery
was being considered. Her cardiologist then came in to discuss
all treatment options and related risks so that she could make an informed