Having a Heart Attack
I remember … when my Dad was having a heart attack… or so I thought … and indeed, he did. Mom never called 911. Dad did have his hand over his heart and his face was grimaced and worrisome. He clutched his nitroglycerin tightly in his hand. His breathing was heavy and he was almost gasping for air. He stated he needed to leave for the hospital and he needed to leave NOW!
Dad insisted Mom drive him to the hospital. This was no small feat as the hospital was in Madison — and nearly an hour away. Mom did not look too pleased with the situation and tried to convince Dad that her driving him to Madison was not the best solution… but he insisted and time was awastin’! Dad took another nitro. They looked each other squarely in the eye and then said “Let’s go.” Then Mom said:
“Sharon, you’re coming along!” What? I had no idea what my role was in this situation! I remember that I had just gotten my driver’s license but did not feel secure enough to drive to Madison – the big metropolis and capital city of Wisconsin. I also knew that urgency was an issue. (Maybe Mom thought she would have a heart attack too, having to drive Dad with chest pain an hour to get medical help? She needed someone with her!)
I sat behind Mom in the back seat of our new 1970 yellow and black Buick LeSabre as she drove furiously. I kept an eye on Dad – not knowing what I was looking for. I remember thinking: What was he going through? Why does he keep taking those little white pills? He did not appear to be in the throes of a massive heart attack. Why aren’t Mom and Dad talking? How much longer until we get to Madison? The restless emotions I felt that day I can still feel today.
There are so many questions we would like to ask our parents once they are gone. How does that happen? I suspect that I did not ask him at the time for fear that any questioning would actually make the heart attack occur. Now I want to know and wonder how similar our symptoms might be. (An interesting side note and memory is that a dozen red roses arrived at home for Mom after this event.)
The Washington Post wrote about heart attack medical care and how it has changed greatly since the 1970’s in a 2009 article entitled “As Health-Care Quality Rises, So Does Price” emphasizing that cardiac healthcare is far more expensive but far more effective.
“In the 1960s, the chance of dying in the days immediately after a heart attack was 30 to 40 percent. In 1975, it was 27 percent. In 1984, it was 19 percent. In 1994, it was about 10 percent. Today, it’s about 6 percent….
The evolution of heart attack treatment over the past three decades is a story of doing more things to more people at greater expense with better results.”
So what was happening as my apprehensive father sat pensively in the front seat of our yellow and black Buick LeSabre? What would his answers have been if I would have spoken up at that time?
Perhaps he was feeling pressure, tightness, pain, squeezing or aching in his chest. It was most likely radiating down his left arm, but it could have been his right arm or even both arms.
He could have been experiencing abdominal “fullness” like “gas” or heartburn, nausea or indigestion.
Pain can spread to the jaw, neck, throat, shoulders, arms and back and usually between the shoulder blades.
I could see him gasping for breath at times. He could have been experiencing dizziness, palpitations, sweating or fatigue.
I remember thinking he was doing the right thing in taking his nitroglycerin .
Today it is recommended that you take an aspirin if you think you are having a heart attack. This little fact was not known in late 1960’s or even the early 1970’s. . The aspirin breakthrough came in 1988 with the Second International Study of Infarct Survival. This was a huge clinical trial that proved aspirin slowed the clotting of blood and decreased mortality by nearly one-quarter when taken during a heart attack.
In fact, Dr. Oz, himself, says:
“If you think you’re having a heart attack, take one 325mg tablet of adult aspirin. Chew it — don’t just swallow it. It allows for the aspirin to get into your blood stream faster and slow the heart attack down.”
What was happening as my father sat so intently beside my mother that day?
A heart attack (myocardial infarction or MI) is simply the death of muscle cells in the muscle (myocardium) of the heart from a lack of oxygen. This occurs when blood flow is unable to reach the heart because of a blockage or clot in the arteries caused by a clumping of blood platelets, or because of inflammation that causes an unstable plaque to break off and block the blood flow in the artery. Sometimes a spasm in the artery blocks the flow to the heart, or the heart goes into electrical chaos and simply stops its synchronized beating on its own.
Presenting to the emergency department with chest discomfort, my father was evaluated for a possible heart attack (myocardial infarction). Electrocardiogram (ECGs or EKGs) are used in the evaluation of patients with chest discomfort but can be normal or not diagnostic in patients with a myocardial infarction. Blood was drawn to check for any heart damage that is indicated by abnormal protein levels in the blood.
The first thing I remember being done upon arrival to the Madison General Hospital (now Meriter Hospital) was the electrocardiogram and all the wires and electrodes. They were asking Dad questions about his symptoms and viewing the strips of electrical activity of his heart via electrodes attached to his chest. The recording demonstrated waves on a monitor beside him.
Not knowing then, but gaining knowledge through the years, there are typical changes to the normal pattern of the heart tracing in an MI. Patterns that occur include things called pathological Q waves and ST elevation. However, it is possible to have a normal ECG even if you have had an MI.
There were terms and phrases being used that had little meaning to me and that I no longer have any true recall of. Today common terminology in a cardiologist’s office relies on such terms as myocardial infarction (MI), acute coronary syndrome (ACS), and acronyms related to electrocardiogram (ECG) tracings – STEMI and NSTEMI.
The American Heart Association uses the term acute coronary syndrome (ACS) to indicate what the lay person would know as a heart attack or unstable angina. Both situations are an “absolute medical emergency” where there is a sudden reduction in blood flow in a coronary (heart) artery.
Two main sub types of ACS can be diagnosed by what is seen on your heart tracing (ECG). The two main types are called ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI).
NSTEMI can also include unstable angina. (The ST elevation refers to a section on the ECG tracing.)
In STEMI, the artery supplying an area of the heart muscle is completely blocked. This is what was referred to as an MI, myocardial infarction, or heart attack when my father was being diagnosed, decades ago.
However, in NSTEMI, the artery is only partly blocked, so only part of the heart muscle supplied by the affected artery is affected. Your treatment can depend upon which type you have – STEMI or NSTEMI.
The doctors had to rely on a person’s symptoms and changes on an electrocardiogram to determine if a heart attack was under way when my father arrived in the Emergency room on that day long ago — some forty-plus years ago. Today, blood tests are available that can detect the chemical response of dying heart cells during a myocardial infarction.
Blood tests were taken immediately. Certain heart enzymes slowly escape out into your blood if your heart has been damaged by a heart attack.
The 2004 journal article entitled “New Blood Tests for Detecting Heart Disease” by Jesse Adams, MD and Fred Apple, PhD (Circulation) states:
“blood tests have been used for approximately 50 years to detect substances that are present in the blood that indicate either disease or a future risk of the development of a disease. Blood tests detect substances that normally are not present or measure substances that, when elevated above normal levels, indicate disease.”
These diagnostic blood tests include creatine kinase (CK), myoglobin and cardiac troponin.
The blood test that measures a chemical called troponin is the usual test that confirms MI. This chemical is present in heart muscle cells. Damage to heart muscle cells releases troponin into the bloodstream. In MI the blood level of troponin increases within 3-12 hours from the onset of chest pain, peaks at 24-48 hours, and returns to a normal level over 5-14 days. A rough idea as to the severity of the MI (the amount of heart muscle that is damaged) can be gauged by the degree of abnormality of the ECG and the level of troponin in the blood.
Another chemical that may be measured in a blood test is called creatine kinase. This too is released from heart muscle cells during a heart attack or MI.
Ischemia modified albumin (IMA) is indicated for use in patients who are felt by their doctors to possibly be experiencing warning signs of a heart attack (ischemia). This test measures changes that may occur to albumin when ischemia has occurred.
A blood test can measure natriuretic peptides, which is a biomarker produced by the heart in response to congestive heart failure.
Attention has been focused on a blood test that measures the level of C-reactive protein (CRP). CRP is a marker for inflammation, and atherosclerosis has an inflammatory component. Patients with elevated levels of CRP have an increased risk for heart attack, stroke, sudden death, and vascular disease. Physicians are beginning to add the measurement of blood CRP levels to other measures of risk to recommend potential options to reduce risk.
The level of CRP has been shown to correlate with future risk as follows:
CRP level less than 1: lowest risk
CRP levels of 1 to 3: intermediate risk
CRP greater than 3: highest risk
Finally, another test (the PLAQ test) has just been released that measures the level of lipoprotein phospholipase A2 (Lp-PLA2). Lp-PLA2 generates oxidized molecules within the blood vessel wall that are more prone to lead to both atherosclerosis and irritability of the atherosclerotic plaque. Elevations in the levels of Lp-PLA2 have been shown to indicate greater risk of plaque formation and rupture independent of the levels of either lipids or CRP.
My father was diagnosed with heart disease during a time when he was told to “rest more”, “slow down” and knew heart disease as a chronic and progressive disease progress. I can imagine his hopelessness and confusion. This scenario was one of several incidents when my father encountered one heart attack after another. It seemed like he was forever in the hospital and it was often for weeks at a time. I remember him putting together dozens of complicated jigsaw puzzles in the hospital and continuing to read and read – always required to do sedentary activities. Yes, heart attack and rest seemed to coincide together during this time period.
Angioplasty.org discusses today’s progress in terms of knowledge and “patient empowerment” stating heart patients have “more options that bring more decisions.”
The first coronary bypass surgery was in 1967. (My father had his CABG in 1971.)
The first angioplasty was in 1977. The first stents were in the 1990’s. (My stents were placed in 2007.)
We know the future holds hope and advanced knowledge and technology for the cardiac patient. Angioplasty.Org is an organization designed “to help you get answers to your questions and gain a sense of control. Experts in the psychology of health and disease management agree that active participation in managing your heart disease, expressing your concerns and priorities, and becoming a partner with your medical team leads to better health.”
Knowledge is power and a sense of control when you feel most vulnerable. It is an essential first step to a healthier heart. The more you know about your condition, the more you can manage it and the better you will feel.
Please bear in mind that This Old Heart blog is a personal blog written and edited by merely me. It is not intended as a substitute for professional medical help. Please talk to your doctor about your health concerns. This information comes from my own search and resolution in answers I look for in relation to manage my health. If it helps another, then I am doubly blessed… and remember…
Take care of your heart. ♥
GO RED FOR WOMEN and their presentation: “JUST A LITTLE HEART ATTACK”