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Ask the Expert

Is it a Heart Attack?

Dr. Deychak

Is it a Heart Attack?
We hear the stories every day. A young, seemingly healthy person collapses and dies suddenly from a heart attack? Should we all be worried? How will we know if it's something serious, or just indigestion?

Dr. Yuri Deychak, Chair of the Cardiology Subsection at Suburban Hospital in Bethesda, answers some frequently asked questions about heart attack and the newly established NIH Heart Center at Suburban Hospital. (Dr. Deychak's biography and contact information follow this article.)

What is a heart attack?
The most common cause of death in the United States is heart disease. The heart works 24 hours a day, pumping oxygen and nutrient-rich blood to the body. Blood is supplied to the heart through its coronary arteries. In coronary heart disease (CHD), plaques or fatty substances build up inside the walls of the arteries. The plaques also attract blood components, which stick to the artery wall lining. Called atherosclerosis, the process develops gradually, over many years. It often begins early in life, even in childhood.

The fatty buildup or plaque can break open and lead to the formation of a blood clot. The clot reduces blood flow. The cycle of fatty buildup, plaque rupture, and blood clot formation causes the coronary arteries to narrow, reducing blood flow. When too little blood reaches the heart, the condition is called ischemia. Chest pain, or angina, may occur. The pain can vary in occurrence and be mild and intermittent, or more pronounced and steady. It can be severe enough to make normal everyday activities difficult. The same inadequate blood supply also may cause no symptoms, a condition called silent ischemia.

If a blood clot suddenly cuts off most or all blood supply to the heart, a heart attack results. Cells in the heart muscle that do not receive enough oxygen-carrying blood begin to die. The more time that passes without treatment to restore blood flow, the greater the damage to the heart.

How would I know if I were having a heart attack? What are the warning signs?
A heart attack is a frightening event, and you probably don't want to think about it. But, if you learn the signs of a heart attack and what steps to take, you can save a life - maybe your own. Many people think a heart attack is sudden and intense, like in a movie when an actor clutches his chest and falls over.

The truth is that many heart attacks start slowly, as a mild pain or discomfort. If you feel such a symptom, you may not be sure what's wrong. Your symptoms may even come and go. Even those who have had a heart attack may not recognize their symptoms, because the next attack can have entirely different ones.

It's vital that everyone learn the warning signs of a heart attack:

  • Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
  • Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
  • Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.
  • Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness.

Some of these symptoms can be caused by other disorders, including heart burn or indigestion. Learn the signs - but remember: Even if you're not sure it's a heart attack, you should still have it checked out. Fast action can save lives.

Are the signs and symptoms different in women?
Women need to understand they are just as vulnerable to a heart attack as men. Women account for nearly half of all heart attack deaths. Heart disease is the number one killer of both women and men.

There are differences in how women respond to a heart attack. Women are less likely to believe they're having a heart attack and more likely to delay seeking emergency treatment. Further, women tend to be about 10 years older than men when they have a heart attack. They are more likely to have other conditions, such as diabetes, high blood pressure, and congestive heart failure - making it all the more vital that they get proper treatment fast.

Women should learn these heart attack warning signs.

  • Pain or discomfort in the center of the chest.
  • Pain or discomfort in other areas of the upper body, including the arms, back, neck, jaw, or stomach.
  • Other symptoms, such as a shortness of breath, breaking out in a cold sweat, nausea, or light-headedness are more likely to occur in women.
If you feel heart attack symptoms, do not delay. Remember, minutes matter! Do not wait for more than 5 minutes at most to call 9-1-1.

What is angina and how is it different from a heart attack?
An episode of angina is NOT a heart attack. However, people with angina report having a hard time telling the difference between angina symptoms and heart attack symptoms. Angina is a recurring pain or discomfort in the chest that happens when some part of the heart does not receive enough blood temporarily. A person may notice it during exertion (such as in climbing stairs). It is usually relieved within a few minutes by resting or by taking prescribed angina medicine. People who have been diagnosed with angina have a greater risk of a heart attack than other people.

What is sleep apnea and how can it affect my heart?
Sleep apnea is a common disorder that can be very serious. The Greek word "apnea" literally means "without breath." Sleep apnea is characterized by brief interruptions of breathing during sleep. These episodes usually last 10 seconds or more and occur repeatedly throughout the night. People with sleep apnea will partially awaken as they struggle to breathe, but in the morning they will not be aware of the disturbances in their sleep. According to the National Sleep Foundation, sleep apnea affects more than 18 million Americans. Fortunately, it can be diagnosed and treated.

Each time a person stops breathing momentarily, as many as 60 times per hour, sleep apnea significantly lowers oxygen levels in the bloodstream and elevates nighttime blood pressure. In addition, these breathing interruptions cause the body to release very high levels of the stress hormone epinephrine. This "fight or flight" hormone not only disrupts sleep, but it puts a tremendous strain on the heart, blood vessels, and other organs.

Recent research findings revealed that early atherosclerosis - a condition in which fatty material deposited along artery walls hardens and may eventually block an artery - was found in 42- to 44-year-old predominately male patients who had severe obstructive sleep apnea but no overt cardiovascular disease.

Further reason for concern was noted in other research that found cardiac deaths peak during sleep hours for patients with sleep apnea. The peak time for cardiac deaths to occur among the general population is between 6 a.m. and noon. For patients with obstructive sleep apnea, however, the peak was reversed: more than twice as many cardiac deaths occurred during the sleeping hours.

I don't want to embarrass myself by going to the hospital with a false alarm. I'd rather wait until I'm sure something's really wrong. What's the rush anyway?
Doctors have clot-busting drugs and other artery-opening procedures that can stop or reverse a heart attack, but they work best when given within the first hour after a heart attack starts. These drugs can limit the damage to the heart muscle by removing the blockage and restoring blood flow. Less heart damage means a better quality of life after a heart attack.

The first hour also is the most risky time during a heart attack-it's when your heart might stop suddenly. If this happens, electric shock (defibrillation) will be required to restore your heart to a normal rhythm. Responding quickly to your symptoms really increases your chance of surviving.

Emergency medical personnel cause such a commotion. Can't I just have my wife/husband/friend/coworker take me to the hospital?
Emergency medical personnel bring medical care to you. For example, they bring oxygen and medications. And they can actually restart someone's heart if it stops after they arrive. Your wife/husband/friend/coworker can't do that, or help you at all if they are driving. In the ambulance, there are people and equipment to give you the help you need and get you to the hospital right away.

I'm not sure I can remember all this. What can I do to make it easier for me?
You can make a plan and discuss it in advance with your family, your friends, your tennis and golf buddies, your coworkers and, of course, your doctor. Then you can rehearse this plan, just like a fire drill. Keep it simple. Know the warning signs. Keep information -such as a complete list of your prescribed medications - in one place. If you have any symptoms of a heart attack for a few minutes (no more than 5), call 9-1-1 right away.

I carry nitroglycerin pills all the time for my heart condition. If I have heart attack symptoms, shouldn't I try them first?
Yes, if your doctor has prescribed nitroglycerin pills, you should follow your doctor's orders. If you are not sure about how to take your nitroglycerin when you get chest pain, check with your doctor.

What about taking an aspirin like we see on television?
You should not delay calling 9-1-1 to take an aspirin. Studies have shown that people sometimes delay seeking help if they take an aspirin (or other medicine). In the hospital emergency room, staff will give people experiencing a heart attack an aspirin as soon as they arrive. The best thing to do is to call 9-1-1 immediately and let the professionals give the aspirin.

What cardiac care options are available at Suburban Hospital?
Suburban Hospital's specialized center for cardiac care, anchored by the NIH Heart Center, brings the clinical and scientific excellence of two renowned medical institutions to a community-based cardiac program conveniently located in the heart of Bethesda. Through collaboration with the National Heart, Lung, and Blood Institute of the National Institutes of Health and Johns Hopkins Medicine, Suburban Hospital can now provide patients easy access to advanced cardiovascular treatments available in very few medical centers.

The NIH Heart Center complements a broad range of existing cardiac programs at Suburban Hospital-from emergency/trauma care to state-of-the-art cardiac diagnostics and rehabilitation-which, over the years, have helped thousands of patients recover from heart disease.

Suburban Hospital has provided primary coronary intervention (PCI) as therapy for acute myocardial infarction (heart attack) since 1996. Now, within the NIH Heart Center at Suburban Hospital, elective angioplasty is available. The hospital recently opened three new digital catheterization labs with a 12-bed patient holding area, both on the same floor as the 20-bed Coronary Care Unit.

To learn more about Suburban Hospital's expert cardiac care program in the heart of Bethesda, call 301.896.3939, or click here.

How can I reduce my risk of heart attack?
You can reduce your risk of having a heart attack - even if you already have coronary heart disease or had a heart attack. The key is to take steps to prevent or control your heart disease risk factors.

  • Stop smoking
  • Lower high blood pressure
  • Reduce high blood cholesterol
  • Aim for a healthy weight
  • Be physically active each day
  • Manage diabetes

 

About Dr. Yuri Deychak
Dr. Deychak received his medical degree from Ohio State University in 1984. He completed an internship with Bethesda Naval Hospital, followed by service as a U.S. Navy Submarine and Diving Medical Officer from 1984 to 1988. In the next six years, Dr. Deychak completed both a residency in internal medicine and a cardiology fellowship at George Washington University Medical Center and an interventional cardiology fellowship at the University of Maryland Medical Center. Since 1994, he has been in private practice with Maryland Heart PC in Bethesda. He is board certified in Cardiovascular Medicine and Interventional Cardiology. He earned recognition as one of the region's top doctors (Washingtonian Magazine) in 2005.

Dr. Deychak can be reached through Maryland Heart PC at 301.897.5301. The office is located at 6410 Rockledge Drive, #200 in Bethesda.



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