Tuesday, December 13, 2011 - Heart Attack Can Hit When You Least Expect It

  A heart attack? While KNITTING? “This can’t be happening,” thought Patricia Johnson, but deep in her gut she knew that it was. She had read about the symptoms.

And yet, it didn’t make sense. The energetic 71-year-old was ending a great day. She went to Zumba dance and yoga classes in the morning. Felt fine. Did her usual activities, had dinner, took a shower, got into her pajamas and was feeling wonderfully relaxed as she watched the yarn take shape into a beautiful scarf. Knitting scarves for cancer patients is one of the things Johnson does with her time since she retired.

The pain stretched across her shoulders and created a pressure unlike anything she had ever felt before. Maybe she pulled a muscle in the gym? Then she started to feel nauseous. Something was very wrong. Her husband called 911, and moments later, Johnson was in an ambulance, heading to Greenwich Hospital.

Calling 911 was the best thing Johnson could have done to boost her chances for a full recovery, according to interventional cardiologist Christopher Howes, MD. “Half the people with heart attacks arrive at the hospital by some mechanism other than ambulance, but the 20 minutes it might take you to drive to the hospital is 20 minutes of treatment delay,” Howes said. EMTs can start treatment immediately in the field, and patients don’t arrive waiting to check in and be evaluated.

“They did an EKG right in the ambulance, transmitted it to the hospital, and started an IV,” Johnson recalled. “When I got to the hospital, everyone was ready for me. They were fabulous. They explained everything to my husband and me.”

Johnson doesn’t have high cholesterol. She exercises, eats well, and neither of her parents had heart disease, so she seems an unlikely candidate for a heart attack.

What likely happened is that a plaque in her blood vessel ruptured and blocked off the artery, explained Michael Cleman, MD, the interventional cardiologist who treated Johnson the night she came into the hospital.

“It’s not unusual for a person to experience a heart attack in a nonactive mode,” added Dr. Cleman. “Exercise can begin the process of plaque rupture.
In winter, it’s fairly common for people to have a heart attack not during snow shoveling, but after. Most people have multiple contributing factors, and we all have some cholesterol deposits in our arteries. Problems arise when these deposits get larger.”

Angioplasty and stents
Johnson underwent a procedure known as emergency angioplasty with the insertion of a stent. This lifesaving procedure restores blood flow to the heart by widening the vessels. Greenwich Hospital provides this service in conjunction with the Yale New Haven Health Heart Institute at Greenwich Hospital.

The vast majority of angioplasty procedures involve a “balloon” inserted with a catheter. This device reestablishes blood flow by compressing the plaque against the blood vessel walls. “In some cases, we’ll aspirate the thrombus,” explained Dr. Howes. “In other words, we’ll suck the blood clot out, and sometimes place a stent – a metal mesh tube – inside the blood vessel to keep it open.”

Cardiac rehabilitation
Once a patient’s post-surgery testing shows a stable heart condition, it’s time for the critical next step… rehab.

“Many people who have heart attacks are not active by nature. They have been sedentary and are basically starting from the very beginning to learn a program they can take with them,” said Dr. Cleman.

“A supervised exercise program can monitor every step to make sure there are no irregularities in heart rhythm and blood pressure. There’s also an important psychological boost in seeing other people who have been through the same thing and are doing very well.”

Cardiac rehab is a fully supervised, multidisciplinary approach to cardiac health. It includes discussions about how to manage stress, eat properly and build on an exercise program in an orderly fashion. “I’ve seen people in rehab get hooked on exercise. It’s something they never paid attention to before and it totally changes their lives,” noted Dr. Cleman.

Ronald Ponchak, who directs the hospital’s physical medicine and rehabilitation services, agrees. “The fact that Medicare and other insurance companies cover cardiac rehab is evidence that it’s a required component,” he says. The program usually lasts three to six months, and Ponchak says that a large number of patients continue exercising on their own after that because they feel so much better as a result.

“People get motivated. They’re seeing the benefit, feeling better and looking better, improving their function and capacity. And then there’s the other side – people get really, really scared, and never want to go through that life-threatening event again,” Ponchak added.

Are you heart-smart?
It’s never too late to improve your heart health. Some of the best things you can do to prevent your risk of heart disease are to eat foods that are low in cholesterol and saturated fat, reduce stress through exercise and relaxation, and stop smoking, if you have a cigarette habit.

Fruits, vegetables, lean chicken and fish are filled with heart-healthy nutrition, but sometimes you need more than smart dietary choices. When high cholesterol is a hereditary risk factor, your doctor may prescribe medication.

“Statin drugs, in addition to lowering cholesterol, are believed to have some level of anti-inflammatory properties,” said Dr. Cleman. “Until recently, people may not have appreciated how big a role inflammation plays in a person’s risk for heart disease.”

Cholesterol, inflammation and other measures for risk of heart attack and stroke are found through blood work. Whether you need a prescription medication or can manage your cholesterol yourself is something that you should discuss honestly with your physician. Your risk factors and your willingness to comply with lifestyle guidelines are serious considerations.

Life after heart attack
For many people, a heart attack is a wake-up call. For Patricia Johnson it’s a paradox, explained Dr. Howes. “In some ways, she’s at lower risk now than she was before her heart attack. She thought she was low risk, and although she’s technically considered high risk now because she's had a heart attack, in practical terms she is actually lower risk because she’s being treated.”

The pumping action of Johnson’s heart was preserved – thanks in part to the quick medical attention she received by calling 911 – so she has a very good prognosis that her heart attack will have no impact on her daily life. That’s good news for her… and for her children and seven grandchildren with whom she spends some of her favorite moments.

Are you having a heart attack?

Don’t take a chance. Call 911 if you experience:
• Discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back
• Uncomfortable pressure, squeezing, fullness or pain in the chest
• Similar discomfort in both arms, or your back or jaw
• Shortness of breath
• Intermittent cold sweats, or are nauseous or light-headed
American Heart Association

February is American Heart Month

Heart Health Fair
Thursday, Feb. 9
Noble Conference Center
No registration is necessary to attend the overall Heart Health Fair. Walk-ins welcome. FREE.

Also at the Heart Health Fair:
Metabolic Screenings to first 60 Registrants
Registration required. 

See February 9th listing in our Calendar for more about the Heart Health Fair and Metabolic Screenings >>