Somebody who’s having chest pain should call 9-1-1. I often tell my patients that
I would rather you would come to the emergency room be evaluated for what isn’t a heart
attack, than to stay home, have a heart attack and then end up in severe problems. I think
if you have any concern that this is a heart attack or a heart attack developing, call
9-1-1. Make sure you take care of yourself. And then we all learn from that.
Not always do many patients understand that a third of people don’t have any symptoms
of the heart attack itself. They sometimes just have symptoms of the heart not functioning
normally. So at a time when you have artery inclusion, many people may feel the chest
pain or the shoulder pain or the jaw pain (which is classic), we think about. They might
feel short-of-breath, they might be short-of-breath with activity. They may even actually have
some stomach indigestion type symptoms.
Not always, women often don’t have the severity of the symptoms; they don’t have the classic
warnings that we think about (the chest pain, the elephant sitting on my chest, the arm
pain). They’re more like to have atypical symptoms, such as short-of-breath, dysemia.
And again, some people don’t have any symptoms at all.
As you get older, there’s a heart attack risk. One of the number one predictors for
developing a heart disease and a stroke is being old enough. We know that people in their
20s and 30s have narrowing of their arteries that gradually develop and progresses to the
point where they have their heart attack at the age of 55 or 60. Even though you might
be healthy and thin, you still might have the genetic previous position or the risk
for developing coronary disease and heart attack or stroke. So making sure you’re
thinking about those things when you’re twenty, when you’re thirty or when you’re
forty could often prevent disease progression to the point where you would prevent having
a heart attack when you’re 55 or 65. I always think of the patient I took care of who was
35 years old and had a heart attack; very athletic, vegetarian, but he was still having
a heart attack. And as I told him, if he hadn’t done those things, he maybe have had that
heart attack earlier. There’s an increased risk for him and his family for having early
heart disease. So taking care of yourself and doing the right things is clearly an important
step, but also know what your individual risk is is the right thing.
Generally true, but what we really need to understand is that a total cholesterol can
be elevated for a couple different reasons. It can be elevated with disproportionately
high bad cholesterol. It can also be elevated with good cholesterol. So what we really need
to do is look at the different components of the total cholesterol and say, “is that
an adverse risk, is this a profile that’s going to limb me towards a heart attack?”
I think yes, but we still need to be smarter about it and know more information.
That’s a common misperception. To develop a heart attack, is years and years of accumulation
of lipids in the artery, developing that plaque. So the issue of having your heart attack today
only reflects those years of accumulation and I think you were healthy yesterday in
that you weren’t bothered, but you truly had the disease that was progressing (it was
what we call subclinical). It was present, but you weren’t bothered by it. Today you
were bothered with your heart attack. It’s a reflection of a long-time accumulation.