Never too young to have a heart attack
You can be feeling absolutely fine one moment and in the next, experience a heart attack.There’s no way doctors can predict when that might happen, according to Carl Levick, director of Cardiology at King Edward VII Memorial Hospital.The sudden death of two well known men in their 40s both from heart attacks was met with shock and confusion by many in Bermuda.One Bermuda Alliance chairman Sean Pitcher, 49, died from a massive heart attack last month; Donald Tucker, a 41-year-old EMT, suffered a fatal heart attack while spearfishing near Cooper’s Island little more than a week ago. Between those two events Bill Zuill, The Royal Gazette’s Editor, also in his 40s, suffered a major heart attack.How is it that these men, who many of us would deem too young to have a heart attack, actually suffered such?According to Dr Levick heart attacks happen when a blood clot prevents sufficient blood and oxygen from getting to the heart.Why does a blood clot form? The answer lies in the build up of plaque on artery walls.Cholesterol and lipids build up on the artery walls in a process called atherosclerosis. It’s a slow process and develops from the teen years.“As the fat is deposited under the surface of the lining of the coronary artery, its build up eventually causes the lining to rupture,” said Dr Levick. “When this happens blood clots form to try and seal the lesion. The clot propagates and the artery becomes obstructed.”Dr Levick said the obstruction causes heart muscle that would normally be fed by blood and oxygen from that blocked branch, to die.“Luckily we are all born with extra heart muscle so a part of the heart can be damaged and it will still work,” he said. “If the damage is extensive, the heart starts to fail and not pump properly. As cells in the heart suffer lack of blood and oxygen, the heart may become electrically unstable.“With each heart beat there is a wave of electricity that tells the heart to pump. If you are having a heart attack the electricity doesn’t follow its normal route; it short circuits. The heart will fibrillate and loses coordination.“When it fibrillates it quivers and does not pump like a unit. It cannot maintain blood pressure and so the person collapses in cardiac arrest.”In medical shows you will often see heart attack patients ‘shocked’ with defibrillator paddles. Dr Levick said it’s an attempt to restart that natural and necessary electrical flow of the heart pumping in its normal rhythm.“The attacks are abrupt,” he said. “You can feel fine one moment but when plaque ruptures and a blood clot forms, the obstruction that may occur, forms abruptly. That’s why they cannot be easily predicted. We all live with plaque the greater the plaque burden the greater likelihood of an event like this.”In fact it’s the electrical instability of the heart that kills about a quarter of those who have a heart attack.“These are the people we read about who die suddenly without prior known cardiac disease,” said Dr Levick. “The other end of the spectrum comes in with chest pain, that may be a blessing as the patient is able to be medically evaluated before they have a catastrophic event.”
Physicians cannot predict when someone will have a heart attack but they are able to warn patients of their likelihood of suffering one.
“In the medical profession when we think about how to prevent heart attacks we would like to reduce burden in people by attending to the factors that cause atherosclerosis,” said Carl Levick, director of Cardiology at King Edward VII Memorial Hospital.
Dr Levick said it has long been proven that smoking causes more rapid plaque build up in arteries and that hypertension, diabetes, high blood cholesterol level or a family history of similar cardiac events, all put a person at greater risk of heart attack.
He said in Bermuda the problem is addressed in the first instance by the medical community, with the general practitioner determining the risk profile of each patient.
“When there is a high-risk patient they must be treated aggressively to control those risk factors,” said Dr Levick. He said the “aggressive” treatment may include medication, diet modifications, implementing exercise, losing weight and attending to diabetes and hypertension.
“These have all been proven to reduce the risk of heart attack and stroke,” he said. “We start with prevention. We screen high-risk patients with a stress test.”
The stress test measures the flow of blood to and from the heart. Its use is a strong indicator of cholesterol build up on the arteries (atherosclerosis) which is the precursor to blood clot formation and obstruction of arteries.
While a cardiac stress test can indicate atherosclerosis, it cannot pinpoint where a blockage or near-blockage is occurring.
To get a clear picture, a procedure called cardiac catherisation has to be done. This procedure, which involves sending a tube through the groin to the chest, is the best way physicians can see exactly what is going on in the coronary arteries.
Cardiac catherisation is not available locally.
