First Hour Essential After Heart Attack

At the first sign of a possible heart attack, get to a hospital immediately.

That’s the message from Dr. Ted Fish, a cardiologist at Washington Regional Medical Center in Fayetteville.

“When you get symptoms, don’t ignore them,” Fish said. “Don’t assume it’s indigestion.”

The risks of cardiovascular disease double after forty, according to the American Heart Association. Stress experienced by many working professionals can increase risks exponentially.

Fish said patients who are treated within the first hour after a heart attack are much more likely to have a full recovery. Heart muscle starts to die after being deprived of blood for 20 minutes, and full damage to a section of the heart can be done in six hours, he said.

“It’s horrible to see someone who has stayed at home with a heart attack for hours,” Fish said. “In the heart-attack business, we have a saying, ‘Time is muscle.’ When you have a heart attack, you’re in the process of killing muscle. I always regret it when people come in here when the heart attack is almost complete.”

Fighting Plaque

The May issue of Scientific American contained a cover story about new theories on what causes heart disease.

According to the article, five years ago, the prevailing theory was that “fat-laden gunk” would gradually build up on the surface of passive artery walls, eventually closing off the artery and causing a heart attack.

Now, the theory is that most heart attacks are caused by inflammation of the arteries, which causes the fibrous cap over plaque to break open, prompting a blood clot to develop, sometimes suddenly, over the plaque.

Plaque is a complex lesion that begins as a minor injury to the surface of a blood vessel. There are three main vessels that carry blood to the heart. A heart attack usually occurs when one of those three vessels is clogged.

Fish said doctors have known for years that plaque played a role in heart disease, but it wasn’t until recently that the extent of that role was determined.

“It’s the rupture of plaque that causes heart attacks 90 percent of the time,” he said.

A plaque rupture would also explain why some people who have never been diagnosed with heart disease suddenly have a heart attack. Such cases account for about one-third of all heart attacks, Fish said.

“We can usually diagnose the presence or absence of heart disease,” he said, referring to atherosclerosis, “but we can’t predict if or when somebody will have a heart attack.”

Fish urges people with a history of heart disease to be tested, but he cautioned that, even if the tests indicate no problems, the patient could have a heart attack the very next day.

Everybody over the age of 60 has some plaque in his arteries, and some people even have it in their 20s, Fish said.

There’s really no way to measure arterial plaque, but Rapid CT, a new test that can tell if there’s calcium in the arteries, is also a “fair indicator of plaque,” Fish said.

Scientific American reported that tests that measure C-reactive proteins in the blood may be a good indicator of inflammation of the blood vessels.

Prevention

We’ve all heard it before: eat right, exercise, don’t smoke. That’s still the recipe for prevention of a heart attack.

Fish said the medical profession has also been more aggressive in the past few years in prescribing cholesterol-lowering drugs and drugs that prevent blood clots.

Fish said people who take cholesterol-lowering drugs have smaller and “more stable plaques,” meaning they are less likely to break loose and cause a blood clot.

“We’re still doing research to see why people get these plaques,” Fish said.

Dr. Peter Libby, author of the Scientific American article, said he believes LDL, or “bad cholesterol,” “probably plays an even larger role in initiating and perpetuating atherosclerosis than is generally recognized.”

Libby, who is chief of cardiovascular medicine at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School, wrote that diabetes elevates glucose levels in the blood, which can increase inflammation and possibly lead to excess plaque. Other factors that can add to vascular inflammation include obesity and high blood pressure.