Heart Attacks Blog

Tim Russert, the well known television reporter died after a heart attack yesterday.

Mr. Russert collapsed at his studios and was pronounced dead a short time later at Sibley Memorial Hospital. Emergency medical services attempted resuscitation efforts but were unsuccessful. Mr. Russert never regained consciousness.

Mr. Russert was 58 years old and had several cardiac risk factors including diabetes. He also had known blockages in his coronary arteries. An autopsy performed on the day of his death revealed a new complete blockage of a major coronary artery (thrombosis of the left anterior descending artery).

It is likely that one of the known blockages “ruptured” and caused clotting inside the blood vessel. This led to a complete obstruction to blood flow and possibly resulted in a life-threatening heart rhythm – called sudden cardiac death. In this scenario, the heart beats extremely fast and cannot fill with blood. The pumping action of the heart becomes ineffective and blood flow to the organs, including the brain and the heart itself, stops. One becomes unconscious within seconds and the body shuts down soon thereafter. The process is probably painless.

Shocking the heart with with electricity via an automatic external defibrillator (AED) can sometimes restore a normal rhythm. Unfortunately, this is often not successful.

My prayers are with Mr. Russert’s family and friends. His death represents a great loss.

A study in the Archives of Internal Medicine asked 3522 patient with heart disease to identify symptoms of a heart attack. Nearly half of those studies scored over 705 on the questionnaire.

Women, younger people, more educated people, and those cared for by a cardiologist scored better.

It is critical for all people, especially those who have had a heart attack or a balloon and stent procedure to accurately and quickly identify heart attack symptoms. This could save your life.

A normal CT angiogram predicts an extremely low chance of a future heart attack. This technology has recently been used to diagnose heart attacks in patients seen in a hospital's emergency department with chest pain.

A study presented at the Society for Academic Emergency Medicine meeting evaluated nearly 600 low risk patients treated in an emergency department for chest pain. Of those patients who had a normal CT angiogram, none had a cardiac complication over the following 30 days.

It is not clear what happened with the patients who had an abnormal scan.

An exciting aspect of this study is the ability to quickly evaluate and discharge a patient with chest pain. A CT-angiogram result is available within minutes. The traditional approach of diagnosing chest pain includes several blood tests and often a stress test. This process can take many hours.

The associated press is reporting that the actor, Kelsey Grammer, suffered a “mild heart attack” this weekend.

Mr. Grammer is 53 years old. He experienced his symptoms while paddle-boarding and was immediately taken to an area hospital. He will be released this week.

Based upon a limited description of events, Mr. Grammer likely suffered a non-ST-elevation myocardial infarction. He likely had angina while exerting and took appropriate action by seeking immediate medical attention. It is not clear if he was treated with medications or the balloon and stent procedure.

I wish Mr. Grammer a speedy recovery and the best of health.

Heart attacks can and do occur in young women. Unfortunately, this patient population has several strikes against it during a heart attack.

First, heart attacks are rare in young women. Symptoms that would normally draw attention may thus be overlooked. For example, a doctor may not place a heart attack high on the list of possible diagnoses in a woman with shortness breath and atypical chest discomfort. The same symptoms in an elderly male patient often prompt a heart attack as the leading diagnosis.

A second problem with diagnosis is that heart attacks in women are often associated with atypical symptoms. Women under 55 often expect chest pressure as the only symptom of a heart attack. Instead, symptoms can include shortness of breath, fatigue, nausea, or sweating. A delay in treatment because the heart attack symptoms are unusual can be life threatening.

An important part of the physical examination for a cardiologist is listening to your neck. A stethoscope can detect vibration (bruit) in the neck’s arteries (carotids). The bruit is caused by blockages in these critical arteries supplying the brain and turbulence in blood flow.

Blockages in the carotid arteries are formed in a similar process as those in the coronary arteries. Those with abnormal cholesterol levels, diabetes, and high blood pressure are more likely to develop both a heart condition and carotid artery disease and a stroke. It’s not surprising that carotid artery bruits and heart attacks occur in the same people.

A study of over 17,000 people, published in Lancet, indicates that those with a carotid bruit are twice as likely to have a heart attack as those without.

If a bruit is heard, further testing, such as an ultrasound of the neck, is needed. Additionally, you may need to start taking aspirin. As with any medical decision, talk to your doctor before initiating, stopping, or changing treatment.

Low thyroid function may put women at risk of a heart attack. A study published in the Archives of Internal Medicine evaluated over 17,000 women with no signs of heart disease. Those with low thyroid hormone levels but no physical signs of thyroid disease were at a 69 percent higher risk of a heart attack, possibly due to a rise in blood pressure and abnormal cholesterol levels.

Similar findings were not noted in men.

It is not clear if treatment with synthetic thyroid hormone could prevent heart disease. More studies need to be done to better understand the connection between thyroid levels and heart disease.

The longer a coronary artery is blocked the more heart muscle dies. Early diagnosis of a heart attack is thus critical. A phrase often heard among cardiologists is “time is muscle”.

Currently electrocardiograms (ECGs) and blood tests are used to diagnose heart attacks. Unfortunately, ECGs are not always accurate and blood tests can take up to eight hours to become abnormal after a heart attack starts.

A new way to diagnose a heart attack within fifteen minutes may come from your saliva. Researchers at the University of Texas at Austin recently developed a technique to use several drops of saliva on a specially designed micro-chip. An abnormal test result can not only diagnose a heart attack but also predict your risk of having one in the future.

LabNow, Inc is developing this exciting new technology.

Bystander cardiac pulmonary resuscitation (CPR ) doubles the chance of survival from a cardiac arrest. The American Heart Association recently issued new guidelines on performing CPR.

Traditionally, those who provide CPR were instructed to give both chest compressions and breaths in a 15:2 ratio. The newer guidelines advise giving significantly more chest compressions relative to breaths (30:2). It turns out that the time spent interrupting compressions to give breaths may be better spent giving more compressions.

The new guidelines advise giving 30 compressions instead of 15 for every two breaths.

By giving more chest compressions, a grater amount blood flow is delivered to the heart muscle. If the heart should recover after a cardiac arrest the extra blood flow provides energy and allows for restoration of normal contraction. Conversely, if compressions are interrupted, the recovering heart may not be able to pump once restarted.

An article in Circulation recommends that bystanders who witness a person’s sudden collapse give compressions in the center of the chest after calling emergency medical services (EMS). The chest compressions should be hard and fast pushing motions without interruption. The article stresses that ventilation is still advisable if possible. However, chest compression alone is acceptable for those unable or unwilling to provide breathing assistance (ventilation).

It’s important to note that rescue breathing is especially critical in some cases. For example, if the cause of cardiac arrest is predominantly due to a breathing, or respiratory, problem such as drowning or choking. Additionally, the new guidelines do not apply to situations in which a person’s collapse is not witnessed and to children with cardiac arrest.

One goal of the new guidelines is to reassure bystanders, who may hesitate to provide mouth-to-mouth breathing to a stranger, that CPR alone is acceptable.

USA Today reports that since 2006 the number of balloon and stent procedures, also known as angioplasty and stenting, has been on the decline in the United States by up to 15 percent. Although the exact cause is not clear, decreasing smoking rates and greater use of medications such as aspirin and statins are likely contributing. Additionally, recent media reports about the controversial use of stenting may be affecting doctors’ decisions.

Look for more information on trends in cardiac procedures from the upcoming meeting American College of Cardiology meeting in Chicago.