3 Realities you need to know about Preventing a Heart Attack
The sudden and tragic death at the age of 43 of elite athlete Dean Mercer shocked Australia because of the obvious concerning paradox: how can a young man, in the prime of his life, who dedicated his life to being an elite athlete die from the very outcome that fitness is said to prevent? Aren’t we meant to exercise 150 minutes per week? If this could happen to an elite athlete, why should we bother to ‘sweat it out’?
The underlying question here is, what is the underlying cause of sudden cardiac death?
Contrary to popular belief, not all cardiac arrests (technically a ‘stoppage’ of the heart) are due to ‘heart attacks’ i.e. blockage of coronary arteries. Whilst the majority are, there are a number of other causes as well such as arrhythmias, disorders of cardiac muscle and congenital disorders which can lead to premature death.
Regarding the former, coronary artery disease, what is it and how is it caused? Coronary artery disease is the build-up, (over decades usually) of small cholesterol articles (LDL), which enter the arterial wall (instead of remaining carried in the blood stream), due to breaches of the lining of the wall caused by smoking, diabetes, high blood pressure obesity etc. The cholesterol attracts other cells, often inflammatory white blood cells, to create a pocket of inflammation which can either
- grow slowly and cause symptoms such as chest pain or arm pain or
- If ‘vulnerable’ with a thin cap and ulceration, rupture without warning causing a heart attack and /or sudden death.
Regarding heart attacks, there are many common misconceptions:
Myth #1. You should experience symptoms such as chest tightness on exertion.
Reality #1 Whilst this is true for the slowly progressive plaque, the reality is almost the opposite- 6 in 10 men and 5 in 10 women will not experience any symptoms at all before their heart attack; it ‘came out of the blue’ you will hear. Expect it unless you have been screened (see below)
Myth #2 You have to have traditional risk factors such as those mentioned above- an adverse cholesterol profile, getting older, smoking, being a male etc. I
Reality #2 Increasingly we are seeing more people without traditional risk factors present with coronary artery disease. A recent public publication from Royal North Shore Hospital reviewed almost 700 heart attack patients from 2006 to 2014 and revealed that:
- The rate of healthy patients having heart attacks went up from 11 per cent to 27 per cent over eight years
- The cause of patients with no risk factors to develop hardening of the arteries was unclear
- It’s a misperception that coronary disease only happens in older men who’ve smoked or lived an unhealthy lifestyle
Approximately 1 in 8 people with no symptoms having imaging of their coronary arteries have much more disease than the traditional cardiac risk factors would predict. Clearly there are as yet other not well-defined risk factors at play here. One obvious culprit is stress with a large body of evidence showing associations between high stress and adverse cardiac outcomes.
Myth #3 Women don’t get coronary artery disease
Reality #3 Women over the age of 50 have: more cardiac and strike deaths than breast cancer, women have a higher rate of hypertension than men. They also have more strokes than men
Secondly, regarding the elite athlete and their cardiac health, there are risks peculiar to endurance athletes which are being recognised by the medical profession which you can read more about here. A heart which is asked to perform at high levels for 12-20 hours a week for years or decades seems to be more prone to clinical conditions such as:
- Arrhythmias-atrial fibrillation (which increases stroke risk) and ventricular fibrillation which causes sudden death
- Abnormal thickening and /or stretching of the cardiac chambers (any muscle under load will get thicker) which can cause a myriad of cardiac complications- heart failure, arrhythmias, sudden death
- Dilatation of the aorta (the main vessel coming from the heart) – this can rupture without warning causing sudden death.
So, what are we to do about this? The following thoughts are what we have found works in our preventative medicine practise: our data shows that of approximately 14,000 assessments, we have had only one person suffer a heart attack which (fortunately) was minor and with full recovery- and our client was well over the age of 80 at the time.
- Do the proven basics- yes, do your exercise moderately (HR <85% maximum) at 150 minus/week. Follow the Mediterranean diet as it reduces risk of heart attack/stroke by 30% which is huge
- Have an annual check-up including BP, cholesterol profile, Diabetes check and a full physical exam (at least a resting ECG if not Exercise ECG)
- If concerned, or your risk factors are creeping up (including a family history of premature coronary disease) seriously consider imaging your coronary arteries with CT scanning. This is a game changer – the technology looks directly into your arteries measuring plaque as well as providing other useful information: chamber size, aortic dilatation if present, lung pathology etc. The technology is just outstanding and improving all the time – the radiation doses administered are constantly reducing such that some CT scanners are now giving dose equivalent of radiation similar to 2 chests x rays
- If an elite athlete, particularly in endurance events, recognise there are peculiar cardiac risks and raise these in your annual check up.
At Executive Medicine, we have developed our successful prevention and screening algorithm over the decades and have seen numerous lives saved- it works. Call and make an appointment for your cardiac check-up here, -it may save your life or those you care for -your family, friends or valued employees.