What is a Heart Attack?

The Street

2 days ago

Transcript

00:00This morning on BRN, what is a heart attack? And joining me now to discuss this, Dr. Matthew

00:10Tomey. He is the chair of the American Heart Association's Cardiovascular Intervention Science

00:16Committee, and he's also an interventional cardiologist at the Mount Sinai Fuster Heart

00:23Hospital in New York City. Dr. Tomey, great to see you. Thanks for joining us on the program

00:27this morning. Really grateful to be here. Thank you. Yeah, we're going to talk about heart

00:32attacks. And I guess my first question is, just as a baseline, what is a heart attack? Because

00:38you hear about it in the press, you hear it happened to other people, but I'm not sure exactly

00:42what it is. So I think anybody who hears the term heart attack has a visceral sense that

00:48it's something serious. And in fact, sometimes people even use the phrase as serious as a

00:54heart attack. And I think it's valuable to take the moment as you're doing here to break

00:59down what it actually is. So when we as physicians talk about a heart attack, what we're referring

01:06to is a sudden change in the balance of blood flow to the heart and demand of the heart for

01:12oxygen, such that the heart doesn't have enough nutrients and oxygen to do what it needs to do.

01:18And that creates a state of scarcity for the heart that if left to continue, can actually

01:24cause heart muscle to die. And that in turn can be associated with serious complications.

01:31And what I know if I suffered a heart attack, if Jeff Snyder or someone on the street was

01:37suffering a heart attack, would I physically know that something is wrong so that I could

01:41raise awareness? So for many who experience heart attacks, there are symptoms that are of sudden

01:51onset. I think we will most often think about the onset of chest pain as the cardinal symptom

01:58of heart attack. But it's critical to recognize that chest pain can be felt in various different

02:06ways by different people. And sometimes it can even be nearly silent. And so having a really

02:13inclusive sense of what the chest pain of a heart attack could be is really important to being able

02:19to recognize when one is occurring. And doctor, are there certain risk groups? Well, I want to talk

02:25about what leads up to a heart attack. And we'll talk about predisposition versus nutrition, etc. But

02:31are there certain groups of people who are more, not capable, but could have more predisposed to

02:40having this type of condition? So we do know that there are certain traditional risk factors for

02:47having a heart attack or myocardial infarction, as we call it. And some of these relate to behavioral

02:55risk factors like physical inactivity or smoking. Some of them relate to medical risk factors, such as

03:03a history of high blood pressure, high cholesterol, or diabetes. And some of them are unfortunately a

03:09little less out of our control, like aging. And we know that with age, the risk of heart attack increases.

03:16And are there steps that we can take, regardless of our age, to improve our outcomes, one, to avoid

03:26a heart attack, but also to survive a heart attack, if we are unfortunate to have that happen?

03:33Absolutely. While I think we're all still looking for the fountain of youth to fix the age part,

03:39focusing on the controllable is really the key thing. I think the foundation of this is really

03:45recognizing that a heart attack as an event is really the pinnacle of a process that has not

03:51just immediately happened in the last minutes or hours, but which has been building up for years and

03:57frankly, decades. Many don't realize that the seeds of plaque in our arteries are actually sown in our

04:06young adulthood. As early as our early 20s, you can start seeing plaque in the arteries. And that really

04:13builds up in a covert manner for years and decades before an individual would ever have their first

04:20heart attack event. And so as a profession, those of us who care about cardiovascular prevention

04:27are really starting to think, how can we do better job earlier in the lifespan, earlier in adulthood,

04:33to really proactively manage some of the controllable risk factors that I'll mention now.

04:38The American Heart Association helps us to identify those risk factors through something called Life's

04:45Essential Eight. And these are eight identified factors that are really within our control,

04:52whether in terms of our behaviors or our partnership with a physician, to help reduce our risk of heart

04:58attack and stroke and more broadly to improve our cardiovascular health.

05:01Yeah. And in terms of the prevention, I mean, is it going to your primary care physician and getting

05:11the standard tests that we all typically get, cholesterol, your triglycerides, all the other

05:18aspects on a regular basis so that your physician can track what's happening internally?

05:24We're certainly much better prepared to take action when we know where we stand. And so knowing your

05:33numbers, I think is a good point of entry. If you're saying to yourself, listen, I woke up today and I

05:40want to do a better job reducing my risk of a heart attack, reducing my risk of a stroke. Start by going

05:46to your doctor and just getting a sense of your numbers. And it doesn't even need to be fancy tests,

05:51just having a baseline understanding of how your blood pressure control is, how your blood cholesterol

05:56control is, being aware whether or not you have difficulties in managing blood sugar, if not a

06:02diagnosis of diabetes. This is a really valuable start. And I think it can provoke some constructive

06:09conversations with a physician on actionable steps.

06:13And in terms of taking some of those actionable steps, what's available to clinicians to help

06:20manage? Say you just can't get your cholesterol down. Maybe it's genetic. I mean, there's all

06:25different reasons. It's your food, it's your body, and you may have a predisposition doing that. Are

06:30there medicines and things you can take to help manage? So if you're far along, if you're an older

06:34guy like me, I'm 52, and you're farther along, can you take certain medications to help manage

06:40this condition over time?

06:44Well, the first thing I'll say is that there's no point of no return. It's never too late to say,

06:48I'm going to start today to be healthier. And wherever you're at, there are opportunities

06:53to reduce risk and to feel better and live longer. You're absolutely right that there's

07:00certain elements of our risk factor profile which are genetically determined or at least influenced,

07:07whereas there are other things that are impacted more so by our choices, our diets, our behaviors,

07:13and so forth. At times in the past, some who have been found to have genetic predispositions to either

07:21risk factors or cardiovascular disease, I think they may have slipped into a sort of determinism and

07:27saying, well, this is my destiny. It doesn't matter what I do. And there's been some important research

07:33which has helped us to realize that even those who have genetic predispositions have opportunity to

07:38reduce risk and promote health through adoption of many of these essential eight factors. And so I

07:44think it's important to appreciate that there are heritable tendencies to cardiovascular disease and

07:49cardiovascular risk factors, but that doesn't mean that there aren't things that we can do to reduce

07:54risk.

07:56Yeah. So, I mean, basically, we as individuals can take the necessary steps to get back on track,

08:02pardon me, if we deviate for whatever reason from the essential eight. Dr. Tommy, we're going to have

08:09to leave it there. Thanks so much for joining us, and we look forward to having you back on the

08:13program again very soon.

08:14It was a pleasure. Thank you.

08:16And don't forget to subscribe to our daily newsletter, The Morning Pulse, for all the news in one place.

08:21Details, of course, at our website. And we're back again tomorrow for another edition of BRN.

08:26Until then, I'm Jeff Snyder. Stay safe, keep on saving, and don't forget, roll with the changes.

08:32Bye-bye.

08:33Bye-bye.

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