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What is a Heart Attack?
The Street
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5 hours ago
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Sports
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00:00
This morning on BRN, what is a heart attack? And joining me now to discuss this, Dr. Matthew
00:10
Tomey. He is the chair of the American Heart Association's Cardiovascular Intervention Science
00:16
Committee, and he's also an interventional cardiologist at the Mount Sinai Fuster Heart
00:23
Hospital in New York City. Dr. Tomey, great to see you. Thanks for joining us on the program
00:27
this morning. Really grateful to be here. Thank you. Yeah, we're going to talk about heart
00:32
attacks. And I guess my first question is, just as a baseline, what is a heart attack? Because
00:38
you hear about it in the press, you hear it happened to other people, but I'm not sure exactly
00:42
what it is. So I think anybody who hears the term heart attack has a visceral sense that
00:48
it's something serious. And in fact, sometimes people even use the phrase as serious as a
00:54
heart attack. And I think it's valuable to take the moment as you're doing here to break
00:59
down what it actually is. So when we as physicians talk about a heart attack, what we're referring
01:06
to is a sudden change in the balance of blood flow to the heart and demand of the heart for
01:12
oxygen, such that the heart doesn't have enough nutrients and oxygen to do what it needs to do.
01:18
And that creates a state of scarcity for the heart that if left to continue, can actually
01:24
cause heart muscle to die. And that in turn can be associated with serious complications.
01:31
And what I know if I suffered a heart attack, if Jeff Snyder or someone on the street was
01:37
suffering a heart attack, would I physically know that something is wrong so that I could
01:41
raise awareness? So for many who experience heart attacks, there are symptoms that are of sudden
01:51
onset. I think we will most often think about the onset of chest pain as the cardinal symptom
01:58
of heart attack. But it's critical to recognize that chest pain can be felt in various different
02:06
ways by different people. And sometimes it can even be nearly silent. And so having a really
02:13
inclusive sense of what the chest pain of a heart attack could be is really important to being able
02:19
to recognize when one is occurring. And doctor, are there certain risk groups? Well, I want to talk
02:25
about what leads up to a heart attack. And we'll talk about predisposition versus nutrition, etc. But
02:31
are there certain groups of people who are more, not capable, but could have more predisposed to
02:40
having this type of condition? So we do know that there are certain traditional risk factors for
02:47
having a heart attack or myocardial infarction, as we call it. And some of these relate to behavioral
02:55
risk factors like physical inactivity or smoking. Some of them relate to medical risk factors, such as
03:03
a history of high blood pressure, high cholesterol, or diabetes. And some of them are unfortunately a
03:09
little less out of our control, like aging. And we know that with age, the risk of heart attack increases.
03:16
And are there steps that we can take, regardless of our age, to improve our outcomes, one, to avoid
03:26
a heart attack, but also to survive a heart attack, if we are unfortunate to have that happen?
03:33
Absolutely. While I think we're all still looking for the fountain of youth to fix the age part,
03:39
focusing on the controllable is really the key thing. I think the foundation of this is really
03:45
recognizing that a heart attack as an event is really the pinnacle of a process that has not
03:51
just immediately happened in the last minutes or hours, but which has been building up for years and
03:57
frankly, decades. Many don't realize that the seeds of plaque in our arteries are actually sown in our
04:06
young adulthood. As early as our early 20s, you can start seeing plaque in the arteries. And that really
04:13
builds up in a covert manner for years and decades before an individual would ever have their first
04:20
heart attack event. And so as a profession, those of us who care about cardiovascular prevention
04:27
are really starting to think, how can we do better job earlier in the lifespan, earlier in adulthood,
04:33
to really proactively manage some of the controllable risk factors that I'll mention now.
04:38
The American Heart Association helps us to identify those risk factors through something called Life's
04:45
Essential Eight. And these are eight identified factors that are really within our control,
04:52
whether in terms of our behaviors or our partnership with a physician, to help reduce our risk of heart
04:58
attack and stroke and more broadly to improve our cardiovascular health.
05:01
Yeah. And in terms of the prevention, I mean, is it going to your primary care physician and getting
05:11
the standard tests that we all typically get, cholesterol, your triglycerides, all the other
05:18
aspects on a regular basis so that your physician can track what's happening internally?
05:24
We're certainly much better prepared to take action when we know where we stand. And so knowing your
05:33
numbers, I think is a good point of entry. If you're saying to yourself, listen, I woke up today and I
05:40
want to do a better job reducing my risk of a heart attack, reducing my risk of a stroke. Start by going
05:46
to your doctor and just getting a sense of your numbers. And it doesn't even need to be fancy tests,
05:51
just having a baseline understanding of how your blood pressure control is, how your blood cholesterol
05:56
control is, being aware whether or not you have difficulties in managing blood sugar, if not a
06:02
diagnosis of diabetes. This is a really valuable start. And I think it can provoke some constructive
06:09
conversations with a physician on actionable steps.
06:13
And in terms of taking some of those actionable steps, what's available to clinicians to help
06:20
manage? Say you just can't get your cholesterol down. Maybe it's genetic. I mean, there's all
06:25
different reasons. It's your food, it's your body, and you may have a predisposition doing that. Are
06:30
there medicines and things you can take to help manage? So if you're far along, if you're an older
06:34
guy like me, I'm 52, and you're farther along, can you take certain medications to help manage
06:40
this condition over time?
06:44
Well, the first thing I'll say is that there's no point of no return. It's never too late to say,
06:48
I'm going to start today to be healthier. And wherever you're at, there are opportunities
06:53
to reduce risk and to feel better and live longer. You're absolutely right that there's
07:00
certain elements of our risk factor profile which are genetically determined or at least influenced,
07:07
whereas there are other things that are impacted more so by our choices, our diets, our behaviors,
07:13
and so forth. At times in the past, some who have been found to have genetic predispositions to either
07:21
risk factors or cardiovascular disease, I think they may have slipped into a sort of determinism and
07:27
saying, well, this is my destiny. It doesn't matter what I do. And there's been some important research
07:33
which has helped us to realize that even those who have genetic predispositions have opportunity to
07:38
reduce risk and promote health through adoption of many of these essential eight factors. And so I
07:44
think it's important to appreciate that there are heritable tendencies to cardiovascular disease and
07:49
cardiovascular risk factors, but that doesn't mean that there aren't things that we can do to reduce
07:54
risk.
07:56
Yeah. So, I mean, basically, we as individuals can take the necessary steps to get back on track,
08:02
pardon me, if we deviate for whatever reason from the essential eight. Dr. Tommy, we're going to have
08:09
to leave it there. Thanks so much for joining us, and we look forward to having you back on the
08:13
program again very soon.
08:14
It was a pleasure. Thank you.
08:16
And don't forget to subscribe to our daily newsletter, The Morning Pulse, for all the news in one place.
08:21
Details, of course, at our website. And we're back again tomorrow for another edition of BRN.
08:26
Until then, I'm Jeff Snyder. Stay safe, keep on saving, and don't forget, roll with the changes.
08:32
Bye-bye.
08:33
Bye-bye.
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