By William C. Dillon, M.D.
“Whoa that was a tough work-out. I feel a little funny in my chest. It is a slight burning that goes up into my throat. It can’t be my heart. I am an athlete and exercise regularly. It probably is a pulled muscle or indigestion.”
For athletes over the age of 35 the most common cause of death is from coronary artery disease. Coronary artery disease is caused by life-long neglect or abuse that then suddenly comes to a head in the form of a heart attack.
“The indigestion is getting worse and now feels like something sitting on my chest. I can’t be having a heart attack. I am an athlete. I dropped everyone on the ride last weekend.”
Most heart attacks come on without any warning. The majority of heart attacks are caused by a rupture of a mild to moderate plaque in the coronary artery; <70% narrowed. This mild plaque would not restrict flow to the heart normally but when it becomes unstable and ruptures a clot forms at the level of the plaque blocking the artery off suddenly. This explains how someone could exercise or pass a stress test without any symptoms and then a few days later have a heart attack.
“This chest pressure is getting bad. I wonder if it is my heart. I may try some Tums or a nap and see if it goes away.”
If you think you are having heart problems, now is not the time to try and tough it out. Seek medical attention immediately. It is often tough for physicians to sort out the causes of chest pain. It is better to be safe than sorry. Time is muscle when dealing with heart attacks. The sooner we can stop the heart attack the better you will do.
“The pain is not going away. I think I will go to the immediate care center to get checked out.”
Up to 30% of patients die before coming in contact with the health care system. Most likely they die from an unstable heart rhythm that is precipitated by the heart attack. Don’t be the person who dies in his car 500 yards from the emergency room. Going to a immediate care center or your primary care doctor is probably not the best option as it will lead to delays in your care. It is best to call 911. The EMS crew can do an ECG and activate a cath lab from your location, which saves a tremendous amount of time. In addition, the EMS crew will be able to monitor your rhythm and initiate treatment. All major emergency rooms have procedures for quickly dealing with patients with chest pain.
The best treatment for a heart attack is to have an angioplasty. An angioplasty is a procedure where a balloon is threaded through an artery in the leg up to the heart. The balloon is inflated and the blockage in the coronary artery is opened. Often a stent is implanted in the coronary artery to help prop it open. Fortunately, in Louisville we have five excellent centers that provide angioplasty 24 hours a day, 7 days a week. It is very important that you ask to go to an angioplasty center. This may not be the closest health care facility for you but will shorten delays. Remember, time is muscle and there is a race to get the artery open.
“I can’t believe that I had a heart attack. I work out all the time.”
If exercise is your primary treatment for diabetes, hypertension and elevated cholesterol, then you could be in trouble. You cannot out exercise your risk factors. In particular, hypertension and high cholesterol are silent assassins. These two risk factors do there damage for a long period of time without much in the way of symptoms until you show up with a heart attack, stroke or some other vascular event. Exercise is part of the answer for being healthy and avoiding heart disease but do not ignore other risk factors.
“Will I live and be able to do my activities like before the heart attack.”
The sooner you can get an angioplasty and stop the heart attack the better you will do. Fortunately, if you are athletic then likely you will not have many other co-morbid conditions and be in better health overall. This will come in handy as you recover from the heart attack. There will be a period of time where you will not do much activity as we allow the heart to heal and recover from its injury. Cardiac rehab will start 2-4 weeks after you leave the hospital. Often for athletes we need to adjust the program to make it more intense to mimic what they will be doing in the future. Some of the medications that you will be on after the heart attack can inhibit your maximal athletic performance. These may have to be adjusted overtime. Mentally, after a heart attack, patients often have a grief reaction and can be subject to depression.
Fortunately, patients are doing better than ever and leading active and productive lives after heart attacks. The best treatment is to prevent the problem and modify all risks. In the event you think you are having a heart attack, don’t delay and seek medical attention quickly.
Image from: www.nutrifile.com
William C. Dillon is a cyclist and swimmer as well as an interventional cardiologist with Louisville Cardiology P.S.C. He is primarily located at Baptist Hospital East.