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[REHAB ADVISER]

Heart Attack Counterattack: Fighting Back Against Heart Disease

Barry A. Franklin, PhD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 12 - DECEMBER 96


People who have heart disease can arm themselves against this potential killer. Knowing how to fight back can bolster their defense, even in the face of alarming statistics:

  • Nearly 1.5 million Americans have heart attacks each year, and about a third of them die. What's more, heart attacks are equal-opportunity killers: About half of the nearly 500,000 annual heart attack deaths are among women. And the survivors can't rest easy, either: They are at increased risk for a second, potentially more serious, heart attack.
  • Every year more than 700,000 patients who have heart disease undergo (1) bypass surgery, in which healthy blood vessels are transplanted to bypass clogged portions of coronary (heart) arteries, or (2) balloon angioplasty, in which cholesterol-narrowed coronary arteries are opened with a small, catheter-inflated balloon.

Yet the disease continues to progress in these people as well, even after such steps.

But the picture for people with heart disease is far from bleak. Several "preemptive strikes" have been shown to be highly effective in reducing the chances of having another serious heart-related problem.

A Hearty Battle Plan

Learn about the enemy. With today's changing healthcare environment, it is more important than ever to be well informed. Knowledge will enable you to discuss your heart condition intelligently with your doctor, whom you should select carefully. Read. Ask questions. The American Heart Association (800-242-8721) is a great resource.

Reduce risk factors. Major risk factors for heart disease include cigarette smoking, elevated blood cholesterol (a fatty substance), high blood pressure, and physical inactivity. A low level of high-density lipoprotein (HDL) cholesterol (the "good," or protective, kind) also increases your risk.

What should be your goals? First, stop smoking. In one study (1), heart patients who stopped smoking enjoyed a 62% reduction in deaths over the next 6 years compared with those who continued to smoke.

Aim for a blood pressure under 140 over 90, a cholesterol value under 200, and a total-cholesterol-to-HDL-cholesterol ratio below 5 (divide your total cholesterol number by the HDL value). Oftentimes, these goals can be achieved with a low-fat, low-cholesterol diet and exercise, with or without medications.

For every 1% that high levels of cholesterol are reduced, your risk of a heart attack is lowered by 2%. That means you can cut your risk in half by decreasing your blood cholesterol by 25%!

Moderate exercise can improve your heart health significantly. Walking is the activity of choice for many heart patients. The recommended "dosage" is 12 to 15 miles per week, but start at whatever distance is comfortable for you, and gradually increase your mileage over weeks and months.

Finally, when faced with stressful situations, learn to respond with thought-out solutions and avoid anger and hostility rather than resort to knee-jerk reactions. Recognize that overreacting to things you can't control can be harmful to your heart health.

Consider joining a cardiac rehab program. Studies (2,3) of heart attack patients show that people in rehabilitation programs have a 20% to 25% decrease in heart-related death rates. Such programs can increase fitness, reduce symptoms, improve coronary risk factors, offer social support, enhance well-being, and provide your doctor with vital ongoing information on the status of your health. A program may also help ease worries as you exercise under the supervision of medical professionals who can help you identify potential signs of trouble.

Take your medication. Drugs are often prescribed after a heart attack to prevent chest pain, reduce threatening irregularities in the rhythm of your heart, promote heart pumping action, and lessen the heart's workload. Never stop medication or alter dosages without your doctor's approval.

Get regular checkups. New warning symptoms should be promptly evaluated. Your doctor may also recommend periodic tests to monitor your heart condition. Depending on the results, additional medications or procedures may be recommended.

Take preventive drugs, if prescribed. Some drugs can, in certain patients, markedly reduce the risk of future heart problems. These may include beta-blockers, aspirin, cholesterol-lowering drugs, anticoagulants (blood thinners), and drugs called angiotensin-converting enzyme (ACE) inhibitors for patients who have weakened hearts. None of these drugs, however, should be taken without your doctor's approval.

Heed heart attack warning symptoms. Seek medical help immediately if you experience chest pain or pressure lasting 2 minutes or more. The discomfort may or may not radiate to your arms, neck, back, or jaw. Dizziness, sweating, nausea, palpitations (rapid or irregular heartbeats), and shortness of breath may also occur.

Why should you seek immediate medical attention? Two reasons:

  • The risk of potentially deadly heart rhythm irregularities is greatest within the first few hours after a heart attack begins. A doctor, nurse, or emergency medical technician has barely 4 minutes to normalize a lethal irregular heart rhythm through defibrillation—by putting electrical paddles on the chest and shocking the heart. Otherwise, death occurs.
  • Also, powerful clot-busting drugs or balloon angioplasty, if administered soon after symptoms begin, can often halt a heart attack in progress, or at least minimize damage. Unfortunately, most heart attack victims wait several hours before seeking medical attention. By that time, heart muscle may be permanently damaged.

Heartfelt Advice

You probably have the single greatest influence on your destiny after a heart attack, bypass surgery, or balloon angioplasty. Perhaps retired general Norman Schwartzkopf summed it up best when asked how he would respond to an enemy attack. "Counterattack," he replied. When the enemy is heart disease, the strategy is no different.

Reference

  1. Sparrow D, Dawber TR: The influence of cigarette smoking on prognosis after a first myocardial infarction: a report from the Framingham study. J Chronic Disease 1978;31(6-7):425-432
  2. Oldridge NB, Guyatt GH, Fischer ME, et al: Cardiac rehabilitation after myocardial infarction: combined experiences of randomized clinical trials. JAMA 1988;260(7):945-950
  3. O'Connor GT, Buring JE, Yusuf S, et al: An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989;80 (2):234-244

Remember: This information is not intended as a substitute for medical treatment. If you have a medical concern, consult a physician.

Dr Franklin is the director of the Cardiac Rehabilitation Program and Exercise Laboratories at William Beaumont Hospital in Royal Oak, Michigan. He is also a professor of physiology at Wayne State University School of Medicine in Detroit and an editorial board member of The Physician and Sportsmedicine.


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