How Not To Die Of A Heart Attack

I’m a 50-something man and over the last few years I’ve seen a number of men my age, in my community, simply drop dead. Why would an apparently-healthy 50 year old just drop dead?

It’s easier, I think, for us to grasp the thought of a young-ish person dying of cancer, a drug overdose, a traffic accident. But to just drop dead—it’s terrifying.

We usually classify these sorts of cases as “sudden cardiac death” (SCD), defined as someone dying within an hour of developing symptoms such as chest pain, or found within 24 hours of last being seen alive. And when this happens in my community, the only good to come of it is a rise in awareness. I will typically get lots of calls, texts, and office visits of people wanting to know what they can do to avoid the same fate.

(Sudden cardiac death is also known as “sudden cardiac arrest” because it doesn’t always end in death—in the right circumstances, someone can be saved.)

It turns out we can’t always avoid sudden death, but we have become pretty good at it. As you can see in the graph below, rates of SCD are dropping dramatically, mostly due to improvements in the treatment and prevention of heart disease.

Quick facts:

• SCD is relatively common: about 350,000 Americans die from it annually.

• Only about 5% of people who suffer SCD survive, so prevention is key

• Men are 3-4 times more likely to suffer SCD than women.

• Already having heart disease is a huge risk factor, and about 60% of people with heart disease die of SCD.

• The risk of SCD increases significantly with age.

Sudden cardiac death is a lot easier to comprehend in older, sicker people. When it happens to a younger person, people ask all sorts of questions: Was he sick? Was he on drugs? Was he ignoring warning signs? Some of these questions can be pretty upsetting to the families and friends of the deceased. I think a lot of it comes from our cultural habit of looking for someone to blame, even though asking who’s to blame is the wrong question. It’s not always about what someone did or didn’t do. Sometimes bad things just happen. But there’s plenty we can do with the right knowledge.

Most people who die from SCD—even in their 40s and 50s—have underlying heart disease—they just don’t know it. It isn’t usually due to drugs or other personal habits. It’s bad luck. But there are patterns. About half the time, SCD is the first indication that someone has heart disease. Since we’ve become so good at preventing SCD when we know someone has a problem, it would be very helpful to find out if, in fact, someone has a problem.

So how can you avoid SCD?

Sudden cardiac death is usually—but not always—a heart attack

First, let’s briefly review what we mean by “heart disease”. In this case we are talking about coronary heart disease (CHD), also known as atherosclerotic heart disease (ASHD). This refers to blockages in the coronary arteries, the blood vessels that feed the heart muscle itself.

Plaques in the arteries build up over time, and generally you don’t know their there. Under the right (or perhaps wrong) conditions, the plaque can rupture, causing a sudden blood clot. The heart muscle supplied by that blood clot is starved oxygen and starts to die—this is a heart attack. Depending on how much heart muscle is affected, this can cause the whole heart to stop pumping, or only part of it, or it can cause a rhythm problem that keeps the heart from pumping properly. If caught quickly, a cardiologist can save the patient’s life. If not, well, then it really is sudden cardiac death.

Knowledge saves lives

As is often the case, simply knowing a few simple facts can save your life. Heart attacks can certainly occur in people who don’t have risk factors. Usually though there are some even if no one knew about them:

• Smoking

• Age

• High cholesterol

• High blood pressure

• Diabetes

• Family history of heart attack

• Other (ethnicity, sex, stress, obesity, poor diet, sedentary lifestyle)

Some of these are what we call “modifiable risk factors”: you can quit smoking or lower your blood pressure, but you can’t change your age or your family history.

This is where having a primary care doctor can make the difference between a long life and a short one. Your doctor can screen you for these risk factors and help you improve them, though lifestyle changes, medications, or both. And in certain situations, we can run tests that help us refine your risk. For example if you are very high risk, are having some chest pains, or even if you’ve simply noticed a recent drop in your endurance, we can do things like stress tests. If you aren’t having symptoms and we’re just trying to narrow down how much risk you actually carry, we can do something called a “coronary artery calcium score”, which is a relatively inexpensive CT scan of the heart. And we have all sorts of risk assessment tools that help us set up a course of action as well.

It’s important to know your risks; to see a doctor regularly (usually once a year unless something needs closer monitoring); and to listen to your body. If you feel something strange, or even just have a nagging feeling something is wrong, listen to that feeling. If a loved one is worried, believe them.

Stay well.

-pal