Recognize the Signs

Many people think a heart attack is sudden and intense, like a “movie” heart attack, where a person clutches his or her chest and falls over. The truth is that many heart attacks start slowly, as a mild pain or discomfort. Your symptoms can even come and go.

“If you feel such a symptom, you might not be sure what’s wrong. Even people who have had a previous heart attack sometimes don’t recognize it if it happens again, because the next attack can have entirely different symptoms,” said Cooper University Hospital cardiologist Elias A. Iliadis, MD, Medical Director of Noninvasive Vascular Intervention at the Cooper Heart Institute.

Also, if you’re a woman, you may not believe you’re as vulnerable to a heart attack as men, but you are. Women account for nearly half of all heart attack deaths. Heart disease is the number one killer of both women and men.

It’s vital that everyone learn the warning signs of a heart attack. They are:

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
• Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
• Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.
• Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness.

As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Act Fast

If you or a family member feels heart attack symptoms, call 9-1-1 immediately. Do not delay. Seek fast treatment. Minutes matter. “Heart attack deaths and heart damage can often be avoided when treatment begins within an hour of when the symptoms started. Most studies show a large reduction in death rates and in heart damage in patients treated within 1 hour of the start of symptoms,” said Dr. Iliadis.

There are differences in how women and men respond to a heart attack. “Women are less likely than men to believe they’re having a heart attack and more likely to delay seeking emergency treatment,” Dr. Iliadis said.

Further, women are more likely to have other conditions, such as diabetes, high blood pressure, and congestive heart failure–making it all the more vital that they get proper treatment fast.

Heart disease is the number one killer of American women, and nearly half of all heart attack deaths each year happen to women. Furthermore, women are less likely to survive a heart attack than men.

Be Safe, Not Sorry

Some people who are experiencing the symptoms of a heart attack might wait hours or even days before seeking needed medical care because they do not recognize their symptoms as life-threatening. That’s why it’s important to know the signs and take action quickly.

“Even if you’re not sure it’s a heart attack, you should still have it checked out. It’s better to be safe than sorry, and sometimes chest pain — even mild chest pain — is the only indicator of the beginning of a heart attack,” Dr. Iliadis said.

Emergency medical personnel, or mobile EMS teams, can diagnose a heart attack and begin treatment on the spot. They can even revive a heart that has stopped or is beating erratically.

“Emergency medical personnel want you to call to get your symptoms checked out. Even if the call turns out to be a false alarm, running the risk of feeling a little embarrassed is better than running the risk of dying or having a permanently damaged heart,” Dr. Iliadis said.

Help Yourself and Others

The time it takes for an individual to decide to ask for help is the most significant portion of time delay in getting needed medical treatment for heart attack. Sometimes heart attack sufferers dismiss the seriousness of their symptoms or they fail to recognize their symptoms as life-threatening.

Studies show that family members should expect lack of awareness or denial of the seriousness of the symptoms from those suffering a heart attack, and resistance to calling for help. Many heart attack sufferers will reject calling 9-1-1, thus delaying the arrival of help. That’s why it’s best to enlist family, friends, and co-workers now. Discuss the symptoms. Talk to your doctors about risk for a heart attack. Make a survival plan, before you need one. And remember, while most heart attacks occur in people over 65 years of age, 45 percent, or nearly half, of all heart attacks occur in people under age 65, and five percent occur in people under age 40.

“Whenever a heart attack is suspected, everyone should know to call 9-1-1 immediately. Don’t wait for the person having symptoms to agree. Take charge to make sure the person gets checked out sooner rather than later,” Dr. Iliadis said.

When You’re Having a Heart Attack, Every Minute Counts.

Cooper cardiologists open blocked arteries without surgery, using angioplasty, which restores blood flow and saves vital heart muscle. On average, Cooper doctors perform emergency angioplasty 32 minutes faster than the national average of 90 minutes, saving lives and reducing complications. Many hospitals in the community provide heart care, but few can mobilize a team available 24/7 to provide the skilled emergency care to open blocked coronary arteries. The Cooper Cardiac Catheterization Lab has the physicians, staff, and technology to provide the best heart-attack care in the region.

Related Links

• Cooper Heart Institute
• 46 Minutes to Save a Life (Video)

In observance of National Cholesterol Education Month, the Cooper Heart Institute reminds you to keep your cholesterol levels in check.

The following information is offered to help you understand the importance of cholesterol testing, and how maintaining healthy cholesterol levels can protect your heart and arteries.

What is cholesterol?

Cholesterol is a soft, waxy, fat-like substance naturally produced by the body. The body needs and uses cholesterol to make hormones, Vitamin D, and substances that help with food digestion. Cholesterol also is in some of the foods we eat. Too much cholesterol in the body, however, can build up in the arteries and narrow them, slowing or blocking blood flow to the heart.

What is meant by “good” and “bad” cholesterol?

Cholesterol travels through the blood in different types of bundles called lipoproteins. Low-density lipoprotein – LDL, the so-called bad cholesterol, delivers cholesterol to the body. High-density lipoprotein – HDL, the so-called good cholesterol, removes cholesterol from the bloodstream. This explains why too much LDL cholesterol is bad for the body and why a high level of HDL cholesterol is good. The balance between the types of cholesterol tells you what your cholesterol level means. For example, if your total cholesterol level is high because of a high LDL level, you may be at higher risk of heart disease or stroke. If your total level is high only because of a high HDL level, you’re probably not at higher risk.

When and how should cholesterol levels be tested?

Cholesterol levels should be measured at least once every five years for everyone over the age of 20. (Tests should be done more regularly for people with higher risk for heart disease [see below].)

The test that is frequently used to measure cholesterol levels is called a lipoprotein profile – a simple blood test that requires fasting for eight hours before the test. A lipoprotein profile also measures triglycerides. Triglycerides are fats carried in the blood from the food we eat. A high triglyceride level has been linked to coronary artery disease in some people. Experts recommend that men age 35 and older and women age 45 and older be routinely screened for lipid disorders (high blood cholesterol and triglycerides).

What are the healthy and unhealthy lipoprotein levels?

Total cholesterol levels:

• Less than 200 is best.
• 200 to 239 is borderline high.
• 240 or more means you are at increased risk for heart disease.

LDL cholesterol levels:

• Below 100 is ideal for people who have a higher risk of heart disease. Higher risks include obesity, high blood pressure, diabetes, family history of heart disease, smoking, etc. Some experts recommend that people with heart disease or blood vessel disease should try to get their LDL cholesterol below 70.
• 100 to 129 is near optimal.
• 130 to 159 is borderline high.
• 160 or more means you are at a higher risk for heart disease.

HDL cholesterol levels:

• 60 or higher greatly reduces your risk of heart disease.
• Less than 40 means you are at higher risk for heart disease.

Triglyceride levels:

• Less than 150 is normal.
• 150 to 199 is borderline high.
• 200 to 499 is high.
• 500 or higher is very high.

Remember, a lipid profile can help determine your risk for heart disease and guide you and your doctor in deciding what treatment might be best for you if your levels are borderline or high. Depending on your results and other risk factors, treatment options can involve lifestyle changes, such as diet and exercise, and/or lipid-lowering medications and therapies.

Diagnosing and treating complex lipid disorders

The Cooper Heart Institute offers special expertise in diagnosing and treating complex lipid disorders. Cooper cardiologist Perry J. Weinstock, MD, Head of the Division of Cardiovascular Disease and Director of Clinical Cardiology at Cooper University Hospital, is one of only a few hundred physicians nationwide certified by the American Board of Clinical Lipidology (ABCL). He also is distinguished as an ABCL Diplomate, a status recognizing his successful completion of advanced education and rigorous examination in the field of clinical lipidology. Dr. Weinstock serves on the Board of the American Heart Association and is an officer on the Board of Directors of the Northeast Lipid Association. He also is a member of the editorial board of the Journal of Clinical Lipidology.

Read more about cholesterol and the advanced lipid testing available at the Cooper Heart Institute from these eHealth Connection articles on this topic:

• “Concerned About Cholesterol? Learn How Advanced Screening Can Determine Whether You Need Treatment,” May 19, 2009
• “Understanding Cholesterol and Blood Lipid Profiles,” February 1, 2008

Related Links

• Cooper Heart Institute
• Perry J. Weinstock, MD

“Multiple research studies have confirmed that taking aspirin reduces the number of heart attacks and strokes in men and women, who do not have a history of heart disease,” says Fredric L. Ginsberg, M.D., clinical cardiologist at the Cooper Heart Institute.

But a daily aspirin regimen isn’t healthy for everyone. Although aspirin can fight blood clots that can cause heart attacks and strokes, high doses can increase the risk of bleeding. This can lead to gastrointestinal bleeding and strokes caused by bleeding, known as hemorrhagic strokes.

“An individual’s benefit from daily aspirin depends on the presence of other risk factors for heart disease and stroke, as well as the risk for gastrointestinal bleeding. Therefore, consulting your physician is important before beginning an aspirin regimen,” says Dr. Ginsberg.

Those who may benefit from aspirin therapy include:

• People with coronary artery disease (CAD) or atherosclerosis anywhere in the body (such as the brain or legs).
• Those who have had a prior heart attack.
• Anyone who has undergone bypass surgery to treat heart disease or has angina (chest pain).
• People with risk factors for heart disease, stroke, or a heart attack.
• Men over the age of 50.
• Those who have had a transient ischemic attack (TIA) or ischemic stroke.

But, for some people, the drug has very little effect.

According to research by Dr. Francis Gengo of the Dent Neurologic Institute and the University at Buffalo, up to 20 percent of people who take aspirin don’t benefit from it at all. Also, taking aspirin for a long period of time may make your body more resistant to the benefits.

In addition, aspirin can interact with other over-the-counter supplements to create unwanted side effects. Saint John’s wort, for example, has known anti-clotting effects that can increase the rise of a patient bleeding dangerously.

While aspirin benefits the heart in several ways, it is important to consult with your physician to determine if it is the right choice for you. A trained cardiologist can determine if you will benefit from aspirin therapy, calculate the appropriate dosage and inform you of any potential side effects you should watch for.

Called “arrhythmias,” such chronic disorders of the rate or rhythm of the heartbeat occur when the electrical impulses that control the heartbeat don’t function properly. This malfunction can cause the heart to beat too fast, too slow or irregularly. In either case, the condition can reduce the heart’s ability to pump enough blood to the body, risking damage to organs, stroke, sudden cardiac arrest or even death.

Causes of arrhythmias vary. Smoking, heavy alcohol use, use of certain illicit drugs (such as cocaine or amphetamines), use of certain prescription or over-the-counter medicines, or too much caffeine can lead to arrhythmias in some people. Also, strong emotional stress or anger, which can make the heart work harder, raise blood pressure, and release stress hormones, can lead to arrhythmias in some people.

A heart attack or an underlying condition that damages the heart’s electrical system, such as high blood pressure, coronary heart disease, heart failure, an over- or under-active thyroid gland, and rheumatic heart disease also can cause arrhythmias.

Some people can also be born with abnormal electrical circuits in the heart which lead to arrhythmias.  In some arrhythmias, such as Wolff-Parkinson-White syndrome, the underlying heart defect that causes the arrhythmia is congenital (present at birth). However, symptoms may not develop until later in life.

Other times, the exact cause of arrhythmia is unknown.

While many arrhythmias can exist without signs or symptoms, the most common symptoms are palpitations (feeling that your heart is skipping a beat, fluttering, or beating too hard or fast), a slow heartbeat, an irregular heartbeat or feeling pauses between heartbeats.

More serious signs and symptoms include anxiety, weakness, dizziness, lightheadedness, fainting or nearly fainting, sweating, shortness of breath, or chest pain.

“Dizziness, syncope (passing out) or pre-syncope (almost passing out) could be a serious warning sign of an abnormal rapid or slow heart rhythm,” said Andrea M. Russo, M.D., Director of Cardiac Ablation and Arrhythmia Services at Cooper. “Either fast or slow rhythms can be life-threatening if not adequately treated,” she said.

Specializing in cardiology and electrophysiology (the evaluation, diagnosis and treatment of the electrical activities of the heart), Dr. Russo has researched and published extensively on gender differences in cardiac arrhythmias. In addition to physiological variances, Dr. Russo has noted a discrepancy in the proportion of symptomatic males and females who are referred by physicians for cardiac evaluation and treatment. “Females are underrepresented by about 23 percent with respect to more invasive treatment of one abnormal heart rhythm arising from the upper chambers of the heart, called ‘atrial fibrillation’,” she said.

“Women and men may present with similar symptoms,” Dr. Russo said, “but in women, some symptoms, such as palpitations, may be taken less seriously. Women are more likely to be diagnosed with anxiety than men.”

Regardless of gender, Dr. Russo advises anyone with recurring heart rhythm issues to:

• Talk with your doctor.
• See a heart specialist (a cardiologist or electrophysiologist).
• Develop a plan for evaluation and treatment with your doctor and follow recommendations.

“Proper evaluation and treatment can often control or eliminate irregular heartbeats and extend your life,” Dr. Russo said.

More women die from heart disease than from anything else. The higher incidence rate may be due to unrecognized and/or misdiagnosed symptoms of heart disease in women, which can be more difficult to detect than the symptoms of heart disease in men. As a result, women, and even some doctors, may fail to heed the warning signs associated with heart disease.

“Although the most common presentation in women is the classic chest pressure, women are more likely to present differently than men,” said Cooper cardiologist Kathleen M. Heintz, D.O., who specializes in women and heart disease. “One of the main objectives at the Cooper Heart Institute is to help educate women as well as physicians about the symptoms of heart disease in women,” she said.

While some women describe the typical symptom of pain in the chest, others report no chest pain at all. “Some women describe a hot or burning sensation in the chest, or even tenderness to the touch in the back, shoulders, arms or jaw,” Dr. Heintz said.

Heart attacks may also behave differently in women than in men. Dr. Heintz said. She describes men as being more likely to have the classic “Hollywood-type” heart attack—the red-faced, profusely sweating, chest-clutching portrayals seen in movies, while women, on the other hand, may have no chest discomfort at all. “Women may experience nausea, vomiting, indigestion, shortness of breath or extreme fatigue, but no chest pain. Unfortunately, these symptoms are easy to attribute to something other than the heart. Women also are more likely than men to have ‘silent’ heart attacks—actual heart attacks which are symptom-free but cause damage to the heart,” Dr. Heintz said.

When women do have chest pain, they may not describe it as pain but rather as an “achy” or “heavy” feeling, and disregard the symptoms.

“For women with persistent symptoms, it may be recommended to have at least an initial evaluation with a cardiologist,” Dr. Heintz said.

What are some of the signs of heart disease in women?

• Trouble breathing
• Trouble sleeping
• Feeling sick to the stomach
• Feeling scared or nervous
• New or worse headaches
• An ache in the chest
• Feeling “heavy” or “tight” in the chest
• A burning feeling in the chest
• Pain in the back, between the shoulders
• Pain or tightness in the chest that spreads to the jaw, neck, shoulders, ear, or the inside of the arms
• Pain in the belly, above the belly button

“If you’re a woman with any of these warning signs, don’t wait to get help. See a cardiologist right away. Remember, preventive measures are available to protect you from the leading cause of death in women,” Dr. Heintz said.

For more information about heart disease and staying healthy, read the transcript of Dr. Heintz’ Health eTalk web chat about “What Women Need to Know About Our Hearts” at www.cooperhealth.org/healthetalk.

A Cooper cardiologist explains: “Heart disease is an umbrella term for a number of complex problems affecting the heart muscle, the blood vessels in the heart, and the veins and arteries leading to and from the heart. While all of the many types of heart disease differ, one can think of them in a simplified way as conditions that affect the rhythm and blood-flow of the heart,” said Perry J. Weinstock, M.D., Head of the Division of Cardiovascular Disease at Cooper University Hospital.

Heart Attack vs. Cardiac Arrest

Perhaps the most misunderstood terms related to heart problems is the difference between heart attack and cardiac arrest.

“Heart attack, which is caused by a circulatory problem in the heart, is quite different from cardiac arrest, which is caused by a rhythm problem in the heart,” Dr. Weinstock said. “A heart attack occurs when a coronary artery is blocked and the heart does not get the blood supply it needs, causing permanent damage to a portion of the heart muscle. All heart attacks are due to to circulatory problems; however, not all heart attacks cause the heart to stop beating.

“Approximately one-third of all heart attacks result in cardiac arrest or sudden death. In cardiac arrest, however, the heart does suddenly stop beating. The heart stops because a chaotic, irregular heart rhythm causes the heart to suddenly stop pumping blood. Cardiac arrest, also known as sudden cardiac death, results in a medical emergency, and may or may not be related to a heart attack. Sudden cardiac death is the number one killer among adults in the United States accounting for approximately 300,000 deaths per year,” Weinstock said.

Types of Heart Disease include:

Coronary Artery Disease (CAD) — the most common type and the leading cause of heart attacks. CAD is a narrowing and hardening of the arteries caused by the build up of plaque within the walls of the arteries that supply the myocardium—the muscular tissue of the heart. Angina pectoris (chest pain) is a frequent symptom of CAD. Myocardial infarction is the medical term for a heart attack.

Heart Failure — Heart failure, also known as congestive heart failure (CHF), is an umbrella term for different types of disorders marked by the inability of the heart muscle to pump enough blood throughout the body. This inability restricts the blood supply to other organs, resulting in damage to the organs or poor functioning of the organs. Heart failure has many causes, including untreated high blood pressure. Symptoms of heart failure include shortness of breath; swelling in the feet, ankles, and legs; and extreme tiredness. Heart failure does not mean that the heart stops beating.

Heart Arrhythmias — a group of conditions characterized by irregular heartbeat or abnormal heart rhythm due to a malfunctioning of the heart’s “electrical system”—or impulses that drive the beating/pumping action of the heart. Symptoms may include palpitations, dizziness, fainting, and shortness of breath and chest discomfort. Many different factors can cause arrhythmias, including CAD, electrolyte imbalances in the blood (such as sodium or potassium), changes in the heart muscle, and injury from a heart attack. Atrial fibrillation (A-Fib) is an irregular and often rapid heart rate that commonly causes poor blood flow to the body and symptoms of heart palpitations, shortness of breath and weakness. It is a common arrhythmia that requires close monitoring and treatment with medication or a corrective procedure. Ventricular fibrillation (V-Fib), on the other hand, is always a medical emergency. When V-Fib occurs, effective pumping of the blood stops. V-fib is considered a form of cardiac arrest, and an individual suffering from it will not survive unless CPR (cardiopulmonary resuscitation) and defibrillation treatment are provided immediately.

Cardiomyopathy — the deterioration of the function of the myocardium—the heart muscle. People with cardiomyopathy are often at risk of arrhythmia and/or sudden cardiac death. Many times, the cause of cardiomyopathy is unknown; however, the most common cause is CAD, heart attacks, or myocarditis (a viral infection that causes the heart muscle to become inflamed). Some people with cardiomyopathy never have symptoms, and others have no symptoms in the early stages of the disease; however, as it progresses, the symptoms are similar to heart failure.

Heart Disease Prevention

“Remember, many types of heart disease can be improved, or even prevented, by making certain lifestyle changes, such as not smoking, maintaining a healthy weight, staying physically active, eating healthful foods, managing stress, and controlling such conditions as high blood pressure, high cholesterol and diabetes,” said Dr. Weinstock.

“Also, don’t ignore the importance of regular medical check-ups. Early detection and treatment can set the stage for a lifetime of better heart health,” Dr. Weinstock said.

Consider these facts from the National Institutes of Health:

• People over age 55 have a 90 percent chance of developing high blood pressure in their remaining lifetimes.
• People who are overweight or obese—or have diabetes—are more likely to develop high blood pressure.
• Treating high blood pressure can save your life. It can reduce your chances of having a heart attack by 27 percent, stroke by 38 percent and heart failure by 55 percent.

The good news is that high blood pressure can be controlled. Better yet, it can be prevented.

Here are 8 things you can do to prevent and control high blood pressure:

1. Lose weight if you are overweight and maintain a healthy weight. Limit portion sizes, especially of high calorie foods, and try to eat only as many calories as you burn each day—or less if you want to lose weight.
2. Eat heart-healthfully. Follow an eating plan that emphasizes fruits, vegetables, and low fat dairy products and is moderate in total fat and low in saturated fat and cholesterol.
3. Reduce salt and sodium intake. Read food labels to choose canned, processed, and convenience foods that are lower in sodium. Limit sodium intake to 2,400 mg, or about 1 teaspoon’s worth, of salt each day. Avoid fast foods that are high in salt and sodium.
4. If you drink alcoholic beverages, do so in moderation. For men, that means a maximum of 2 drinks a day, for women, a maximum of 1 a day.
5. Become more physically active. Work up to at least 30 minutes of a moderate-level activity, such as brisk walking or bicycling, each day. If you don’t have 30 minutes, try to find two 15-minute periods or even three 10-minute periods for physical activity.
6. Quit smoking. Smoking increases your chances of developing a stroke, heart disease, peripheral arterial disease, and several forms of cancer.
7. Know you numbers. Talk with your health care professional. Ask what your blood pressure numbers are and what they mean.
8. Take medication as prescribed. If you need medication, make sure you understand what it’s for and how and when to take it, and then take it as your doctor recommends.

“Nearly 1.5 million people suffer heart attacks each year in the U.S., and almost no one has a plan for what to do or where to go,” says Perry J. Weinstock, M.D., Director of Clinical Cardiology at Cooper University Hospital and past president of the South Jersey Regional Board of Directors of the American Heart Association. “The public doesn’t realize that how quickly you receive care to treat a clot or blockage causing your heart attack, and where you receive care, is absolutely critical.”

Research conducted over the past several years has pointed to the importance of limiting the time gap between the onset of heart attack symptoms and when treatment begins. The preferred or gold standard of treatment for myocardial infarction (a heart attack) is to open the blocked artery using percutaneous transluminal angioplasty (PTCA). During angioplasty, an intravenous catheter (tube) is inserted into the groin and carefully threaded up into the heart using specialized x-rays.

The procedure is performed without surgery in a cardiac catheterization laboratory and has proven to be the most effective way to open the artery, return blood flow to the artery, and the heart muscle, and minimize heart damage.

“The problem that arises is that not all hospitals can provide the care that is needed—and provide it quickly,” says Janah Aji, M.D., Director of the Cardiac Catheterization Laboratory.

The American Heart Association and the American College of Cardiology have established specific guidelines for heart attack care. These include restoring the blood flow to the heart muscle within 90 minutes of arrival at the hospital with a cardiovascular surgical team as emergency back-up.

“People are not aware that many community hospitals do not have catheterization labs or staff on site at all times,” says Dr. Aji. “Currently, there are only three hospitals in all of South Jersey that meet the criteria for emergency treatment—and Cooper is one of them.”

“We have the advanced technology, experienced staff and specific protocols in place to meet the targeted goal of 90 minutes or less ‘door-to-balloon’ time. Consequently, our cardiac catheterization lab has some of the best patient outcomes in the country,” says Dr. Aji.

This commitment to providing excellence in cardiac care extends to the entire South Jersey region because of the Cooper Transfer System (COTS).

“COTS has provided urgent transfer of acutely ill patients from community hospitals throughout South Jersey since 2002,” says Joseph E. Parrillo, M.D., Director of the Cooper Heart Institute. “This system allows us to provide broad access to advanced heart care.”

What advice do Drs. Aji and Weinstock give their patients about heart attacks? Plan ahead.

“Every family should have a plan if someone becomes ill,” says Dr. Weinstock. “Calling 911 in an emergency is more or less expected these days. However, there are other important details as well, such as having access to information like medication lists, physician phone number and if given a choice, the name of the hospital you prefer.”

From Dr. Aji, the recommended planning is even more specific. “If you are going to Florida or abroad on vacation, take the time to check out the hospitals in the area where you will be staying,” says Dr. Aji. “It only takes a little bit of research to find out which hospitals serve the area where you are going and which has the most advanced heart care.”

For more information about the Cooper Heart Institute or to schedule an appointment with a Cooper physician, please call 1-800-8-COOPER (800-826-6737).