Heart attacks and "healthy people''
Nathan Laufer, MD, is on staff at Banner Estrella Medical Center.
Question: My brother is active, involved with sports and very healthy. He gets a physical every year and always gets a clean bill of health. Two weeks ago he had a heart attack. How could this happen?
Answer: This is not as uncommon as one might think. Even though a person has passed a standard exercise stress test, has a good cholesterol score and exhibits no sign of poor health doesn’t mean they are immune to having a heart attack. The cause – Atherosclerosis or blockage of the arteries.
A heart attack occurs when the blood flow to part of heart muscle becomes blocked, restricting oxygen to the heart. If the blood flow isn’t restored quickly, the heart muscle will become damaged and begin to die.
Plaque in the arteries is one of the main culprits. There are two kinds of plaque that can clog up the arteries much like buildup in the drain pipes of your sink. It was originally thought that hard plaque was the major cause but the real danger comes from soft (vulnerable) plaque.
The soft plaque creates a small pimple that forms under the endothelium or inner lining of the artery. If the pimple, which is primarily filled with cholesterol, bursts open it can puncture the lining of the endothelium dumping its contents into the blood stream. A blood clot then forms at the site of the tear as part of the healing process. The clot and the resulting spasm caused by the tear frequently cause an obstruction of the blood flow. The clot and the compromised flow of blood to the heart muscle causes pain. If the flow is restricted long enough it will cause the death of the heart muscle or a heart attack.
Heart attacks need to be dealt with immediately. Anyone feeling pain lasting for several minutes should call their doctor. It doesn’t matter whether or not a pain subsides, you are still at risk. Make the call.
With the proper noninvasive tests, arterial disease can be identified and treated thereby drastically reducing the instance of heart attack. Unfortunately, up to 50 percent of people who have had a heart attack may not have had any prior symptoms. Even a stress test can be normal several weeks before a heart attack, because the pre-existing plaque may not be tight enough to cause symptoms or an abnormal stress test.
Yet this plaque can still rupture, triggering a clot to completely occlude the artery. The best predictor of a heart attack is actually the blood cholesterol level. If high, the plaque becomes fatty and can more easily tear.
Talk to your doctor about adding noninvasive testing of your arteries and blood tests to make sure that your arteries are healthy and not a time bomb waiting to explode.