Since both questions in today's Health Matters deal with heart attacks, let's start with a short primer. Heart attacks typically are years in the making; cholesterol in the blood is deposited in the walls of the arteries going to the heart, forming a buildup over time of a raised bump that narrows the center of the artery. This buildup of cholesterol and other material, called a plaque, may suddenly rupture and expose the inside of the plaque to the blood stream. A clot can then form on top of the plaque, which then totally blocks the artery. As a consequence, the heart muscle tissue beyond the blockage doesn't get enough nutrient blood flow, and dies. It is this dying of heart muscle that is a heart attack. The damaged muscle eventually forms scar tissue, but the scar tissue doesn't help the heart pump blood, and the pumping action of the heart may be reduced.
Q. Many 40-year-old men seem to be having heart attacks lately and dying of them. Why does it seem the younger you are and experience a heart attack, the more likely you are to die of it?
A. Fortunately, the opposite is true -- the younger you are, the lower the mortality after a heart attack. Both the frequency and the risk of heart attacks steadily increase with aging. And thanks to modern treatment, the risk of dying of a heart attack at any age has fallen considerably over the years. The likely explanation for your observation is that a heart attack or death in a 40-year-old is so unexpected and shocking that it sticks in our mind. But be reassured; a heart attack in a 40-year-old is much less common than in an 80-year-old, and the 40-year-old is much more likely to survive.
Q. Recently I heard about a new test for diagnosing heart attacks. What is all the excitement about?
A. There are many causes of chest pain or discomfort, some of them serious (like heart attacks), but many are not (like a pulled muscle). Differentiating heart attacks from all the other causes of chest discomfort is a common challenge for emergency departments. Perhaps the single most useful way to do this is with a blood test that can detect injured heart muscle. When heart muscle dies from a heart attack, the cell membranes in the heart muscle become more porous, and allow some of the material inside the damaged cells to leak out into the blood stream. The blood test can detect this, and thus enable the physician to diagnose the heart attack. The problem is that it may take up to 6 to 9 hours for the material to be detected, and the patient thus has to wait until a definite diagnosis can be made. The excitement is that there is a new blood test that can shorten the waiting period to only three hours; even the current testing method can be adjusted to reliably exclude a heart attack in only three hours. So this is big news because it should allow a significant shortening of the waiting period, and allow patients to know if they have something serious (like a heart attack) or something simple (like a muscle pull) in a much shorter time.
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Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.
