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Stop! You may be heading toward heart attack row

by Cheryl Sobun

September 1999

First the bad news. "Coronary heart disease is the leading cause of death today in America for both men and women," said Dr. David Engle, a Brookfield cardiologist. Now the good news. "We’re improving," he said. "We have recognized there’s a problem."

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Brookfield cardiologist Dr. David Engle watches as Eugene Pohl performs a stress test. Regular exercise and eating right are key factors to preventing heart disease.

"Between 1985 and 1995, the death from heart attacks has declined by 28.7 percent. That’s a big improvement, due in part to the advances in how we treat heart attacks. But the biggest thing that’s happened is people have recognized certain risk factors that make a heart attack more likely and they’re changing their lifestyles to accommodate that."

So put down your cigarette and glass of wine and don’t pick up that piece of cheese.

Indeed, the American Heart Association has identified six risk factors that contribute to heart disease and heart attacks. Work hard at keeping these risk factors under control, cardiologists say, and you decrease your chances for heart disease and/or a heart attack.

"(With the exception of genetics) these are modifiable risk factors," said Dr. Sanjay Singh, a cardiologist at the Waukesha Heart Institute in the Waukesha Moreland Medical Center. "We can treat these. We can control them."

The Six Risk Factors

1. High blood pressure

This is also referred to as hypertension. Know what your blood pressure is and understand what it means, said Engle. A normal blood pressure should be equal to or less than 140/90. Anything above that needs to be monitored by your doctor. Generally, if your blood pressure is 150/95 or higher, you will need medication to reduce it.

2. Smoking

You’ve heard all the warnings. Smoking and second-hand smoke is bad for you. "Women who smoke and use contraceptives increase their risk of coronary heart disease 39 times," said Engle. "If a spouse smokes, you have an increased risk for developing heart disease," he continued. Cigar and pipe smokers are also at risk because, although they’re less likely to inhale, they’re still getting second-hand smoke and making themselves prime candidates for mouth or throat cancer. "Stop smoking, don’t just cut down. We have a number of things we can do to help, patches, gum, medication. The real thing is you have to decide you want to quit, or it will never happen," Engle said.

The real incentive to quit smoking, he added, is that you’re back to normal in one to two years. In other words, you have a second chance at being healthy, no matter how heavy a smoker you once were.

3. Diabetes

Diabetics are more susceptible to heart disease and heart attack and need to be monitored closely by their physicians.

4. Extra weight or obesity

Exercise and eating right is  important for preventing heart problems. Engle advises exercising three times a week to hold the  weight you’re at, or four times a week to lose weight. Warming up before exercise and cooling down afterward is important.

Singh advised exercising four times a week for at least 20 minutes each time, and he stressed it must be aerobic exercise. Walking and stopping on a leisurely stroll through a park does not count, nor does standing around waiting for your turn at a softball game. Exercise must be continuous brisk walking, hiking, swimming, running, tennis, etc., Engle said.

It doesn’t seem fair, but the older you are, the longer you need to exercise. A 20-year-old might need to run only a mile in ten or 15 minutes and be done. A 40-year old would do better to take a one-hour, three or four-mile brisk walk.

Stay away from fatty foods, such as ice cream, whole milk, fried foods, fast foods and meat. Engle said the American Heart Association recommends limiting meat, poultry and fish intake to just six ounces a day. Instead of making a steak the central item on your plate, make the vegetables and fruits the central items on your plate, he said.

The doctors also suggest eating five helpings of fruits and vegetables a day. Engle said some studies suggest taking Vitamin C and E supplements lower the risk of heart attacks in those known to have coronary heart disease. But don’t take more than what’s  recommended on the bottle, he said.

5. High cholesterol

"Cholesterol is a substance the entire body needs. It’s a healthy thing. It forms cell membranes and hormones. But if there’s too much, it’s a big risk factor for heart disease," said Engle. People should get their cholesterol checked every three to five years, starting in their teens or early 20s, he said, and they should understand the difference between good and bad cholesterol.

HDL (high density lipoprotein) is good cholesterol. The HDL is the vehicle that transports cholesterol away from arteries and to the liver where it is passed out of the body.

LDL (low density lipoprotein) is bad cholesterol. When a person has too much LDL cholesterol circulating in the blood, it can slowly build up within the walls of the arteries feeding the heart. The plaque that forms can clog the arteries.

6. Genetics

If a person’s mother or father had a heart attack at age 65 or younger, that person has cause to be more concerned about having a heart attack. There is even more of a concern if the father or mother had a heart attack at an extremely young age, in his or her 20s or 30s. An extended family member, such as an uncle or great aunt who suffered a heart attack at a young age does have some influence in a person’s chances for having a heart attack, but to a lesser extent, said Singh. Whether or not a person is genetically inclined to heart disease and heart attacks, Singh recommends annual physicals for everyone beginning in their late 20s.

Understanding heart attacks and heart disease is an important part of trying to prevent them from happening. Heart disease covers a wide range of heart problems and a heart attack is a specific form of heart disease, explained Dr. Michael Cinquegrani, a faculty member at the Medical College of Wisconsin, Division of Cardiovascular Medicine in Milwaukee.

Singh explained the four most common types of heart disease:

Coronary Artery Disease

Coronary heart disease is a hardening of the arteries, the most common form of heart disease which can lead to heart attacks. There are three tubes that feed blood into the heart. Like hard water deposits in pipes, a complex chemical substance called Atheroma deposits in these "pipes" leading to the heart. Cholesterol is the most common of these chemicals. The tubes slowly narrow. When one is completely clogged, it causes that part of the heart to die and that is a heart attack.

If you think you may be having a heart attack, check for these symptoms: Chest pain or pressure in the chest, shortness of breath, irregular heart beats, sensation or discomfort in the stomach. A person might think it’s indigestion, but really it’s the lower part of the heart having trouble.

In about eight percent of the cases, a person has a "silent heart attack." That is, he or she felt no pain or experienced no warning signs prior to the heart attack. This most commonly occurs with diabetics who experienced nerve damage and therefore don’t feel the pain or discomfort.

To prevent a heart attack, you should change and modify the risk factors mentioned. High blood pressure should be monitored and can be controlled with drugs. Stop smoking. Eat the right foods and exercise.

Cardiomyopathy

Cardiomyopathy is a weakness of the heart muscle, the second most common form of heart disease. In the majority of cases, the cause is unknown, but some things that cause the weakness is years of excessive alcohol abuse or heavy smoking; viral myocarditis, or inflammation of the heart muscle from a viral infection (treatable); rheumatic myrocarditis, caused from a bacterial infection (curable); Chaga’s Disease, due to an infection from parasites (curable); obesity induced cardiomyopathy and diabetic cardiomyopathy.

Only the first cause of cardiomyopathy can be prevented by avoiding alcohol and smoking.

Valvular Heart Disease

About one to two percent of the population is born with congenital, aortic valve disease which results in two leaflets that make up the aortic valve instead of three and is correctable with surgery. The valves can also start malfunctioning due to rheumatic fever which is curable, or old age, senile valvular heart disease. Unfortunately there is no cure for it.

Electrical problems in the heart

Electrical problems with the heart come about because either the heart is beating too fast, which is called Tachycardia, or too slow, which is Bradycardia.

Dr. Mickey Gadhoke, director of the Arrhythmia Center at the Waukesha Heart Institute explained this further.

Electrical problems are very common, but because of advances in the early ’90s, they are completely curable. A slow heart beat can be corrected by implanting a pacemaker. If the heart beats too fast following a heart attack, it is called ventricular tachycardia and is usually life threatening, Gadhoke said. It requires an implantable cardioverter defibrillator. If a person is born with too fast a heart beat, this condition is called supraventricular tachycardia, and it can be corrected with a procedure called radio frequency ablation which burns off the area causing the problem. There is no cure for this ailment.

What about men versus women? Is one sex more at risk than the other?

"It is a big fallacy to think men are more susceptible," said Singh. "If you look at men and women up to age 40 and 50, incidents are higher in men than in women. After menopause, the risk in women starts rising above the risk for men. At age 80, the risk becomes equal."

"Women are protected by their hormones," said Cinquegrani. "However, as women age and go into menopause, they begin increasing their risk for heart attack."

"It’s not just a men’s disease," Engle summed up.