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Thursday, February 21, 2013

Why does a heart attack occur?

Back in April of 2009, I wrote a blog article titled You're never to old for the "big one"
While it is a few years old, the science and explanation remains sound. Not a week goes by where I do not spend a great deal of time explaining the process of atherosclerosis, the "vulnerable plaque" and myocardial infarction to a patient and his/her family. This discussion frequently happens when I am helping a young heart attack victim but more and more I am having the discussion with patients in the 70's and 80's too.

Therefore, I though it would be helpful to republish this explaination -- I hope it helps:

Here goes:

"This past weekend I took care of a 47 year male in the early stages of a large heart attack. On the outside he appeared to be a healthy and fit guy. However, on the inside, he had a huge clot in his proximal left anterior descending artery -- a lesion we call the "widow maker." Think Tim Russert.

Heart attackes (myocardial infarctions/MI's) come in many different flavors. The ones that we all worry about are the acute ST elevation MI's (think Sanford and Son). This is when a cholesterol plaque ruptures and in the process of thrying to heal the crack in the innner lining of the wall of the artery -- a large clot froms. This clot can end up filling up the enite inside (lumen) of the artery and choke the heart muscle (myocardium). If not treated quickly, permanent damage will occur.
My job is to quickly and safely get in that artery and open it up with a balloon and a stent.

How could this have been prevented? My patient did have a family history of heart disease and high cholesterol.
In my patients, I help assess their risk of "cardiovascular events" with the following:
  • cholesterol levels
  • highly sensitive CRP (marker of inflammation)
  • stress test
  • carotid ultrasound
  • review of risk factors: smoking history, blood pressure, diabetes
  • family history
  • physical activity levels
  • eating habits
  • Calcium Score/Cardiac CT
Please consult with your doctor to evaluate your risk of heart disease."

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