Heart Attack Archive

Good news for heart attack victims: hospitals across the country have shaved more than 30 minutes off the time it takes to begin artery-opening angioplasty and stent placement, the best treatment for a heart attack in progress.

Hospitals use a measure called door-to-balloon time (named after the balloon used to open an artery) to track how quickly they can get a patient from his or her arrival at the hospital to the start of angioplasty. In 2005, the median door-to-balloon time was 96 minutes. At the end of 2010, it was 64 minutes (Circulation, Aug. 30, 2011). That's a remarkable improvement, prompted by efforts from the American Heart Association, the American College of Cardiology, and other organizations.

People with heart disease should take aspirin; the decision is trickier for those without it.

For survivors of a heart attack or a clot-caused (ischemic) stroke, and for almost everyone else with coronary artery disease, there's an across-the-board recommendation to take an aspirin a day. But what about folks who haven't been diagnosed with heart disease? Can an aspirin a day help them, too?

By Richard Lee, M.D.
Associate editor, Harvard Heart Letter

When I was a newly minted cardiologist, heart attacks were feared far more than they are today. They terrified people who were having them, and their families, because they were known killers. Heart attacks made doctors nervous, too, since we were less certain about how to treat them and the therapies available to us were less effective than the ones we have at our disposal today.

Surviving a heart attack — A success story

Morbidity and Mortality Chart Book, National Heart, Lung, and Blood Institute, 2009.

Measuring blood pressure: Let a machine do it

Myers MG, Godwin M, Dawes M, et al. Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial. BMJ 2011; 342:d286.

Millions of women and men take calcium pills to strengthen their bones and ward off osteoporosis. Whether taking calcium is good, neutral, or bad for the heart is a matter of conflicting studies and lively debate. Australian researchers have sounded another note of caution in a controversial paper they published in the medical journal BMJ.

The Australian team took a fresh look at data from the Women's Health Initiative Calcium–Vitamin D Supplementation Study. It randomized 36,282 women to a calcium–vitamin D supplement or to a placebo. The results of the trial, published in 2006, showed a small improvement in hip bone density but no effect on hip fracture. The researchers reported that the numbers of heart attacks and other cardiovascular problems were the same in both groups.

These drugs may harm more than help after a stroke linked to a degenerative brain condition.

The drugs known as statins do many good things. They are the most powerful cholesterol-lowering agents discovered so far. They help prevent heart attacks in people who have had one, as well as in those at high risk for one. They lessen the risk of having an ischemic (clot-caused) stroke, the most common kind of stroke in the United States. Use of statins has been linked to stronger bones, better brain health in old age, and other noncardiovascular benefits.

Parents pass on many things to their children — genes, love, a taste for certain foods, some habits, and heart attack risk. Yet family history isn't included in the Framingham risk score, a widely used tool for gauging heart attack risk. Intriguing information from the global INTERHEART study suggests that family history — specifically if and at what age a parent had a heart attack — should be used to help calculate a person's chances of having a heart attack.

The INTERHEART investigators asked 12,000 heart attack survivors and an equal number of healthy men and women about their parents' cardiac health. The risk of having a heart attack increased with the number of parents who had one, especially before age 50 (see table). The relationship persisted even after the investigators made adjustments for age, gender, and other factors that are key contributors to cardiovascular risk. Having one parent who had a heart attack after age 50 slightly increased an individual's heart attack risk; having two parents who had attacks before age 50 substantially increased the risk.

Unnecessary blood transfusion can do more harm than good.

Blood transfusion deserves a prominent place in the pantheon of medical advances. It has saved countless lives on the battlefield and in hospital emergency departments. It is a life-prolonging treatment for people with conditions that prevent the body from making blood or blood components, from kidney disease and cancer to disorders such as hemophilia and sickle cell anemia. But whether blood should be routinely transfused during or after heart surgery is a question that more and more people are asking. The answer is tilting toward "no."

Rheumatoid arthritis begins in the joints, but it doesn't end there. The inflammation that causes swelling and pain in fingers, wrists, knees, and other joints can also affect the heart. A large study from Sweden suggests that a new diagnosis of rheumatoid arthritis should get you thinking about your heart, too.

In a group of 7,500 men and women with new rheumatoid arthritis whose health was followed for up to 12 years, more people than expected had a heart attack, developed chest pain with activity or stress (angina), or needed a procedure to open or bypass a blocked heart artery within five years of their diagnosis (Journal of Internal Medicine, December 2010).

The electrocardiogram (ECG) is one of the most common, enduring, and important tests in all of medicine. It's easy to perform, noninvasive, produces results right away, and is useful in diagnosing dozens of heart conditions. The ECG has taken on even more importance lately because a particular ECG pattern, called ST elevation, is a strong indication that a serious heart attack has occurred, and there's more emphasis than ever on treating heart attacks as soon as possible. An ECG isn't necessarily going to be part of a routine physical, but if you need medical attention because you have chest pain, sudden unexplained shortness of breath, or other symptoms that suggest a possible heart attack, you will almost certainly get an ECG.

The ECG is a reading of the electrical impulses in the heart that activate the heart muscle and its blood-pumping action. Twelve electrodes affixed to the skin on the chest, arms, and legs sense those impulses from various vantage points. Part of the reason the ECG has had such staying power is that the output is visual: a line graph with peaks and valleys, not a stream of numbers. As a result, reading an ECG is a matter of pattern recognition, not computation. There are many permutations, but someone can be trained to recognize the most common patterns relatively quickly.