Heart Disease—A Threat to Life
EACH year millions of men and women worldwide have heart attacks. Many survive with few aftereffects. Others do not survive. For still others the heart is so damaged that “a return to useful activities is questionable,” cardiologist Peter Cohn says, adding: “It is imperative, therefore, to nip heart attacks in the bud whenever possible.”
The heart is a muscle that pumps blood throughout the body. In a heart attack (myocardial infarction), part of the heart muscle dies when deprived of blood. To stay healthy, the heart needs oxygen and other nutrients that are carried by the blood. It gets these by way of the coronary arteries, which wrap around the outside of the heart.
Diseases can affect any part of the heart. However, the most common is the insidious disease of the coronary arteries called atherosclerosis. When this occurs, plaque, or fatty deposits, develops in the artery walls. Over a period of time, plaque can build up, harden and narrow the arteries, and restrict blood flow to the heart. It is this underlying coronary artery disease (CAD) that sets the stage for most heart attacks.
Clogging in one or more arteries precipitates an attack when the heart’s demand for oxygen exceeds the supply. Even in arteries less severely narrowed, a deposit of plaque can crack and lead to the formation of a blood clot (thrombus). Diseased arteries are also more susceptible to spasm. A blood clot can form at the site of a spasm, releasing a chemical that further constricts the artery wall, triggering an attack.
When heart muscle is deprived of oxygen long enough, nearby tissue may be damaged. Unlike some tissue, heart muscle does not regenerate. The longer the attack, the more damage to the heart and the greater the likelihood of death. If the heart’s electrical system is damaged, the heart’s normal rhythm can become chaotic and the heart can begin to quiver wildly (fibrillate). In such an arrhythmia, the heart’s ability to pump blood effectively to the brain fails. Within ten minutes the brain dies and death occurs.
Thus, early intervention by trained medical personnel is vital. It can rescue the heart from ongoing damage, prevent or treat the arrhythmia, and even save a person’s life.
Recognizing and Acting On the Symptoms
WHEN symptoms of heart attack occur, it is vital to seek medical help immediately, as the risk of death is greatest within the first hour after an attack. Quick treatment can save heart muscle from irreparable damage. The more heart muscle that is spared, the more effectively the heart will pump after the attack.
However, some heart attacks are silent, manifesting no outward symptoms. In these cases the person may be unaware that he has coronary artery disease (CAD). Sadly, for some a massive attack may be the first inkling of heart trouble. When cardiac arrest occurs (the heart stops pumping), there is little chance for survival unless a rescue team is called immediately and bystander cardiopulmonary resuscitation (CPR) is applied right away.
Of the majority who have symptoms of CAD, the Harvard Health Letter reports, about half will put off seeking immediate medical help. Why? “Usually because they don’t recognize what their symptoms signify or don’t take them seriously.”
John,a a heart-attack victim and one of Jehovah’s Witnesses, implores: “When you sense that something is not right, don’t delay in getting medical help out of fear of appearing melodramatic. I almost lost my life because I didn’t react quickly enough.”
John explains: “A year and a half before my heart attack, I was warned by a doctor about my high cholesterol, a major risk factor in CAD. But I evaded the issue, as I felt that I was young—under 40—and in good health. I greatly regret that I did not take action then. I had other warning signals—shortness of breath with physical exertion, pains I thought were indigestion and, for several months before the attack, extreme fatigue. Most of these I blamed on too little sleep and too much job stress. Three days before my heart attack, I had what I thought was a muscle spasm in my chest. It was a minor attack prior to the big one three days later.”
Chest pain or pressure, called angina, gives warning to about half of those who suffer a heart attack. Some experience shortness of breath or fatigue and weakness as symptoms, indicating that the heart is not getting enough oxygen because of a coronary blockage. These warning signals should send one to a doctor for a heart evaluation. Dr. Peter Cohn states: “Once angina is treated, there is no guarantee that a heart attack will be prevented, but at least the chances of an imminent attack are reduced.”
John continues: “That day we were going to play softball. As I gobbled a hamburger and fried potatoes for lunch, I shrugged off some discomfort, nausea, and upper-body tightness. But when we got to the ballpark and began playing, I could tell something wasn’t right. In the course of the afternoon, I felt progressively worse.
“Several times, I lay on the players’ benches, face up, and tried to stretch my chest muscles, but they kept getting tighter and tighter. While playing, I said to myself, ‘Maybe I’ve got the flu,’ as I felt clammy and weak at times. When I ran, I was noticeably out of breath. I lay down on a bench again. When I sat up, there was no doubt that I was in serious trouble. I yelled to my son James: ‘I need to go to the hospital NOW!’ My chest felt as though it had caved in. The pain was so great that I couldn’t get up. I thought, ‘This can’t be a heart attack, can it? I’m only 38!’”
John’s son, who was 15 years old at the time, relates: “It took only minutes for my dad to lose his strength, so that he had to be carried to the car. My friend drove the car while asking Dad questions to keep up with his condition. Finally, Dad didn’t answer. ‘John!’ my friend shouted. But my father still didn’t respond. Then Dad jerked in his seat, going into convulsions and vomiting. I shouted over and over: ‘Dad! I love you! Please don’t die!’ After his seizure, his whole body fell limp in the seat. I thought he had died.”
At the Hospital
“We ran into the hospital to get help. Two or three minutes had passed since I thought Dad had died, but I hoped he could be revived. To my surprise, about 20 fellow Witnesses of Jehovah who had been at the ballpark were in the waiting room. They made me feel comforted and loved, which was a great help at such a miserable time. About 15 minutes later, a doctor came and explained: ‘We were able to revive your dad, but he has had a massive heart attack. We aren’t sure he’ll live.’
“He then allowed me to see Dad briefly. Dad’s expressions of love for our family overwhelmed me. In great pain, he said: ‘Son, I love you. Always remember that Jehovah is the most important person in our lives. Never stop serving him, and help your mother and brothers never to stop serving him. We have a solid hope in the resurrection, and if I die, I want to see all of you when I come back.’ We were both crying tears of love, fear, and hope.”
John’s wife, Mary, arrived an hour later. “When I walked into the emergency room, the doctor said: ‘Your husband has had a massive heart attack.’ I was stunned. He explained that John’s heart had been defibrillated eight times. This emergency measure involves the use of electrical voltage to stop the heart’s chaotic beat and restore normal rhythm. Together with CPR, oxygen delivery, and intravenous drugs, defibrillation is an advanced lifesaving method.
“When I saw John, my heart ached. He was very pale, and there were many tubes and wires connecting his body to monitors. Silently, I prayed to Jehovah to give me the strength to endure this trial for the sake of our three sons, and I prayed for guidance to make wise decisions about what might lie ahead. As I approached John’s bed, I thought, ‘What do you say to your loved one at a time like this? Are we really prepared for such a life-threatening situation?’
“‘Honey,’ John said, ‘you know I may not make it through this. But it’s important that you and the boys remain faithful to Jehovah because soon this system will end and there will be no more sickness and death. I want to wake up in that new system and see you and our boys there.’ Tears streamed down our faces.”
The Doctor Explains
“The doctor later called me aside and explained that investigation showed that John’s heart attack was due to a 100-percent blockage in the left anterior descending artery. He also had blockage in another artery. The doctor told me that I must make a decision regarding John’s treatment. Two of the available options were drugs and angioplasty. He thought the latter would be better, so we opted for the angioplasty. But the doctors made no promises, as most do not survive this kind of a heart attack.”
Angioplasty is a surgical technique in which a balloon-tipped catheter is inserted into a coronary artery and then inflated to open the blockage. The procedure has a high rate of success in restoring blood flow. When several arteries are seriously blocked, bypass surgery is usually recommended.
After the angioplasty, John’s life continued to hang in the balance for another 72 hours. Finally, his heart began to recover from the trauma. But John’s heart was pumping at only half of its former capacity, and a large portion of it had become scar tissue, so the prospect of his being a cardiac cripple was almost inevitable.
In retrospect, John admonishes: “We owe it to our Creator, our families, our spiritual brothers and sisters, and ourselves to heed the warnings and to take care of our health—especially if we are at risk. To a considerable extent, we can be the cause of happiness or grief. It’s up to us.”
John’s case was severe and required immediate attention. But not all with heartburn-type discomfort need to run to a doctor. Still, his experience is a warning, and those who feel that they have symptoms should have a checkup.
What can be done to reduce the risk of heart attack? The next article will discuss this.
a Names in these articles have been changed.
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Symptoms of a Heart Attack
• An uncomfortable feeling of pressure, squeezing, or pain in the chest that lasts more than a few minutes. Could be mistaken for severe heartburn
• Pain that may spread to—or be present in only—the jaw, the neck, the shoulders, the arms, the elbows, or the left hand
• Prolonged pain in the upper abdomen
• Shortness of breath, dizziness, fainting, sweating, or feeling clammy to the touch
• Exhaustion—may be experienced weeks before the attack
• Nausea or vomiting
• Frequent angina attacks not caused by exertion
Symptoms may vary from mild to strong and do not all occur in every heart attack. But if any combination of these takes place, get help fast. However, in some cases there are no symptoms; these are referred to as silent heart attacks.
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Actions for Survival
If you or someone you know shows symptoms of heart attack:
• Recognize the symptoms.
• Stop whatever you are doing and sit down or lie down.
• If symptoms last more than a few minutes, call a local emergency telephone number. Tell the dispatcher that you suspect heart attack, and give him the information needed to locate you.
• If you can get the victim to a hospital emergency room more quickly by driving there yourself, do so. If you think you are having a heart attack, ask someone to drive you there.
If you wait for an emergency medical crew:
• Loosen tight clothing, including a belt or a necktie. Help the victim to get comfortable, propping him with pillows if necessary.
• Stay calm, whether you are the victim or the helper. Excitement may increase the likelihood of life-threatening arrhythmia. Prayer can be a strengthening aid in remaining calm.
If the victim seems to stop breathing:
• In a loud voice ask, “Can you hear me?” If there is no response, if there is no pulse, and if the victim is not breathing, begin cardiopulmonary resuscitation (CPR).
• Remember the three basic steps of CPR:
1. Lift the victim’s chin up, in order to open the airway.
2. With airway open, while pinching the victim’s nostrils closed, blow slowly twice into the mouth until the chest rises.
3. Press 10 to 15 times on the middle of the chest between the nipples to push blood out of the heart and the chest. Every 15 seconds, cycle two breaths followed by 15 compressions until pulse and breathing are regained or the emergency team arrives.
CPR should be performed by someone trained to do it. But when no one trained is available, “any CPR is better than none,” says Dr. R. Cummins, a director of emergency cardiac care. Unless someone initiates these steps, chances of survival are very poor. CPR buys time until help arrives.
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Quick treatment after a heart attack may save a life and reduce heart damage
How Can the Risk Be Reduced?
CORONARY artery disease (CAD) is associated with a number of genetic, environmental, and life-style factors. CAD and a heart attack can result from years, if not decades, of risks associated with one or more of these factors.
Age, Gender, and Heredity
With increased age comes an increased risk of heart attack. About 55 percent of heart attacks occur in people over 65. Some 80 percent of those who die of heart attacks are 65 or older.
Men under 50 are more at risk than women of the same age group. After menopause, a woman’s risk increases because of the sharp decrease in the protective hormone estrogen. According to some estimates, estrogen replacement therapy may reduce the risk of heart disease in women by 40 percent or more, although there may be an increased risk of some cancers.
Inheritance can play a key role. Those whose parents had an attack before the age of 50 have an increased risk of an attack. Even if parents had an attack after age 50, there is an increased risk. When there is a history of heart trouble in the family, the offspring are more likely to develop similar problems.
The Cholesterol Factor
Cholesterol, a type of lipid, is essential for life. The liver produces it, and the blood carries it to the cells, in molecules called lipoproteins. Two types are low-density lipoproteins (LDL cholesterol) and high-density lipoproteins (HDL cholesterol). Cholesterol becomes a risk factor for CAD when too much LDL cholesterol is concentrated in the blood.
HDL is thought to play a protective role by removing cholesterol from tissues and carrying it back to the liver, where it is altered and eliminated from the body. If LDL tests high and HDL low, the risk of heart disease is high. Lowering the LDL level can result in a significant drop in risk. Dietary measures are a keystone in treatment, and exercise can be helpful. Various drugs can bring results, but some have unpleasant side effects.a
A diet low in cholesterol and saturated fats is recommended. Replacing foods high in saturated fats, such as butter, with foods that are lower, such as canola oil or olive oil, can lower LDL and conserve HDL. On the other hand, the American Journal of Public Health notes that hydrogenated or partially hydrogenated vegetable oils found in most margarine and vegetable-shortening products can raise LDL and lower HDL. Cutting down on high-fat meats and substituting low-fat cuts of chicken or turkey is also recommended.
Studies have shown that vitamin E, beta-carotene, and vitamin C can slow down atherosclerosis in animals. A study concluded that these may also reduce the incidence of heart attack in humans. Daily consumption of vegetables and fruits rich in beta-carotene and other carotenoids and vitamin C, such as tomatoes, dark leafy greens, peppers, carrots, sweet potatoes, and melons, may provide some protection from CAD.
Also said to be useful are vitamin B6 and magnesium. Whole grains like barley and oats as well as beans, lentils, and some seeds and nuts can be helpful. Additionally, it is thought that eating fish such as salmon, mackerel, herring, or tuna at least twice a week may reduce the risk of CAD, as these are rich in omega-3 polyunsaturated fatty acids.
Sedentary people have a higher risk of heart attack. They spend most of the day physically inactive and do not exercise regularly. Heart attacks often occur in these people after strenuous activities, such as heavy gardening, jogging, picking up heavy weights, or shoveling snow. But the risk decreases among those who exercise regularly.
A brisk 20- to 30-minute walk three or four times a week may lower the risk of an attack. Regular exercise improves the heart’s ability to pump, helps weight loss, and may decrease cholesterol levels and lower blood pressure.
Hypertension, Excess Weight, and Diabetes
High blood pressure (hypertension) can injure artery walls and enable LDL cholesterol to enter the artery lining and promote the buildup of plaque. As plaque deposits increase, there is more resistance to blood flow and thus an elevation in blood pressure.
Blood pressure should be checked regularly, as there may not be any outward sign of a problem. For every one-point reduction in diastolic pressure (the bottom number), the risk of heart attack may be reduced by 2 to 3 percent. Medication to lower blood pressure may be effective. Dieting, and in some cases restricting salt intake, together with regular exercise for weight reduction can help control high blood pressure.
Excess weight promotes high blood pressure and lipid abnormalities. Avoiding or treating obesity is a primary way to prevent diabetes. Diabetes accelerates CAD and increases the risk of heart attack.
Cigarette smoking is a strong factor in the development of CAD. In the United States, it is directly responsible for about 20 percent of all heart-disease deaths and nearly 50 percent of the heart attacks in women under 55 years of age. Cigarette smoking increases blood pressure and introduces toxic chemicals, such as nicotine and carbon monoxide, into the blood stream. These chemicals, in turn, damage the arteries.
Smokers also put those who are exposed to their smoke at risk. Studies reveal that nonsmokers living with smokers have an increased risk of heart attack. Thus, by quitting smoking, a person can reduce his own risk and may even save the lives of nonsmoking loved ones.
When under severe emotional or mental stress, those who have CAD face a much higher risk of heart attack and sudden cardiac death than people who have healthy arteries. According to one study, stress can cause arteries laden with plaque to constrict, and this decreases the flow of blood by as much as 27 percent. Significant constriction was seen even in mildly diseased arteries. Another study suggested that severe stress can create the environment for plaque in the artery walls to rupture, triggering a heart attack.
Consumer Reports on Health states: “Some people seem to go through life with a bad attitude. They’re cynical, angry, and easily provoked. Whereas most people let minor aggravations slide, hostile people shift into emotional overdrive.” Chronic anger and hostility raise blood pressure, increase the heart rate, and stimulate the liver to dump cholesterol into the bloodstream. This damages coronary arteries and contributes to CAD. Anger is thought to double heart-attack risk, and this remains an immediate danger for at least two hours. What can help?
According to The New York Times, Dr. Murray Mittleman said that people who tried to remain calm in emotional conflicts might be able to reduce their risk of heart attack. This sounds much like the words recorded in the Bible centuries ago: “A calm heart is the life of the fleshly organism.”—Proverbs 14:30.
The apostle Paul knew what it was like to be under stress. He spoke about anxieties that rushed in on him daily. (2 Corinthians 11:24-28) But he experienced help from God and wrote: “Do not be anxious over anything, but in everything by prayer and supplication along with thanksgiving let your petitions be made known to God; and the peace of God that excels all thought will guard your hearts and your mental powers by means of Christ Jesus.”—Philippians 4:6, 7.
While there are other factors related to heart problems, the ones discussed here can help identify risk so that a person can take appropriate action. Some, though, have wondered what it is like for those who must live with the aftermath of a heart attack. How much recovery is possible?
a Awake! does not endorse medical, exercise, or dietary treatments but presents well-researched information. Each person must decide what he himself will do.
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Smoking, becoming angry easily, eating fatty foods, and leading a sedentary life increase the risk of heart attack
The Road to Recovery
IN THE wake of a heart attack, it is normal for a person to experience fear and concern. Will I have another attack? Will I be disabled or limited by pain and loss of strength and vitality?
John, mentioned in our second article, hoped that as time passed, the daily discomfort and chest pain would subside. But after a few months, he said: “So far they have not. That, along with tiring quickly and the fluttering of my heart, makes me constantly ask myself, ‘Am I on the verge of another attack?’”
Jane, from the United States, a young widow at the time of her heart attack, admitted: “I thought that I was not going to live or that I’d have another attack and die. Panic set in, as I had three children to care for.”
Hiroshi, of Japan, related: “It came as a shock to be told that my heart could no longer function as it had before; my pumping rate had dropped 50 percent. I was almost sure that I would have to curtail some of my activities as a minister of Jehovah’s Witnesses, for I could do less than half of what I had been doing.”
When one is faced with limited strength, bouts of depression and feelings of uselessness may set in. Marie, an 83-year-old Australian who devoted herself full-time to the preaching work of Jehovah’s Witnesses, lamented: “My inability to be as active as before saddened me. Instead of helping others, now I needed help.” In South Africa, Harold commented: “I was unable to work for three months. The most I could do then was just walk around the garden. That was frustrating!”
Bypass surgery was necessary after Thomas, of Australia, had his second heart attack. He said: “I do not tolerate pain well, and to have major surgery was almost too much to contemplate.” Jorge, of Brazil, commented on the aftermath of heart surgery: “Because of my poor financial situation, I feared that I would leave my wife alone and without assistance. I felt that I would not last much longer.”
What has helped many to recover and to get their emotions back on an even keel? Jane observed: “When I felt panicky, I would always go to Jehovah in prayer and throw my burdens upon him and leave them there.” (Psalm 55:22) Prayer helps a person to gain the strength and the peace of mind that are essential when he is faced with anxieties.—Philippians 4:6, 7.
John and Hiroshi took part in rehabilitation programs. Good diet and exercise strengthened their hearts, so that both resumed working. And they attributed their mental and emotional recovery to the sustaining power of God’s spirit.
Through support from his Christian brothers, Thomas found the courage to face his surgery. He stated: “Before the operation, an overseer came to visit me and he prayed with me. In a very passionate plea, he asked Jehovah to strengthen me. That night I concentrated on his prayer and felt very blessed to have elders like him whose empathy during emotional periods is in itself part of the healing process.”
Anna, from Italy, coped with depression in this way: “When I’m discouraged, I think of all the blessings I have already received as one of God’s servants and of the blessings to come under God’s Kingdom. This helps me regain serenity.”
Marie is grateful for Jehovah’s help. Her family has been by her side, and she says: “My spiritual brothers and sisters, each with his own load to carry, made the time to visit me, call me on the telephone, or send cards. How could I stay sad with all this love being shown?”
No Lonely Hearts
It has been said that the healing heart should not be a lonely heart. The support of family and friends plays a large, positive role in the recovery of those whose hearts must literally and figuratively mend.
Michael, of South Africa, commented: “It’s hard to explain to others what it is like to be despondent. But when I walk into the Kingdom Hall, the concern that the brothers show is very heartwarming and uplifting to me.” Henry, of Australia, was also strengthened by the deep love and understanding that his congregation expressed. He said: “I really needed those tender words of encouragement.”
Jorge appreciated the depth of concern others showed by assisting his family financially until he was able to work. Olga, of Sweden, likewise appreciated the practical help given to her and her family by many spiritual brothers and sisters. Some did her shopping, while others cleaned her house.
Often, heart patients have to limit their participation in activities that they have held dear. Sven, of Sweden, related: “Sometimes I have to abstain from taking part in the ministry when the weather is too windy or cold, as it induces vascular spasm. I appreciate the understanding that many of my fellow Witnesses show in this matter.” And when confined to bed, Sven is able to listen to the meetings because the brothers lovingly record them on tape. “They keep me informed about what is going on in the congregation, and it makes me feel like a participant.”
Marie, confined to bed, feels blessed to have those with whom she is studying the Bible come to her. In this way she can continue to discuss the marvelous future that she looks forward to. Thomas is grateful for the concern he is shown: “The elders have been very considerate and have reduced the number of assignments they give me.”
Families Need Support
The road may be as difficult for family members as it is for the victim. They are subject to much stress and fear. Concerning his wife’s anxiety, Alfred, of South Africa, observed: “When I came home from the hospital, my wife used to wake me up many times during the night to see if I was still all right, and she would insist that I visit the doctor every three months for a checkup.”
Proverbs 12:25 states that ‘anxious care in the heart will cause it to bow down.’ Carlo, of Italy, notes that since his heart attack, his loving and supportive wife “has fallen into depression.” Lawrence, from Australia, said: “One of the things to watch out for is that your partner is being cared for. The strain on the partner can be very great.” Thus, we should keep in mind the needs of all in the family, including the children. The situation can take an emotional and physical toll on them.
James, mentioned in our second article, withdrew into a shell after his father’s heart attack. He said: “I felt that I couldn’t have fun anymore because I thought that the minute I did, something bad would happen.” Expressing his fear to his father and working at establishing good communication with others helped to relieve his worry. During that time James did something else that had a great effect on his life. He said: “I increased my personal study of the Bible and preparation for our Christian meetings.” Three months later he dedicated his life to Jehovah and symbolized it by water baptism. “Since then,” he says, “I have developed a very close relationship with Jehovah. I really have much to thank him for.”
In the aftermath of a heart attack, one has time to reexamine life. For example, John’s perspective changed. He said: “You see the vanity of worldly pursuits and realize how important love of family and friends is and how much we mean to Jehovah. My relationship with Jehovah, my family, and my spiritual brothers and sisters has an even higher priority now.” Reflecting on the trauma of his experience, he added: “I can’t imagine coping with this without our hope of a time when these things will be corrected. When things get me down, I think about the future, and what’s happening right now seems less significant.”
As they travel the ups and downs of the road to recovery, these heart-attack survivors have their hope firmly anchored in the Kingdom for which Jesus Christ taught us to pray. (Matthew 6:9, 10) The Kingdom of God will bring to humans everlasting life in perfection on a paradise earth. Then heart disease and all other disabilities will be eliminated forever. The new world is just ahead. Truly, the best of life is yet to come!—Job 33:25; Isaiah 35:5, 6; Revelation 21:3-5.