Heart attacks call for fast action

While brushing his teeth seven years ago, Bob Belive of Glenville began having a hard time breathing
Bob Belive exercises in the Cardiac Rehab Center in Ellis Hospital. Bob had a heart attack seven years ago. He is doing well and goes to cardiac rehab three times a week.
PHOTOGRAPHER:
Bob Belive exercises in the Cardiac Rehab Center in Ellis Hospital. Bob had a heart attack seven years ago. He is doing well and goes to cardiac rehab three times a week.

While brushing his teeth seven years ago, Bob Belive of Glenville began having a hard time breathing.

“There was no pain at all,” recalled Belive, then 47. “I thought it was from smoking too much. I knew something was wrong, but I wasn’t really sure what. The denial thing was huge.”

He lay down to rest for a few minutes, and when he got up he was drenched in sweat.

After opening his video store in Burnt Hills, he called his wife, Ellie, and asked her to take him to the emergency room.

A pack-a-day smoker for more than 20 years who had lost 100 pounds three years earlier, Belive found out he was having a heart attack.

Reading the signs

Here are some signs that can mean a heart attack is happening:

– Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.

– Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.

– Shortness of breath. It may occur with or without chest discomfort.

– Other signs may include breaking out in a cold sweat, nausea or lightheadedness.

While some heart attacks are sudden and intense, when there is no doubt about what’s happening, most start slowly with mild pain or discomfort. People affected often aren’t sure what’s wrong and wait too long before getting help.

“The biggest problem is denial,” said Dr. William Vacca, a cardiologist with Cardiology Associates of Schenectady. “People will often experience symptoms and try to explain them some other way.”

Vacca said getting to a hospital emergency department quickly is critically important.

“Interventional cardiologists have a phrase, ‘time is muscle,’ ” said Vacca. “Time is your enemy. The quicker you act, the more heart damage you can prevent.”

Calling 911 is almost always the fastest way to get lifesaving treatment. Emergency medical services staff can begin treatment when they arrive. They are also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too.

If you can’t get emergency medical services, have someone drive you to the hospital right away. Don’t drive yourself, unless you have absolutely no other option.

Best hope

“To be evaluated by a doctor in the emergency department is your best hope for recovery,” said Vacca.

Doctors will review the patient’s medical history and give a physical examination.

Doctors also use an electrocardiogram (ECG) to discover any abnormalities caused by damage to the heart. An ECG is a medical device that makes a graphical record of the heart’s electrical activity.

Doctors will also use a blood test to detect abnormal levels of certain chemicals that can spill into the blood if damage has been done to the heart muscle.

“Thrombolytic,” or “clot-busting,” therapy is used to stop a heart attack in its tracks. The drugs prevent or limit heart muscle damage by dissolving clots that block an artery. This opens up the artery and restores the blood flow.

Clot-busting drugs must be given immediately after heart attack symptoms begin. The sooner they are started, the greater the chances of a full recovery. To be most effective, they need to be given within one hour of the start of symptoms.

Vacca said nearly all heart attacks today are treated with interventional angioplasty and stenting.

In coronary angioplasty or balloon angioplasty, a fine tube or catheter is threaded through an artery into the narrowed heart vessel. The catheter has a tiny balloon at its tip. The balloon is repeatedly inflated and deflated to open and stretch the artery, improving blood flow. The balloon is then deflated and the tube is removed.

Doctors often insert a stent or a wire mesh tube during the angioplasty, which stays permanently in the artery.

Bypass surgery

Less frequently, doctors perform coronary artery bypass graft surgery, in which a piece of vein taken from the leg or an artery from the chest or wrist is attached to the heart artery above and below the narrowed area, thus making a bypass around the blockage. Sometimes, more than one bypass is needed.

“With angioplasty and medications, the indications for coronary bypass surgery have been modified so that fewer people need it,” said Vacca. “But for the people who need it, it is profoundly effective.”

Bypass surgery may be used if the angioplasty did not sufficiently widen the blood vessel, or the blockages cannot by reached by or are too long for angioplasty.

Sometimes, medications are used to prevent or control coronary heart disease and to reduce the risk of a repeat attack. Some of them include: blood thinners; beta blockers to slow the heart; digitalis to make the heart contract harder and is used when the heart’s pumping function has weakened. It also slows some fast heart rhythms. Ace inhibitors to help the heart pump blood better; nitroglycerine to relax blood vessels and stop chest pain; calcium channel blockers to relax blood vessels; and cholesterol lowering medications.

Lifestyle changes

While Vacca said not all heart attacks are preventable because of genetics, he said a large percentage of heart attacks can be averted through the following lifestyle changes.

– Stop smoking.

– Eat a healthy, low-fat diet.

– Reduce high cholesterol.

– Lower high blood pressure.

– Aim for a healthy weight.

– Be physically active each day.

– Manage diabetes.

Watch children’s weight

Vacca also urged parents to make sure their children are not overweight.

“Because of the epidemic of childhood obesity, we are seeing more diabetes,” said Vacca. “Diabetes is a major risk factor for coronary artery disease. If we intervene now, we can prevent a lot of heartache down the line.”

Belive had angioplasty with two stents in 2001 and immediately stopped smoking. Three months later, he began having difficulty breathing while walking on a treadmill. Following tests, he learned his blockage was too long for further angioplasty, and he needed triple bypass surgery.

Since then, he walks three miles daily to keep his weight at 145. He eats a low-fat diet and goes to cardiac rehab to exercise three times a week.

“I exercise more than most people, but my schedule allows me to do it,” said Belive. “Now, I usually feel great. I am thankful to be alive.”

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