Is Heart Attack Possible Without Risk Factors?
You've seen the numbers and they're grim. According to the CDC, an estimated 935,000 heart attacks occur each year and of those, one third are fatal. One in four deaths is caused by heart disease and a heart attack is one possible outcome of heart or cardiovascular disease.
Myocardial infarctions (MI) or heart attacks occur when the blood flow to the heart muscle is compromised. Classic heart attack symptoms include:
- Shortness of breath
- Chest pain
- Abdominal discomfort
- Arm, neck, jaw, or back pain
During an MI, time equates to loss of heart muscle once it is deprived of blood flow, so if you are experiencing a heart attack, seeking help right away is extremely important. Blood contains life-saving oxygen and nutrients. Unlike other organs, such as the liver, the heart tissue does not significantly regenerate.
Plaque buildup in the arteries caused by aging, diabetes, obesity, high cholesterol, and high blood pressure can restrict blood flow. But other problems can contribute to heart attacks as well.
The majority of people who suffer heart attacks have risk factors they are either unaware of or choose to ignore. You can quit smoking, start exercising, eat a better diet, or take medication to control high blood pressure or high cholesterol. However, not all risk factors can be modifiable.
Non-modifiable risk factors are inherited conditions that can't be controlled—your gender (men have a greater risk for heart attack than women); increasing age (the average age for a man to experience a first heart attack is 66); family history; and race. (African Americans, Mexican Americans, American Indians, native Hawaiians, and some Asian Americans have increased risk partly due to higher rates of high blood pressure, obesity, and diabetes in these populations.)
William Borden, MD, a Perelman Heart Institute cardiologist at New York Presbyterian Weill/Cornel Medical Center says every man should know his numbers. "Blood pressure, cholesterol, blood sugar, and his body-mass index (BMI) numbers are important indicators of an individual's chances of suffering a heart attack," explains Borden. "There's no magic here. It's a standard formula that gives you and your doctor important information about your health."
According to Borden, it's pretty unusual to have a heart attack without a risk factor. "There are times it may appear someone has a heart attack out of the blue (without a risk factor) but more often that person has risk factors they just aren't aware of," says the cardiologist.
Causes of Atypical Heart Attacks
Scott J. Cameron, MD, PhD, and Clinical Fellow of Cardiovascular Disease at the University of Rochester School of Medicine and Dentistry says medicine isn't black and white. Heart attacks can be caused by a spectrum of issues. People can have symptoms that are minor, major, or a combination of both.
"Early in my career, I saw my first atypical presentation for heart attack in a 62-year old marathon runner who looked 42. The patient had no family history of heart problems, his cholesterol profile was excellent, good blood pressure control, and he never smoked," recalls Dr. Cameron. "With a case like this, clearly other factors such as genetic profile and environment are playing a role."
Routine heart tests—such as an electrocardiogram (EKG) which measures the electrical activity of the heart and cholesterol/blood pressure testing—do not reveal certain blood conditions/clotting disorders. "There are rare situations where people have blood clots because of disorders of the clotting system, but that is not the majority of heart attacks," says Dr. Borden.
A daily dose of aspirin is sometimes recommended for men with cardiovascular disease as it fights inflammation and inhibits blood clots. The decision to use aspirin therapy to treat heart disease depends on your particular case. Be sure to consult your physician first.
If you have a family history of heart disease or high cholesterol (clots can form on cholesterol plaques), ask your doctor about having a C-reactive protein blood test (us-CRP). High us-CRP levels can be a marker for inflammation and related to an increased risk of heart attack. A blood test for high homocysteine levels (above 10) can reveal other heart-related problems that can lead to MIs. Note that there have been conflicting studies about the benefits and risks related to treatment of elevated homocysteine levels with folic acid and B vitamins. Again, be sure to ask your doctor before taking these supplements.
Scott Massey, PhD, PA-C a professor physician assistant studies at Misericordia University says the term heart attack is frequently misused. "It can be a catch-all phrase for other heart problems including heart failure and sudden cardiac arrest," says Massey. "When you hear about a professional basketball player who dies suddenly from what's termed a heart attack, it probably wasn't a heart attack that killed him. It was more likely heart failure from something called myocardial hypertrophy." (Myocardial hypertrophy is an abnormal enlargement of the muscle tissue.)
Cardiomyopathy—a disease of the heart muscle that causes the heart to pump inefficiently—is another heart condition that is largely inherited and can go unnoticed. Some people with the problem have no signs or symptoms. An EKG can find the problem but cardiomyopathy isn't something that's screened for routinely. "A young person can have the condition, but a sports physical for a high school athlete doesn't normally require an EKG," Massey explains.
Some problems progress in athletes because they don't want to be taken out of a game. "They'll ignore something as seemingly benign as feeling dizzy after physical exertion, but that can be symptomatic of a heart condition," says the physician assistant who has worked with many heart patients. Massey recommends getting a complete physical exam that includes an EKG and blood work before starting any exercise program. "This is particularly important if you've been sedentary and your heart is not accustomed to exertion."
Illegal drugs can lead to an MI as well as complications from inflammation in the body due to a serious infection or arthritis. Heart attacks can also stem from anemia or acute blood loss—both conditions that compromise oxygen levels in the blood.
Having cholesterol levels tested every year, getting regular physicals and living a healthy lifestyle can extend your life. Many more people could survive or recover better from heart attacks by knowing their risk and recognizing the symptoms of heart disease. If you think you are experiencing a heart attack, don't delay. Go immediately to the hospital. Receiving help right away can be the difference between life and death. Of the people who die from heart attacks, about half die within an hour of the first symptom and before they reach the hospital. Don't let this happen to you.
National Heart Lung and Blood Institute
American Heart Association
Interviews with Doctors Borden and Cameron and Scott Massey, PhD, PA-C, professor of physician assistant studies at Misericordia University.
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