SPECIAL REPORT

By Chauncey Crandall, M.D.

ince I became a cardiologist more than 25 years ago, Ive witnessed many improvements in the eld of cardiology. We have more technology, better procedures, and far more types of medication than we did before. We now routinely save people who would have died in the past. But what we, as doctors, no longer have is the luxury of time. The entire healthcare industry has changed. These days were under much more pressure to see more patients in shorter periods of time. This means that most doctors arent able to form the kinds of personal bonds with patients that once were the norm. At the same time, though, patients need our guidance more than ever. People are getting fatter than ever because we have a society that promotes relaxation over physical tness. As a result, the rates of high blood pressure, diabetes, and obesity are soaring and threatening to wipe out all the progress weve made in ghting heart disease. This is the reason why I created Dr. Crandalls Heart Health Report. I wanted a forum where I could share important new information about heart health, and, as I do for all of my patients, provide sound guidance for transforming your overall health. But, rst and foremost, I wanted to give you this special report, entitled, These Four Things Happen Before a Heart Attack, so you can learn the all-important signs you must know to protect your heart. So lets get started right away!

These 4 Things Happen Right Before a Heart Attack

What Is a Heart Attack?
First I want to explain what a heart attack is, so you can understand why the symptoms occur. All of our organs, like the kidneys, liver, and stomach, have different jobs. The hearts only job is to keep blood moving through your body continuously. Basically, your heart is a pump. In order to accomplish this task, your body has its own circulatory system, which is comprised of three main coronary arteries that descend, like a crown, from the hearts main blood vessel, the aorta. These three main coronary arteries, which cover the outside of the heart, are called the right coronary artery, the left circumex coronary artery, and the left anterior descending artery, or LAD. These coronary arteries are not very wide. And, in fact, they are rather delicate. Over time, they can become clogged with fatty deposits, often called plaque. When this happens, it creates what is referred to, variously, as heart disease, coronary artery disease, atherosclerosis, or hardening of the arteries. Most heart attacks occur when this plaque ruptures and blocks the ow of blood through the arteries to the heart muscle.

The Four Things That Happen Before a Heart Attack

I will offer a complete list of symptoms you can experience when youre having a heart attack later in this report. Before that, I want to focus on the four things that happen most often before a heart attack. Over the course of my career, I have determined

from a wealth of experience that these are the four most common signs that a heart attack is about to take place or is already in progress. Chest pain is the one symptom that we associate most often with a heart attack. And theres a good reason for that: It actually is the most common symptom. However, chest pain can mean more than one thing, and it can manifest itself in many ways. There is one type of pain that occurs all over your chest. There is another type of pain that occurs just off to the left side or the center of the chest. It can also start in the jaw and radiate down the left arm. The pain can also occur at different intervals and different intensities. It might come and leave very suddenly or last for a few minutes or more. The discomfort can be mild, or it can be severe, and it can also feel like uncomfortable fullness, squeezing, or pressure. When this type of pain is severe, it can manifest itself in what weve come to nickname The Hollywood Heart Attack, because it looks like the dramatic type of heart attack we see on TV and in the movies. But its important to understand that the pain doesnt have to be as severe as that; it can be mild, especially at rst, and so you may not realize anything serious at all is happening.

When chest pain is severe, it can manifest itself in what weve come to nickname The Hollywood Heart Attack, because it looks like the dramatic type of heart attack we see on TV and in the movies.

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While most people nd chest pain alarming, they are not aware that shortness of breath, even in the absence of chest pain, can signal an impending heart attack. In fact, one study, published in The New England Journal of Medicine, found that of 18,000 patients referred for cardiac stress testing, those who experienced shortness of breath were three-to-ve times more likely to die. This included some patients who reported no chest pain at all. This shortness of breath can occur suddenly, right before or even during a heart attack. It can also provide you with an important clue that something is wrong with your heart that demands checking out. One of my patients, Grace, was accustomed to being very active. In fact, when she lived in New England, she loved to hike through the hills and even chopped her own rewood. Gradually, though, she found herself becoming so winded she could no longer walk up her own driveway without becoming short of breath. Her kids told her to relax, she was just growing older. But Grace didnt

shortness of breath

Dr. Crandalls Heart Health Report is a publication of Newsmax Media, Inc., and Newsmax.com. It is published monthly at a charge of $54.00 per year and is offered online and in print through Newsmax.com. Our editorial ofces are located at 560 Village Blvd., Ste. 120, West Palm Beach, FL 33409. The owner, publisher, and editor are not responsible for errors and omissions. Rights of reproduction and distribution of this newsletter are reserved. Any unauthorized reproduction or distribution of information contained herein, including storage in retrieval systems or posting on the Internet, is expressly forbidden without the consent of Newsmax Media. For permission, contact the publisher at : PO Box 20989, West Palm Beach, FL 33416. CEO Christopher Ruddy Associate Publisher Travis Davis Author Chauncey Crandall, M.D. Contributing Editor Matthew Kalash Production/Art Director Elizabeth Dole To contact Dr. Crandalls Heart Health Report send e-mail to: askdrcrandall@newsmax.com. Subscription/Customer Service contact 1-800-485-4350 or customerservice@newsmax.com. Send e-mail address changes to customerservice@newsmax.com. 2012 Newsmax Media, all rights reserved. Please note that this advice is generic and not specic to any individual. You should consult with your doctor before undertaking any medical or nutritional course of action.

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feel right. Fortunately, she came to see me. I performed some cardiac tests and it turned out it wasnt age at all; she was on the brink of suffering a massive heart attack. One of the challenging things about chest pain is that it often doesnt feel like chest pain. Sometimes it feels like indigestion, or even heartburn. Take Jack, for instance. Hes a top-ight salesman with a heavy travel schedule. He was in the habit of closing a deal by going out for a big dinner, with a couple of scotch-and-sodas followed by a thick steak. So he wasnt particularly surprised when he started experiencing indigestion. But on one occasion, it wasnt indigestion; this was the early warning sign of an impending heart attack. How is it that pain from your heart can be felt somewhere else? Because we dont actually perceive pain directly. Even if you stub your toe, the discomfort you feel is rst interpreted through our central nervous system, which is comprised of the brain, spinal cord, and nerve cells. Because the nerves in the stomach are located near the heart, its not surprising that such signal confusion sometimes occurs in the case of a heart attack.

indigestion or heartburn

Nausea and vomiting are often classified as atypical symptoms. but in the thousands of patients Ive treated, I find that they are really not at all uncommon.

Nausea and vomiting are often classied as atypical symptoms of heart attack, meaning they dont usually occur. However, in the thousands of patients Ive treated, I nd that they are really not that uncommon at all. Nausea and vomiting can occur alone, but they often also occur with other heart attack symptoms. Obviously, having any one of these symptoms does not necessarily mean you are having a heart attack. But if you believe you are having a heart attack, call 911 and ask to be taken to the nearest hospital.

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Angina Pectoris: Classic Chest Pain

Chest pain can have many other causes besides heart attack. People who have coronary artery disease often experience a type of chest pain known as angina pectoris, or simply angina. This occurs when the heart has to work extra hard to pump blood throughout the body. Other symptoms include pressure, heaviness, or tightness in the chest.

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Do not attempt to drive yourself, or allow someone to drive you because you could require emergency treatments that can be started in the ambulance.

Why Knowing These Four Things Is So Important

The vast majority of heart attacks dont come on suddenly right out of the blue. In fact, symptoms of an impending heart attack can stretch out over days, weeks, or even a month or two.

Most people who have a heart attack will tell you it happened suddenly right out of the blue. However, I can tell you from experience (including my own near heart attack) that the vast majority of heart attacks dont happen that way. In fact, the symptoms of an impending heart attack can occur gradually, and stretch out over days, weeks, or even a month or two. So you have to know this information in order to recognize the symptoms of heart disease as early as possible. By the time you have a heart attack, it could be too late. While its true that most people do survive a heart attack, they also can experience permanent damage to their heart muscle. Or, during an attack, the heart can go into an irregular rhythm, which can result in cardiac arrest or sudden death. So dont wait for that heart attack learn the symptoms of a heart attack, so, if they occur, you can seek medical help.

Additional Signs of a Heart Attack

Now that Ive given you the Four Major Things that happen before a heart attack, heres a rundown of some other symptoms you might experience: Discomfort that spreads to the shoulders, arm, back, neck, or jaw Indigestion, heartburn, or a choking feeling Profuse sweating Rapid or irregular heartbeat Dizziness, weakness, or lightheadedness Vague, general feeling of illness Anxiety or a feeling of doom Passing out

The Inflammatory Response

When fatty deposits start building up inside the arteries, the vessel narrows. This buildup of plaque reduces the blood flow through the artery and also irritates the arterial wall, resulting in calcification or hardening of the arteries.

Normal Artery

Narrowed Artery

Blood Flow

Plaque Blood Flow

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Obviously, some of these are very general, and may indicate a less serious condition such as a respiratory infection or the u. But they can occur with the four symptoms Ive seen occur more commonly in the people Ive treated over the years for heart attacks. You should also know that if youve already had a heart attack, you are at increased risk to suffer another. The symptoms of another heart attack may be the same as the rst, or they may be different, which is why its important to consider symptoms carefully, and not to assume that they are not coming from your heart.

Pre-Heart Attack Symptoms

As I noted, heart attacks rarely occur out of the blue. In fact, people may experience symptoms four-to-six weeks before an actual attack. In fact, one study showed that 78 percent of those who suffered a heart attack experienced one of these pre-heart attack symptoms a month before the attack occurred. Here are typical pre-heart attack, or prodromal symptoms: Unusual fatigue Sleep disturbance Anxiety Pain in the shoulder blade or upper back Sweating Irritability Heart attacks can occur in people who have no known risk factors or at least they think they dont. Upon reection, however, most heart attack victims realize that they have one or more of the major risk factors. If you do, this increases the possibility that, whether you experience one of the Four Major Things that happen before a heart attack, or one of the less common signs, you are indeed having a heart attack, or one is in the offing.

About Chauncey Crandall

The Four Major Heart Attack Risk Factors

The Coronary Arteries

Aorta

Left Circumflex Coronary Artery Left Anterior Descending Artery Right Coronary Artery

Three main arteries descend, like a crown, from the hearts main blood vessel, the aorta: the right coronary artery, the left circumflex artery, and the left anterior descending artery. Blockages in these arteries are the main cause of heart disease, and can lead to heart attack, heart failure, angina, or cardiac arrest.

hauncey W. Crandall, M.D., F.A.C.C., is chief of the cardiac transplant program at the world-renowned Palm Beach Cardiovascular Clinic in Palm Beach Gardens, Fla., where he practices interventional, vascular, and transplant cardiology. Dr. Crandall received his post-graduate training at Yale University School of Medicine, where he also completed three years of research in the cardiovascular surgery division. He lectures nationally and internationally on preventive cardiology, cardiological healthcare of the elderly, healing, interventional cardiology, and heart transplants. Known as the Christian physician, Dr. Crandall has been heralded for his values and message of hope to all his heart patients.

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Heres a rundown of the major risk factors, so you can use them to evaluate whether you are having a heart attack. Remember: even if youre uncertain, its always best to call for help rst, rather than regret it later.

A Special Warning For Diabetics

iabetes can double or even triple your heart attack risk. But it does something else that is deadly as well: Diabetes damages not only your bodys organs, it also damages your nerve endings. As a result, diabetes can dampen the pain signals that you may ordinarily have felt, including the warning sign of chest pain that signals you may be developing heart disease, or even be in the midst of a heart attack! Ill tell you how to make certain your doctor keeps a close eye on your heart, a factor that, literally, can mean the difference between life and death!

High blood pressure, also called hypertension, is so common that its now estimated that 1 in 3 Americans have this condition. Its also known as a silent killer because it can cause its damage without your ever noticing any symptoms at all. Sometimes, high blood pressure can occur for no known reason, but often, people who have it are overweight, have diabetes, smoke, or have a family history of the disorder. Men tend to develop high blood pressure earlier than women, but the risk equalizes at about age 55. And after the age of 75, women are at a higher risk. Having high blood pressure means that your heart is working too hard to pump blood throughout your body. Because of this, the heart becomes enlarged and weakened. This condition also damages the coronary arteries, leading to heart disease and, ultimately, heart attack.

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People with diabetes have a metabolic disease that hampers their ability to transform sugar from the foods they eat into energy. The result is a buildup of glucose in the blood, which damages both the heart and the coronary arteries, along with the rest of the blood vessels and organs in the body, including the kidneys, the eyes, and more. Diabetes doubles the risk of a heart attack in men, and triples it in women. The frightening thing about diabetes is that, like high blood pressure, it does its damage silently, often for years, before its diagnosed. In fact, its not uncommon for people to learn they have high blood pressure, diabetes, or both only after theyve suffered a heart attack. Over the years, Ive helped scores of my patients not only manage their diabetes, but even reverse it, by showing them a new way to eat and how to build exercise into their lives, both which I will share with you in upcoming newsletters. A heart attack happens when plaque, which is a fatty substance that builds up in the walls of the coronary arteries, ruptures. Those fatty deposits occur when there is too much cholesterol in the blood. Your body manufactures cholesterol, but you also get it from the foods you eat. Eating a plant-based diet, not drugs, is the secret of bringing your cholesterol level down to the lowest its been in years even possibly lower than when you were decades younger. In future issues of my newsletter, I will tell you exactly how to do that.

diabetes

high cholesterol

stress

Most doctors focus on the role that physical conditions, such as high blood pressure, high cholesterol, and diabetes play in heart health, and
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they tend to overlook the impact of stress. But, over and over, Ive seen stress trigger heart attacks in my patients. Stress can contribute to atherosclerosis. The cascade of hormones your body releases when you are under stress can also trigger a deadly heartbeat irregularity. So I always take stress seriously, and, in my newsletter, I will share some of the ways to reduce it.

Additional Risk Factors

Reversing the four major risk factors Ive just outlined are key to your protecting your heart and winning a victory over heart disease. But there are other important risk factors you can take control of as well. These include: Obesity: Being overweight triples your risk of a heart attack. Obesity also is a major factor in the cause of high blood pressure, diabetes, and high cholesterol. When these three factors occur together, it creates a condition known as metabolic syndrome. This greatly accelerates heart attack risk. In fact, having metabolic syndrome is almost a guarantee that you will suffer a heart attack. Inactivity: Americans like to say they exercise, but a recent study using pedometers to measure the amount of exercise that people actually did, found that most exercise less than they say they do. A lack of exercise not only contributes to the development of high blood pressure, diabetes, and high cholesterol, but it is also a heart attack risk factor in itself. Smoking: We think of smoking in terms of lung cancer or lung damage, but smoking also causes major damage to your heart. In fact, it is a leading cause of heart attacks. Every time you inhale cigarette smoke, you draw into your lungs a mixture of 4,000 chemical substances, many of which are poisonous. The only reason I dont list smoking as one of the Four Major Risk Factors

Being overweight triples your risk of a heart attack. Obesity is also a major risk factor in the cause of high blood pressure, diabetes, and high cholesterol. When these three factors occur together, it creates a condition known as metabolic syndrome.

Heart Attack Symptoms in Women

Women can experience the same Four Main Things that happen before a heart attack as men do, but they are also likely to experience different symptoms. Thats why the 435,000 American women who will suffer a heart attack this year are less likely to recognize it. Worse yet, their doctors are less likely to recognize it, too! Women can also experience chest pain, but they are more likely to experience symptoms that are generalized and vague, like indigestion, nausea, and fatigue. One of the first studies to recognize this looked at 515 women, 43 percent of whom felt no chest pain, and the ones who did described it not as severe pain, but as tightness, pressure, or an aching feeling upon having a heart attack. They also cited other symptoms, including shortness of breath, sweating, and pain in one or both arms, although this study found sweating more common in men. The take-home message is this: If you are female, at risk for heart disease, and you are experiencing symptoms, seek immediate medical help, and make sure you are taken seriously. Your life depends on it.

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for heart disease is because of the recent decline in the rates of smoking. But I do know that many people still smoke. In fact, I see many of them in my emergency room!
The secret to living a contented life is more than just keeping track of blood pressure or cholesterol numbers. Rather, regaining and maintaining your good heart health is the first step to living a vibrant, full life.

My Near Heart Attack Experience

Ten years ago, I had just returned to Palm Beach, Fla., from a speaking trip in New York City. I had a pain in my shoulder, but I assumed I had strained it carrying my luggage earlier that day. The pain didnt go away, though. In fact, it continued to build. By the next day, it had spread to my chest. I went for a walk with my wife, but I could barely make it home. Gasping, I told her I had to go to the hospital. I was rushed to the cardiac emergency lab, where one of my fellow cardiologists performed an angioplasty procedure on me, to widen my left coronary artery, to restore the blood ow to my heart, and save me from what would have been a massive heart attack. That experience taught me a great deal about heart disease. I learned rsthand that a heart attack doesnt necessarily feel like what people think it does. It can begin like mine did, with a pain in my shoulder that felt exactly like a pulled muscle. Yes, sometimes chest pain can be the great masquerader, so its important to know all about your heart, and by subscribing to my newsletter, youve taken the very rst step!

Youve Taken the First Step

In the coming months, Ill provide you with all of the information you need to take control of the health of your heart. Ill share with you my secrets on how to prevent, manage, and even reverse the major causes of heart attacks. Ill share with you the joys and benets of eating a plant-based diet, and how you can get started on an activity plan that will lead you to a happier, more satised life. Ill also offer you tips on how to reduce stress and share with you more of my personal story, including how prayer and belonging to a religious community gives me balance. Also, through my newsletter, Ill show you a bit of the volunteer work that enriches me, like the regular medical missions I lead to stamp out cholera in hurricane-ravaged Haiti. After all, the secret to living a contented life is more than just keeping track of blood pressure or cholesterol numbers. Rather, regaining and maintaining your good heart health is the rst step to living a vibrant, full life. Welcome aboard. o

Please note: All information presented in Dr. Crandalls Heart Health Report is for informational purposes only. It is not specific medical advice for any individual. All answers to reader questions are provided for informational purposes only. All information presented in Dr. Crandalls Heart Health Report should not be construed as medical consultation or instruction. You should take no action solely on the basis of this publications contents. Readers are advised to consult a health professional about any issue regarding their health and well-being. While the information found in Dr. Crandalls Heart Health Report is believed to be sensible and accurate based on the authors best judgment, readers who fail to seek counsel from appropriate health professionals assume risk of any potential ill effects. The opinions expressed in Dr. Crandalls Heart Health Report do not necessarily reflect those of Newsmax Media. 8 drcrandall.newsmax.com
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