Dr. David Hill: Welcome to Expert Insights from the Carle Foundation Hospital. I'm Dr. David Hill, and today we're offering potentially life-saving information on heart attacks and sudden cardiac death with Dr. Issam Moussa, medical Director of the Heart and Vascular Institute at Carle Health and Associate Dean for research and innovation at the Carle Illinois College of Medicine, Dr. Moussa. welcome.

Issam Moussa, MD: Thank you. Thank you, David. Pleasure to be here.

Dr. David Hill: So I want to talk about a story that's been going around the medical community. A lot of us follow a TikTok and Instagram celebrity, who's an ophthalmologist who goes by Dr. Glockem Flickem, not his real name, but he famously died in the middle of sleeping. And then his wife, who's an obstetrician, resuscitated him. He's not the only person I know that happened to. I actually have a friend who's a cardiologist who had to do the same thing for her husband. So to most of us, sudden cardiac death sounds exactly the same as a heart attack, and yet there are some really important differences in these conditions. Can you talk about what they are and how they differ?

Issam Moussa, MD: Yeah, absolutely. I thank you for the question. I could see how that can be confusing to many. So to put it simply, sudden cardiac death, can be due to a major heart attack. Or can be a pure electric phenomenon in the heart where the heart electrical system comes to a stop, right? So, sudden cardiac death then can be caused by a heart attack or an electrical event in the heart that has nothing to do with a heart attack. On the other hand, when we say a heart attack, this is when we have a sudden a hundred percent blockage in one of the arteries that supply the heart with blood, right?

So, the way we think about it, one, to understand that the heart attack is due to sudden lack of blood supply to the heart. Sudden death, on the other hand, maybe due to the heart attack, but also maybe due to the electrical system of the heart seizing to function suddenly. So that's really the simplest way I can put it.

Dr. David Hill: That's fantastic. Let me throw in a third term, just to confuse matters, angina. I mean, we know that a heart attack will usually cause pain, discomfort in the chest, angina sounds like a heart attack. There's a blockage, there's chest pain. Are those the same things?

Issam Moussa, MD: So, angina right is a symptom. So in a sense, a heart attack is an actual, damage to the heart muscle. angina can be a symptom of a heart attack or a symptom of a partial blockage that's causing pain in the chest, but not a heart attack because the blockage is not a hundred percent. So the main distinction really, that the heart attack is actual damage to the heart. The angina is a symptom that comes with a heart attack or without a heart attack.

Dr. David Hill: That's very helpful to hear. Now, speaking of angina, I think we think of that as the first warning sign that somebody's having a heart attack. But does everybody having a heart attack experience angina? And if they do, do they experience it in the same way?

Issam Moussa, MD: Very, very important question. Really very impactful for patients, not every patients with a hot attack will have the typical angina. So the typical angina is a feeling of pressure in the middle of the chest and sense of numbness or pain that radiates to the arm or the back. So this is the typical angina. Not everyone with a hot attack will have that particular symptom. Some, patients could have breathing difficulty, a sense that they can't just breathe normally. Some could have, pain in their upper neck, in their jaw.

Some may feel very weak and sweaty, and especially in diabetic patients. Patients who have diabetes, they tend not to describe this chest pain, but other alternative symptoms. So angina is the most famous symptom, but unfortunately not every heart attack presents with angina.

Dr. David Hill: And what about women and men? Are there sex differences in how people experience symptoms of a heart attack?

Issam Moussa, MD: So, yes. women tend to have more atypical symptoms, and when we say atypical meaning not angina the way we know it, obviously some women do have angina, right? So angina does occur both in men and women. However, in women, there's more, frequently they would have symptoms other than angina. That could be, again, breathing difficulty, sweating, weakness, sometimes nausea on vomiting, that symptoms that they may confuse with stomach issues.

Dr. David Hill: Hmm. That does sound really confusing. So there are a lot of other symptoms that are not just classic chest or shoulder pain. Did we cover them all? Is there anything else we should be thinking about or looking for that should worry us about the possibility of a heart attack?

Issam Moussa, MD: No, I mentioned, right, I saw engine on the top, breathing, difficulty weakness, nausea, vomiting and fatigue. Those are really in terms of frequency. Now, some people may have a heart attack, especially small ones, and when we ask them if they ever had any symptoms, they say no. Now, does that mean there's truly totally asymptomatic heart attacks? We don't know because sometimes the symptoms can be mild and subtle. , maybe either a patient didn't pay attention, right?

But there is a category where patients deny actually having symptoms. So there is a category of asymptomatic heart attacks, but typically those tend to be small because if it's a large heart attack and really significant damage to the heart, a person would feel it somehow.

Dr. David Hill: So some having some of these symptoms maybe with exercise. Without exercise, even got maybe some chest discomfort, shoulder discomfort, nausea, vomiting, shortness of breath. Should I just wait for those things to pass? They'll get better in time, or is it important to get care and if so, how much time do I have?

Issam Moussa, MD: Yeah. Again, another important question. I would say the most common reason why patients don't come to the hospital in time is denial, right? And because what happen often, if a person have chest pressure or pain or things that they haven't had in the past. The initial tendency is to say, ah, this is nothing. Right? So this is really common. So it is really important, obviously, when someone have symptoms that they never had in the past, obviously the same time, we don't wanna scare people that every time there's something in the chest to run to the hospital.

But if that sensation is totally new. Never happened in the past. Is severe enough, right? Severe enough that when say, gosh, I'm gonna stop what I'm doing, right? So both a new symptom, severe enough. Especially in the age group, obviously the older the person, the more likely the event. But still this event, heart attack could happen with people in their thirties and forties and fifties, right? Not only sixties and seventies, statistically less like less likely. So new onset symptom, severe enough, right? In the chest I think one should definitely seek attention.

Now obviously if the pain comes, for just two minutes and goes away by itself and you are totally fine, one could schedule a visit right, with a doctor and go see the doctor within few days. If the pain is there for 10, 15 minutes, then it's a 911 call or a visit to the emergency room. So the time and the severity is really important to say, okay, what should I do?

Dr. David Hill: So let's say I have these symptoms and I'm smart enough to say, wait a second, this isn't right. I had to stop mowing the lawn and sit down and maybe I better get this seen. So I go to the ER or I call EMS. What are they going to do for me?

Issam Moussa, MD: So the first thing when a, patient go to the emergency room with symptoms suggestive of a heart attack, is obviously to measure. The, what we call vitals, the blood pressure, the heart rate, and get what's called an electrocardiogram, which is a map to the electrical activity is the heart. And the electrocardiogram in over 90% of patients, if there's a heart attack would show some changes. Now here, obviously when we say heart attacks, there are different kinds and obviously there's no time to go, but something called ST elevation.

And I know this is a technical term, but it is fundamental term because some heart attacks when they're small and certain areas in the heart, they may not show in the EKG. So normally EKG doesn't rule out all heart attacks. But it's 90% rule out major heart attacks. So typically the EKG in a real ST elevation heart attack would show changes, and then if those changes exist and the patient have symptoms, the best therapy is to send the patient to the catheterization laboratory. So it's more an operating room where we go inside the heart through an artery in the wrist or the groin without surgery.

We take pictures for the arteries and if there's a blockage, the blockage get opened right away. So that's kind of the ideal response if somebody have a major heart attack.

Dr. David Hill: Are there medicines that can be helpful in the beginning or in the middle of a heart attack as well?

Issam Moussa, MD: Yes. So, the first response would be before coming to the lab is to give aspirin and, there's multiple other blood thinners that also we give something called clopidogrel and there's two others. We also give intravenous heparin. There's other medicine too, based on the blood pressure and the heart rate. So certainly when the patient come to the er they will receive, a set of medicine to thin the blood and probably to slow the heart rate if the heart rate is going too fast. Now, the clot busters, they used to be used in the past to try to give a very strong blood thinner to lyce the clot.

But that's not really indicated. If the patient comes timely to the emergency room, if they come within a few hours or three hours, four or five hours of the chest pain, we prefer to take them directly to the cath lab to open the artery mechanically. That's more effective way in opening the artery than a clot buster.

Dr. David Hill: So it sounds like we've got this real golden window of time where if we act quickly, we can get a patient to the cath lab plus or minus some medications, and get that artery open and really save heart muscle, and often lives. Is that correct?

Issam Moussa, MD: Absolutely. So, coming timely right to the hospital and opening the artery is lifesaving, right? And this's been demonstrated for decades and obviously the main problem that unfortunately not a lot of people come timely, right? Some delay more than 12 hours, some for days, right? Because of this not knowing when to go and maybe denial and other factors. So, again, seeking attention, timely when they suspect there's something wrong with the heart and having those new, severe symptoms is really critical to both save muscle and save lives.

Dr. David Hill: All right, so don't go to sleep and hope that you're gonna wake up in the morning and, be fine. Is that right?

Issam Moussa, MD: Absolutely, because as you know, your story and other stories does happen more often than we would like to see.

Dr. David Hill: Do you have any final thoughts you wanna leave us with today, Dr. Moussa?

Issam Moussa, MD: Yes. That, obviously, people need to take care of themselves, right? This is for prevention, but also if there's specifically, they have risk factors like diabetes, high blood pressure, smoking, family history. And begin to have symptoms in their chest, that's concerning to them, right? That feels not just the ordinary thing that they have every day. It is important to really just act on it rather than deny it. Because worst case scenario, you go to the emergency room and they find it's not from the heart, which can happen, right? But I think obviously on the other side, if there's something real, it is life or death. So I would again suggest that people take these things seriously. They do have those sort of symptom.

Dr. David Hill: Those are literally words to live by Dr. Issam Moussa. Thank you so much for speaking with us today.

Issam Moussa, MD: Thank you so much for having me.

Dr. David Hill: For more information and to get connected with one of our providers, please visit carle.org. Thank you for listening to Expert Insights from the Carle Foundation Hospital, and tune in again for more useful health information.