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Prakash Chandran: Did you know that in the United States alone, someone has a heart attack every 40 seconds and during a heart attack, seconds count. It's important to learn the risk factors and prevention of heart disease before you or your loved ones are affected. We're going to learn about it today with DR. Ahmad Munir. A Cardiologist at McLaren. This is McLaren's in Good Health, a podcast from McLaren. I'm Prakash Chandran, so dr. Munir, physiologically, what exactly happens when you have a heart attack?

Dr. Ahmad Munir: For the understanding of heart attack, you know, you have to realize that heart is the muscle, probably the strongest muscle in the human body and from that standpoint, like every other muscle that requires its blood supply, there are three main blood vessels that supply the heart muscle. So when the blood supply to the heart muscle is interrupted by rupture of a plaque or a clot forming in one of the blood vessels, that's when a heart attack happens. And what it means is the downstream portion of the heart muscle from the blocked artery starts to die because of lack of nutrition. And then that portion of the heart does not contract and does not contribute towards the pumping function of the heart. And that leads to severe symptoms of just come from shortness of breath, you know, breaking out in a sweat and a host of other symptoms. So in essence, you know, when the blood supply to the heart muscle is obstructed by a clot or a plaque, and the downstream muscle dies, that's what is called a heart attack.

Host: And what are the usual causes of a heart attack and what kind of symptoms can you expect when you're having one?

Dr. Ahmad Munir: The most important cause of a heart attack is cholesterol plaque built up and the blood vessels that slowly encroaches on the lumen of the blood vessel and got cuts blood supply. And usually the final or the last straw on the camel's back is the little lining that keeps the cholesterol plaque confined, finally ruptures due to some acute event. And as soon as that ruptures, body tries to contain that plaque by forming a blood clot on top of that. And in doing so, it actually occludes the lumen of the blood vessels. So that is the most common cause of having a heart attack. So basically cholesterol buildup on healthy lifestyle and a host of other risk factors contribute towards developing of the cholesterol plaque. We do not know of one single big thing that we can say, okay, this is what causes it. Our understanding of this disease of plaque buildup is an evolution, and more research is being done to increase our understanding.

So as far as symptoms are concerned, you know the most common symptom of heart attack is chest pain slash chest pressure. Usually when you ask people, they tell you that it's more of a pressure like discomfort in the chest as if people describe an elephant sitting on their chest or somebody's wound a rope around the chest and is squeezing them. And associated with that usually is some in the left arm such as numbness, tingling, pain, heaviness, and sometimes the pain also goes into the jaw. Most commonly associated with shortness of breath, uneasy feeling and breathing, nausea, vomiting, dizziness and sometimes also lightheadedness and feeling of indigestion. So most commonly chest discomfort, shortness of breath, left arm and jaw discomfort. All the way to the nonspecific symptoms such as nausea, vomiting, indigestion, fatigue or lightheadedness

Host: Are the symptoms, do they happen to be different in women?

Dr. Ahmad Munir: Yeah, women are said to have more atypical symptoms, but still having said that, still the most common presentation is some form of chest discomfort slash pressure or squeezing sensation. But in ladies it's a higher incidence of atypical symptoms such as a feeling of unusual fatigue, just nausea, vomiting or maybe just discomfort in one or both arms, feeling of upper abdominal discomfort, lightheadedness. So those symptoms occur a little bit more frequently in ladies as opposed to gents. It's usually an unusual occurrence of this without any cause or without any provocation a lot of times. And that is what brings it to our attention. If somebody's thinking that they might be having a heart attack and go out and as it's commonly recommended to take an aspirin and they actually do so, then it is definitely comes to go to the emergency room to get yourself checked out.

Host: I've heard of the term sudden cardiac arrest before. And I know that people are often confused between having a heart attack and having cardiac arrest. So maybe you could explain cardiac arrest and maybe talk about the differences between the two events.

Dr. Ahmad Munir: Cardiac arrest is where the pumping function of the heart is just totally knocked off. There's no effective pumping function left. And usually when somebody has a heart attack, a blood vessel supplying the heart muscle occlude the downstream muscle dies and several things can happen. You can just have just discomfort and present to the emergency room with just discomfort. And usually you're diagnosed with a heart attack and we try to treat it and prevent further damage. Some unfortunate people, if the blockage of the artery is way upstream and a lot more muscle of the heart stops functioning, then it doesn't pump any more and you actually collapse and fall down when there's no pumping function coming out of the heart, either due to massive death of a heart muscle or some rhythm problem that does not allow the heart to pump more efficiently, that is called a cardiac arrest. And that is usually a consequence of a heart attack, usually a massive heart attack. That's sort of the downstream consequence of having a heart attack.

Host: So you mentioned that lifestyle can attribute to whether or not you have a cardiac event in the future, but I've also heard that family history plays a role as well. Can you talk a little bit about that?

Dr. Ahmad Munir: Family history is also important and in family history, the thing to notice, your first degree relatives, your parents, your siblings, have they had heart problems or a heart attack before the age of 55 in men and 65 in ladies. So, the more important thing is having family members with cardiac problems very early in their life. That sets you up for a higher risk. A lot of times, you know, you ask, you have a family history for heart disease and they reply, yeah, my grandfather passed away with a heart attack at age 88. So having that history and having, you know, maybe your father or your mother with a heart attack at age, maybe 44 or some younger age is much more important. So family history plays a part in the whole risk factor profile. The younger family members having, increases your risk of having a cardiac event more so than somebody in your family who has had a heart attack much later in their life. So family history is important. It's not the whole story, but it is one piece in the puzzle of this whole heart disease process.

Host: For our listeners who don't have a clinical background like myself, what should we do if someone collapses or we suspect that they're having a cardiac event?

Dr. Ahmad Munir: So the first thing is you establish that they are unconscious and immediately call for help, and find out amongst people who are near you, can somebody perform a CPR on that patient? So calling for help, number one, recognizing that there is no pulse, no breathing, and the patient is unconscious, initiating CPR at that point is going to be crucial. Number two, as you find out if the collapse happens in a facility where they have an automatic external defibrillator, so you ask for that immediately as somebody is doing CPR and apply the patch. So I think activating 911, finding out of somebody is trained in CPR, and asking for an automatic external defibrillator, which is just a defibrillator lot of government facilities and other public places are carrying. It's a small device, you know, you open it up, it's voice activated. Once you turn the switch on, it tells you where to apply the pads and as soon as it detects the patient's rhythm automatically, and if the patient requires an electric shock to revive the person, then it will deliver that. It has been a significant improvement in therapies that we can offer to people who have collapsed. So those are kind of the steps that we have to take.

Host: That makes sense. But how do you know if someone collapses from a cardiac event versus something else? It feels like it might be potentially dangerous to put a defibrillator on someone that potentially would pass out because they maybe didn't eat enough that day. Talk to us a little bit how you might distinguish the two things.

Dr. Ahmad Munir: In the basic resuscitation protocols, you have to establish number one, loss of consciousness. Number two, you check for their pulse, and number three is you check for their breathing. Those are the three things you have to check before you initiate. And a defibrillator device has been refined over time to the point that it will not deliver a shock unnecessarily. Only if the rhythm is something that the patient can be shocked out of only then it will deliver a rhythm. You can get a history from their friends or family that are accompanying the patient, you know, is it a diabetic patient or did you notice that his arm was weak or he had a stroke or a headache or some other history immediately available. The problem starts when somebody collapses and there's nobody around the patient who can provide any sort of history. So if there is no pulse then you know, regardless of whatever the etiology is, the life saving maneuver to do is to start CPR, whether it be stroke, low blood sugar levels or anything. So till that thing is evaluated, it is still recommended that in the absence of pulse and respiration in an unconscious person, you should immediately start CPR.

Host: And just to wrap up here, we talked about lifestyle, we talked about family history. Is there anything else that people should know to reduce their chance of having a heart attack or sudden cardiac arrest?

Dr. Ahmad Munir: So apart from diet, cholesterol, couple other things. Absolutely smoking is probably the number one, put away your cigarettes and that will make the biggest impact on your risk factor profile. So smoking cessation is absolutely necessary. And the second thing is, you know we didn't talk about control of blood pressure, control of your sugar, control of cholesterol. So you go down the list of risk factors to control and if you have a family history or if you think you need to be evaluated, you must see your primary physician and get an estimate of all your risk factors, you know, all the way from family history, smoking, inactivity, and then come up with a plan of how to address those risk factors. All these little pieces of the puzzles, if you do, you will reduce the chances of having a heart attack.

Host: Well Dr. Munir, I really appreciate your time today. That's Dr. Ahmad Munir a Cardiologist at The McLaren. Thanks for checking out this episode of McLaren's in Good Health. Learn more about Dr. Munir or submit a question about cardiology events at McLaren.org/Munir. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.