Scott Webb (Host): There are many heart attack misconceptions and my guest today is going to help to educate us all and dispel many of the myths about heart attacks. I'm joined today by Dr. Francis Kim. He's the Associate Director of the Cardiac Catheterization Laboratory at The Valley Hospital. 

Welcome to Conversations Like No Other, Heart Care, presented by the Heart and Vascular Institute of Valley Health System in Paramus, New Jersey. Our podcast goes beyond broad everyday cardiac topics to discuss very real and very specific subjects that impact your heart health. We think you'll enjoy our fresh take. I'm Scott Webb. Thanks for listening.

 Doctor, it's great to have you here today. We're going to talk heart attack misconceptions, you know, dispel some myths, some rumors, that kind of thing. Just want to have you, as we get rolling here, start by explaining the difference between cardiac arrest, heart failure, and heart attack.

Francis Kim, MD, FACC: So cardiac arrest, really refers to just the sudden cessation of cardiac activity, usually from an electrical activity, such as a ventricular fibrillation or tachycardia, just the heart just stops beating. The term heart failure is actually a syndrome, which means a group of symptoms. Oftentimes those symptoms are shortness of breath, fatigue, exercise intolerance or edema. So those collections of symptoms is what we collectively call heart failure.

 And heart attack, or what we call myocardial infarction, myocardial injury or ischemia is really when the heart muscle is strained or actually the muscle dies. And so that, oftentimes is, uh, the result from an artery of the heart closing, which we refer to as a heart attack.

Host: Sure. Yeah. And I think for us lay people, Doctor, we tend to use some of these things interchangeably, but that's why we have experts. It's great to have you here to kind of, you know, set the record straight in some of this stuff. And I've always wondered, are heart attacks always linked to high cholesterol and poor diet?

Francis Kim, MD, FACC: So there's actually five different types of heart attacks, but the most common type of heart attack that we all know of is what we call a Type 1 heart attack. And that's a heart attack from when an artery does close. And within this Type 1 heart attack, definitely high cholesterol, poor diet are significant risk factors that do lead to this Type 1 heart attack. But these heart attacks are not always linked to high cholesterol and poor diet. 

Host: Yeah, and as I mentioned, kind of teased as we got rolling here, we're going to sort of dispel some myths, if you will. So, the first one I've got here for you is that a heart attack always feels like intense chest pain, but I'm guessing that symptoms can vary, right?

Francis Kim, MD, FACC: Yeah, absolutely. And in 2021, the American Heart Association and the ACC, along with some other groups, actually came out with a very good concensus document about chest pain. And so one of their key points to take out of this document was that chest pain really means more than just pain in the chest.

And so there are other symptoms that can present as what we call anginal equivalence. And that includes obviously chest pain, chest pressure, tightness, but it can also be referred or transferred to the shoulders, the arms, the neck, the back, the jaw. It can also present as shortness of breath and fatigue.

So, all these symptoms can present as anginal equivalents, but also the other important point is that the studies have shown and just seeing different patients that women and certain diabetic patients can have what we call non typical or atypical symptoms, which certainly do not present as regular chest pain, but nausea or shortness of breath. So it's very important to be cognizant of these other symptoms.

Host: Yeah, I'm assuming the recommendation is any of these types of things that you don't typically experience, maybe especially with exertion, but not exclusively with exertion. You know, if anything seems wrong, seems off, listen to your bodies, right?

Francis Kim, MD, FACC: Absolutely.

Host: Yeah, got another myth for you that if we exercise and eat healthy, we're completely safe from a heart attack. Never going to happen. Is there such a thing as zero risk?

Francis Kim, MD, FACC: Unfortunately, there's no such thing as zero risk, but you should absolutely do those things. You should absolutely exercise and eat healthy, but there are other attributable risk for having a heart attack. Study looking at this identified nine attributable risks. These do include smoking, high cholesterol, hypertension, diabetes, abdominal obesity, other psychosocial factors, so even stress could do this.

Lack of consumptions of fruits and vegetables, so that's where your poor diet comes in. Regular or high alcohol consumption and certainly lack of regular physical activity. So certainly a lot more other factors that can contribute to your risk of having a first heart attack, but absolutely you should exercise, eat healthy, but unfortunately no such thing as zero risk.

Host: Right. Never a bad recommendation to exercise and eat healthy, but there could be other risks and there's no such thing as zero risk, of course. And another myth for you, you know, if we're having some symptoms, we should probably just wait and see if they improve, right? I'm guessing that's not the recommendation.

Francis Kim, MD, FACC: No, absolutely not. So in the same document, actually, there was a key stressor on this and in that if you have symptoms of chest pain or those other symptoms that we went over; really early care for acute symptoms is absolutely paramount. So if you're having acute chest pain or chest pain equivalent, such as shortness of breath or radiation to the jaw, the arm, you should immediately call 911, seek medical care.

Although a lot of patients will not have a cardiac issue, it's so important to get this early. So, absolutely early care for acute symptoms.

Host: Yeah, I think they say in the business, Doctor, that time is heart, uh, time is brain, so when in doubt, even if it's not a heart attack, you know, 911 is the best plan. Try not to drive yourself there, you know, unless you happen to be right by the hospital, right? If you're at home, call 911, have the EMS take you.

 I don't know if this is going to be maybe too old a reference for some folks, but I used to watch Sanford and Son when I was a kid. And Fred Sanford would always fake these heart attacks and he would clutch his chest and he would say, you know, I'm having the big one, right? And think a lot of TV and movies, you know, there's that classic sort of clutching of the chest and people collapsing. But does it always happen that way? Or are the movies and television shows just kind of exaggerating a little bit?

Francis Kim, MD, FACC: Yeah, thankfully all heart attacks do not happen that way, but certainly they do. And oftentimes those are really bad ones. And what's happening there is actually that when these people are having the heart attack and they're clutching their chest, this heart attack causes a very dangerous arrhythmia, such as ventricular tachycardia or ventricular fibrillation, which causes cardiac arrest, which causes them to collapse and faint.

And these are the really bad heart attacks. And unfortunately, we do see those type of heart attacks. So they're not completely fiction, but thankfully, not all heart attacks happen that way. And so, there's a wide wide range of them. The other end of the spectrum are people, you know, calmly talking or even maybe even joking around with you while the EKG is clearly showing a heart attack.

Host: Yeah, I don't know that there's anything, Doctor, you know, again, just being a layperson, just being a person, I don't know that there's such thing as a good heart attack versus a really bad one, but, I've heard stories of folks that have had heart attacks so minor, if you will, that they didn't even know that they had them and they were sort of told about them later by a provider. Is that a thing?

Francis Kim, MD, FACC: Yeah, that is a thing. It's quite remarkable about how the heart can compensate for injury or these heart attacks. But, I've had cases where, we study them, with a cardiac catheterization and they all of a sudden have a 100 percent blockage, which happens sometime, but the patient is unable to say when or if they had any symptoms. So, absolutely is possible.

Host: Yeah, I've heard that story, like, a provider asking a patient, when did you have your heart attack? And the patient replies, what heart attack, right? Yeah, so another myth for you. Once you've had a heart attack, you really can't live an active life anymore. You can't exercise. You can't play pickleball. Is that true?

Francis Kim, MD, FACC: Yeah, thankfully this is absolutely not true. And fortunately I have a lot of patients who are more fit than I am. And I have marathon runners who ran marathons before and then got back to running after their heart attacks. I have patients who run, you know, three to five miles every day after their heart attacks, after full recovery, of course.

But the key point that I would say to you is, and to everybody really, is the more active and the more fit you are before, God forbid, a heart attack, basically the easier, chance you'll have to recover back to your old self.

Host: Sure. Yeah, right. If you're already in pretty good shape, then perhaps the heart attack, you know, won't be as devastating and you'll still be able to live that active lifestyle. Just want to finish up today, and this is good stuff. I love when we do these podcasts where we dispel myths that we, things that people think are true, but they're not, and the experts know, have all the answers.

What can we do to reduce our risk of heart attack? You talked earlier about kind of like the nine points. There's just all these different things, smoking and otherwise, but what can we do to help ourselves?

Francis Kim, MD, FACC: Yep, so it's essentially just the opposite of those nine risk factors, so absolutely be smoke free, do regular exercise. The guidelines and the recommendation is 150 minutes of moderate aerobic exercise or 75 minutes of high intensity exercise, eat a heart healthy diet, rich in fruits and vegetables, avoid carbs, processed foods. Maintain a healthy body weight. Lower your alcohol intake. The recommendations there are one glass, one drink for women or one to two drinks for men, but really these days it's try to abstain if at all possible. Certainly look after your mental health, manage blood pressure, cholesterol. Manage diabetes if you have it, if you're pre diabetic, do anything, everything to prevent diabetes.

And really specifically for people who are in the ages of 40 to 75, if they have any history of family members, first degree family members who have heart disease less than the age of 60; we have what we call a calcium score or screening test that can further risk stratify these patients.

And so, I would recommend for those fitting in that category to consider getting one.

Host: For sure. Yeah, so things that we can do, ways that you can help, of course, perhaps after the fact, but as we talked about today, you know, if you suspect that you may be having a heart attack, 911 is the best plan. Get to the hospital, get to the ED. That's where the medicine and the doctors are. Thank you so much.

Francis Kim, MD, FACC: Great. Thanks again.

Host: Thanks for joining us on this episode of Conversations Like No Other, Heart Care. We hope today's discussion on cardiovascular health has been helpful. Remember, your heart is at the center of your overall well-being, and it's never too early to start taking care of it. Don't forget to subscribe and share this episode with loved ones. For more resources on heart health, visit valleyhealth.com/heart.