When the heart attacks: a tear rolled gently down Michelle's cheek as we talked. At 39 she appeared healthy; however, a heart attack had taken its toil. A strong family history, a stressful job, and a high cholesterol level were contributors. She was in denial. A 39-year-old female should not have had a heart attack. As we prayed together, the slow process of healing began.

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Today, a vibrant Michelle boldly speaks about heart disease, giving hope while emphasizing awareness and knowledge of the problem. That's what I want to do here. I want you to learn about a disease touching everyone; a disease that can be treated, prevented, and yes, even reversed.

Cardiovascular disease is, unfortunately, all too common. Yet we don't hear much about it in the media.

Let me share some numbers. Over the next 24 hours, 3,000 Americans will suffer a heart attack. This is nearly the same number of persons who died in the tragedy of September 11, 2001. In fact, in women, cardiovascular disease poses a greater risk than cancer and all other diseases combined.

This is not just an American problem, but a growing worldwide concern. Cardiovascular disease (heart attack, strokes, heart failure, rhythm anomalies) is now the leading cause of death in the world, claiming approximately 13 million lives a year--and those numbers continue to rise.

A Battle in the War

The heart attack is the battle. Preventing a heart attack and reversing the causes, that's the win:

John is a 45-year-old executive who exercises daily, takes no medications, and, in general, feels "great." One morning, while preparing for the commute to work, John develops chest pressure, a new feeling for him. He's having a heart attack--sometimes referred to as a MI, or myocardial infarction. An artery supplying the heart with oxygenated blood is completely blocked. Without its blood supply, the heart muscle begins to die, producing the symptoms he's experiencing.

So, the real enemy is obstruction of blood flow in the coronary arteries. This leads to muscle death--a heart attack.

If the artery is small, the heart attack can be small. But if an abnormal rhythm develops, even a small heart attack could be fatal. If the obstruction is in a large artery or in an important location, the heart attack can be devastating. Sometimes the terms "coronary artery disease" or "coronary arteriosclerosis" are used to describe blockages. These terms may include heart attacks as well as conditions where the arteries are partially blocked.

Symptoms

A symptom is an abnormal feeling that tends to persist. A symptom of a heart attack could be a pressure in the chest, chest pain, extreme sweating, a racing heart, extreme shortness of breath, discomfort in the arms, back, neck, or jaw. Sometimes a heart attack might feel like indigestion. Some create extreme fatigue. The list goes on and on. But by and large, people who are experiencing a heart attack do not feel "right." If you don't feel "right," get help immediately.

Diagnosis

The diagnosis of a heart attack is made by the symptoms and usually an electrocardiogram (EKG). Blood work can detect the slightest injury to the heart and help in making a diagnosis. Other tests used may include a sound wave picture of the heart called an echocardiogram or an angiogram where dye is injected into the arteries of the heart to detect blockages.

Causes

What causes these blockages? Cholesterol is a substance in the blood that is comprised of different types of lipids. Lipids are fats and can gradually build up on the inside of blood vessels and become calcified or hardened. Other chemical elements become involved making the blockage larger and larger. Blood has a difficult time passing through the arteries and cannot reach its destination, thus causing the above symptoms to develop.

Different processes can also disrupt the flow of blood. Sometimes a small blockage called a "plaque" may become unstable. If a plaque, which could be described as an internal pimple, "pops," there could be major problems even if there is just a 30-40 percent narrowing. When the pimple ruptures, the body sees this as an injury.

If you cut your finger, your body repairs the damage by clotting the blood. Cells are recruited and rush to the area as quickly as possible. The very same thing happens inside the arteries. Cells are summoned to the ruptured area by an elaborate mechanism to repair the damage. These cells mean to do their job, but in the process they can clog up the artery, stopping blood flow, and thus causing a heart attack. This is the type of heart attack John experienced.

Sometimes a coronary artery becomes clogged with lipids over years and years until no blood can pass through. This is another type of heart attack.

An attack can also occur when an artery spasms. There may be no blockages at all! The artery just, simply, closes. Two possible causes of spasm are high altitudes--when the oxygen content is lower--and certain chemicals such as cocaine and nicotine.

A final type of heart attack is when a clot from elsewhere in the body floats into the artery and jeopardizes blood flow. The most common type of heart attack is when the small blockages become unstable and rupture.

No Tests

Unfortunately, there are no diagnostic tests to predict which plaque will rupture. If such a test existed, it would be possible to predict heart attacks. When John's plaque ruptured, the recruited cells that were sent to help with the damage, formed a clot resulting in a loss of blood flow. Severe pain developed immediately.

Other Factors

There are several adverse things that can happen if blood flow to the heart is not restored quickly. Because of the lack of flow, the electrical system could be damaged, causing dangerous fast or slow heart rhythms. When these rhythms occur, the heart might be beating so fast or slow that it is unable to efficiently pump blood through the body.

Sometimes the muscle itself will be too weak and unable to pump oxygenated blood. Without oxygenated blood, other organs of the body can't function.

The heart valves controlling the direction of blood flow depend on muscles that may be damaged during a heart attack. Blood flow might move in the wrong direction because the valve is not working properly. This presents a real problem. During a heart attack, it's even possible that a dead muscle may break open or rupture. This is usually fatal. As you can clearly see, getting immediate treatment could save your life.

Treatment

John's problem was diagnosed quickly and treatment began. The cornerstone in the treatment of a heart attack is to first restore blood flow to the heart, and then help prevent development of problems related to the lack of blood flow. The quicker this happens, the better.

Long-term treatment includes trying to halt or even reverse the disease process. This is called regression.

The good news is that modern medicine has many methods to restore blood flow during a heart attack. These may include:

* Angioplasty with stents, or the use of clot-busting medications.

* When dangerous fast rhythms develop, the heart can be shocked.

* Pacemakers are useful in treating dangerously slow rhythms.

* Sometimes surgery is needed to bring extra blood to the heart or repair damage to the heart.

* Many medications are available which can lower the workload of the heart by thinning the blood and lowering cholesterol levels.

Treatment must be initiated as soon as possible. It's estimated that one in three individuals who suffer a heart attack don't make it to modern medicine in time.

Remember, treating a heart attack is the initial battle, but winning the war requires altering the body chemistry to prevent cardiovascular disease from developing in the first place.

Where There's Smoke ...

A brief exposure--just 30 minutes--to secondhand smoke can rapidly increase a person's risk for heart attack, even if he or she has no risk factors.

Stephen J. Jay, professor of medicine and public health at the Indiana University School of Medicine, explains how it can cause fatal heart attacks. "When substances in smoke enter the bloodstream, they can throw off the delicate balance of chemistry in the small blood vessels. That can cause a person's platelets to grow sticky and clump together, creating a blockage that can result in a heart attack or stroke."

The U.S. Surgeon General concluded in his report, Secondhand Smoke, What it Means To You, "It hurts you. It doesn't take much. It doesn't take long.... People who have heart disease should be very careful not to go where they will be around secondhand smoke."

ASH Smoking and Health Review

by James L. Marcum, M.D.

James L. Marcum, M.D., F.A.C.C., is author of "Heartbeat--A Biblical Approach to Understanding and Preventing Heart Disease" (Review and Herald). He's a behavioral cardiologist practicing with The Chattanooga Heart Institute and director of Heartwise Ministries (www.beartwiseministries.org), a television, radio, print, and seminar ministry dedicated to promoting Biblical principles to treat and prevent cardiovascular disease.