Heart Attack—Coping with Our Modern Plague
A young woman describes how this great killer struck her mother, and how knowledge helped her to cope with the situation.
MY MOTHER, like well over a million other Americans each year, experienced a heart attack. This is the way she described it:
“On the way to work in midtown New York, I suddenly felt something in the center of my chest. Grabbing my chest, I thought, ‘What is happening? Did I eat something that disagreed with me?’
“I felt very weak, and had to stand still a long while. I was trying to breathe, but I couldn’t breathe deep, because of the intense pressure. It seemed to be coming from my stomach, but it was different from any sensation I had ever experienced before.”
Mother is certainly fortunate to be alive—over quarter of a million victims die suddenly from such attacks. Heart disease kills some 750,000 Americans annually. All, together, well over half of all deaths in the United States are caused by heart and blood-vessel disease!
But the problem is not limited to the United States—heart attack plagues industrialized nations throughout the world. I read where Dr. Jean Mayer, Harvard University professor, said: “We are in a new age of pandemics, since nearly half of the men of the Western countries (and an increasing proportion of the women) are dying of a single ailment.”
‘What,’ you may ask, ‘is causing this? What can I do to prevent a heart attack? Or, if I suffer one, what can I do to increase my possibility of surviving?’
At the time I did not know, and I have since discovered that few people understand what is involved. My mother’s experience led to my finding out.
Another Attack
Mother did not realize that she was having a heart attack that Friday morning back in May 1972. She thought it was indigestion, and that she was simply overly tired. So, when she rested a few minutes, she caught the subway and went to work.
The following week mother consulted a doctor, but he did not identify her trouble, and so she continued to work. She told me what happened that Wednesday:
“The heavy pressure in my lower chest occurred again. I doubled over in pain. A coworker got scared, and brought a glass of water, asking, ‘What happened?’
“I answered: ‘I don’t know—maybe some gas from something I ate. I feel like I’m choking.’
“She said: ‘You’d better go to the doctor.’
“I agreed. The union clinic is only a couple of blocks away. When I got down the elevator, the pressure on my chest increased. I could hardly breathe, and my arm was so weak it was difficult to hold my pocketbook. I staggered like a drunk person, but nobody offered to help. I prayed to God, ‘Help me to get to the clinic.’ I opened the door and collapsed, for a moment losing consciousness.
“The doctor examined me, and wanted to put me in a hospital. But I told him: ‘I feel much better now. Let me go home. My daughter will take me to the hospital.’ When I insisted, he let me leave. I was so weak I was barely able to make it home.”
Remarkable Survival
Mother was standing there doing some washing when I came home. I said, “Mama, something is wrong!” She looked so pale and so yellow. We live together, as we have ever since we came from Europe when I was a little girl. My father and other relatives died during the second world war.
Mother went to bed, saying very little to me. At about two in the morning I was awakened by her call. She had severe chest pains and could hardly breathe. Frantically I called our family doctor. He said: “Give her a little bit of whiskey. Keep her warm and quiet and when she feels better take her to the hospital.”
The next morning I called a taxi and took her to New York Infirmary. Still mother did not believe that it was her heart, and she wanted to leave. But then she had another attack, falling to the floor gasping for breath. Doctors and nurses came running.
Tests confirmed that it was mother’s heart. Myocardial infarction is what the doctors called it, and it was very serious. They could hardly believe that she had survived. She was kept in the hospital for twenty-four days.
When mother came home she was still extremely weak; she hardly moved from her bed for two weeks. What should I do for her? Myocardial infarction, coronary occlusion, coronary thrombosis—all these terms were confusing to me. What was wrong with mother’s heart? What caused these attacks? I went to the library and got some books to try to find out. Learning how the heart works is what began to help me to understand her trouble.
An Amazing Organ
I discovered that the heart is basically uncomplicated in physical structure. It is a large hollow muscle, which is divided into two parts. Each part is, in turn, divided into two chambers, one to receive the blood, the other to deliver it. The receiving chamber is called the atrium, and the delivering chamber, the ventricle. So there is a right atrium and a right ventricle, and a left atrium and a left ventricle. Thus the heart is composed of two separate pumps that pump simultaneously.
The heart, I learned, works like this: The right atrium receives blood from the body. The blood is squeezed from there into the right ventricle, which pumps it to the lungs, where carbon dioxide is removed and oxygen is absorbed. The freshly oxygenated blood then goes from the lungs to the left atrium. From there this life-sustaining blood is squeezed into the left ventricle, which pumps it out to the body.
Amazingly, the heart’s millions of cells each have the independent ability to contract and relax. This contraction is coordinated by electrical impulses coming from something called the sinus node, located in the right atrium. This ensures that the muscle cells contract in the proper sequence and at the proper rate—about seventy times per minute. With each contraction about two and a half ounces of blood are pumped—some seventy-five gallons an hour. But during exercise an athlete’s heart may pump hundreds of gallons of blood an hour!
The staggering strength of the heart surprised me. Doctors say that it produces so much energy that if its lifetime output could be concentrated into one burst of power it could lift a battleship several feet out of the water! It was encouraging to learn of the heart’s amazing capacity.
I found that one cardiologist even went so far as to say that if the entire right ventricle is destroyed by disease or injury, readjustments can be made in the circulatory system and the heart continues to do its work. He even said that if over 75 percent of the muscle tissue of the left ventricle is destroyed, the remaining muscle can compensate and continue supplying the entire body with blood!
But did this mean that mother’s heart had, in some way, been almost totally destroyed? What caused her heart nearly to fail?
Source of the Problem
Lack of nourishment, I learned, was the problem. ‘But how can that be,’ you may ask, ‘since the heart is literally bathed in blood, tons of it flowing through the heart chambers daily?’ It is because the heart is not nourished by this blood in its chambers.
A comparison might be to a gasoline truck, and its source of fuel. The truck may be carrying thousands of gallons of gasoline to customers, and yet run out of gas and stop. This is because the truck does not run on the gasoline it hauls, but must stop at service stations to get its own fuel. Likewise the heart receives nourishment, not from the blood in its own chambers, but from blood that is pumped out of the heart and then returns to the heart muscle by way of the two coronary arteries.
The blood is pumped from the heart into the body’s huge artery, the aorta, but a supply is almost immediately channeled off from it into the coronary arteries, so named because they encircle the top of the heart somewhat like a crown. These two arteries divide into a network of smaller branches and eventually into capillaries, bringing oxygen and chemical nutrients in the blood to all parts of the heart muscle. About 5 to 10 percent of all blood that the heart pumps is channeled into these coronary arteries to feed the heart. Trouble in these arteries, I discovered, is what causes heart attacks.
The source of the problem is a buildup of fatty deposits in the coronary arteries, resulting in a condition called atherosclerosis. To help visualize the problem, doctors may compare the process to the accumulation of rust in a hot-water pipe, which, in time, interferes with the flow of water.
In a blood vessel, however, atherosclerosis does not cause a uniform narrowing. A buildup of deposits occurs intermittently along the blood vessel, while the diameter of the rest of the vessel may be normal. Thus the effective flow of blood is not necessarily decreased, since the blood flow may merely speed up as it passes each obstruction. Yet I began to see how this condition of atherosclerosis can set the stage for a heart attack.
How so?
The Blockage Causing an Attack
When blood is forced through an unusually small opening, substances in the blood are triggered to form a clot or thrombus. Normally, this reaction protects us from bleeding to death from wounds, and helps wounds to heal. But should the clotting substances in the blood be activated in a severely narrowed blood vessel, the thrombus formed could block the blood flow. Sometimes a piece of the fatty buildup itself breaks loose and blocks a vessel. When the blocked vessel is in the heart, it is called a coronary thrombosis, or a coronary occlusion.
The result of the blockage, I learned, is what is referred to by myocardial infarction. “Myo” refers to muscle, “cardial” to heart, and “infarction” means the area of tissue that has died because of the interrupted blood flow. If the blocked vessel is a major one that supplies nourishing blood to a large section of the heart, the resulting death of muscle tissue usually causes the heart to stop—it is a fatal heart attack.
It was interesting to me that atherosclerosis can cause this vessel blockage in other parts of the body, although the coronary arteries for some reason are most frequently affected. However, if blockage occurs in a vessel in the brain, one has a stroke. But in the heart it causes myocardial infarction, that is, a heart attack.
Heart Attacks Without Blockage
I found out, however, that in many heart attacks—perhaps the majority—a blood clot is not involved; there is only narrowing of blood vessels due to atherosclerosis. In fact, fatal attacks may occur when there is only minimal damage to the heart muscle. Why do essentially healthy hearts stop?
It seems that in such cases the heart needs more blood to meet some physical or emotional emergency, and the blood reaching it through the narrowed vessels proves inadequate. Then, when only a small portion of the heart muscle is temporarily starved of blood, electrical patterns somehow become disturbed, upsetting the beating rhythm. The heart then goes into what is called ventricular fibrillation—an unusual and serious complication in which it twitches chaotically and stalls from the lack of a driving force. Death follows within a few minutes unless proper pumping of the ventricles is restored. Thus thousands of essentially healthy hearts stop each year.
Unrecognized Attacks and Healing
I was amazed to learn that many heart attacks occur with only minimal symptoms. In fact, heart specialists estimate that perhaps 20 percent of initial attacks occur without any awareness by the victims. This may be because a blood vessel in the heart is closed off gradually over a period of weeks or months, instead of abruptly. Later the resulting damage to heart muscle is often detected by the electrocardiogram in routine physical examination.
Then, again, the symptoms may simply not be recognized as a heart attack, as illustrated in the case of my mother. She thought it was a severe attack of indigestion, as do many others. Vomiting may occur, along with fatigue and an ashen appearance. This is a typical case I read about:
A man in his mid-seventies consulted a doctor when he finally began suffering from advanced heart disease. Electrocardiograms showed two old coronary occlusions—a clot had resulted in death of heart muscle. The man remembered about an attack of what he thought was acute indigestion about twenty-five years before, and then another attack two years later. He had not consulted a doctor, yet lived to a ripe old age! Doctors say there are thousands of such cases.
Actually there is really little that doctors can do to heal the area of involved heart muscle. If the heart survives the infarction—or does not go into fatal fibrillation—the area of dead muscle simply must be given time to be replaced by scar tissue. Restricted activity is important to permit the formation of a tight, effective scar. This will draw the living muscles as close together as possible so that they can function properly without the useless part.
The doctor showed us mother’s electrocardiogram, pointing to the evidence of the coronary clot and the resulting death of heart muscle. All that could be done now, he said, was to rest the heart by minimal activity to give it a chance to heal. Mother did not appreciate how critical this recuperative period is for a heart patient. However, this was soon impressed on her in a frightening way.
Another Crisis
Mother could hardly stand the inactivity; she was anxious to get back to work. She appeared to be doing well; in fact, we enjoyed a week-long vacation in the country. But apparently she overdid it.
A few days later I returned home one night to find her in tremendous pain— her left arm and whole left side were paralyzed. I called the doctor who had attended her in the hospital. He said that I should immediately get her to the hospital. But mother felt that it was useless. I could not force her to go, so asked if the doctor could come to our apartment. He said he could not come.
“What can I do?” I wanted to know.
“Just wait and see, and get prepared,” he said; “she may remain paralyzed, have a stroke or even die. There’s nothing you can do.”
I called another cardiologist who had examined her before. He was more sympathetic, but apologized for not being able to come. I was really frantic. I was in such an emotional state that I couldn’t think.
But then I got down on my knees and prayed, asking God to give me strength and guidance. When I got up I was not panicky anymore. I immediately consulted one of the medical books I still had.
Emergency Treatment
First, it said to eliminate all solid food for at least three or four days—just give liquids. So I fed mother two ounces of freshly squeezed grapefruit or orange juice every two or three hours. Several days later I gradually began to give her a little bit of cooked, mashed vegetables for lunch.
Also, the book said to keep the patient warm, give cleansing enemas, and twice daily to give hot mustard footbaths. And, particularly, the patient should not be permitted to move, not even to go to the bathroom. Looking back, mother and I feel that attempts that night to get to a hospital might well have killed her.
I took off from my job for a week and nursed her day and night. Then, when I returned to work, I arranged for a friend to be with her. For three weeks we did not permit her to get out of bed. Gradually she began to feel better, and to move around.
Thankfully mother’s heart did not go into fibrillation. If it had, I would not have known what to do. Since then I have learned about cardiopulmonary resuscitation (CPR), a combination of external heart massage and artificial respiration. Awake! discussed the technique in its July 22, 1973, issue. And last year a doctor with the New York Heart Association estimated that its use could help to avert up to 4,000 of the 14,000 yearly heart-attack deaths in New York city.
But I wondered, as I am sure others personally affected have, What is behind this modern plague? What causes the buildup of deposits in arteries that result in heart attacks?
Uncertain, Conflicting Views
Authorities are not sure, I learned. This is evident from their differing conclusions based on continuing research. However, cholesterol and fats (glycerides) are somehow involved in the deposits and hardening of the arteries. A variety of foods contain cholesterol. Yet, at the same time, cholesterol is also manufactured by our liver and other organs. But in many people deposits of the fatty substances build up in arteries, with disastrous consequences. Why?
A popular view, the one endorsed by the American Heart Association, is that a diet high in saturated fats and cholesterol causes elevated blood cholesterol levels, which, in turn, are responsible for atherosclerosis in addition to arteriosclerosis, commonly referred to as “hardening” of the arteries. But evidence now also seems to indicate that blood-cholesterol levels may be determined just as much by emotional stress. For example, a study of public accountants revealed that their blood-cholesterol levels were higher prior to April 15, the tax deadline, than in May and June when their sense of time urgency had almost disappeared.
But there are other views. Excess sugar in the diet is said to trigger abnormal production of certain hormones, notably insulin. This is believed to result in blood-level increases of fats called triglycerides, which are said to cause the buildup of fatty deposits in arteries. Another view is that chlorine in water supplies is a principal factor in the precipitation of fatty deposits.
Certain factors are generally accepted by most medical authorities as contributing to heart attacks. In addition to emotional stress and a diet high in fats and cholesterol, these factors include: heredity, smoking, high blood pressure and today’s sedentary life-style. Yet, admittedly, the cause of atherosclerosis, which is responsible for most heart attacks, is still actually unknown. No doubt a combination of factors is involved, and perhaps different ones in different victims.
What We Can Do
Nevertheless, from what I learned, there are sound, common-sense preventive measures we can take. “What is required,” the famous heart specialist Paul Dudley White said, “is a widespread change in established habits of overeating, physical lethargy, and heavy smoking.”
Since neither mother nor I smoked, no change was needed there. But we have adjusted our eating habits, in accord with what I have read on the subject. Principally this involves eating small meals. Also, no longer do we use salt or sugar or drink coffee. And we only infrequently or never eat foods rich in cholesterol, including whole milk, butter, ice cream, eggs and fatty meats.
Another important measure to prevent heart attacks is exercise. Regular brisk walking is one of the best. This apparently establishes collateral circulation in the heart. When a person is sedentary the arteries supplying blood to muscles may become narrower in size, and many small vessels perhaps even disappear. Thus the blood to muscles is less, and, hence, so is oxygen.
However, regular exercise apparently causes a person’s arteries to become larger, so they can carry more blood. Also, more blood vessels open up in muscle tissue, providing new routes for delivering more oxygen. Particularly in the heart muscle is this an advantage, for then, even if one artery becomes “clogged,” blood supplied by auxiliary routes may be sufficient to keep the heart muscle from starving for oxygen and stopping.
Very slowly, over a period of months, mother increased her physical activity. Now she cooks, does the housework and is quite active. I am convinced that this care is largely responsible for what doctors consider her remarkable recovery.
I believe that other contributing factors to my mother’s heart attack were lack of sufficient rest, poor eating habits, but, particularly, worry. So after her heart attack I got a little parrakeet and taught him to say, “Don’t worry, mommy. Be happy.” Such a disposition is important, as God’s Word the Bible also shows: “Anxious care in the heart of a man is what will cause it to bow down,” but “a heart that is joyful does good as a curer.”—Prov. 12:25; 17:22; 14:30.
I know that with all the distress in the world today it is difficult for many to find much to be joyful about. Yet I have discovered that there truly is reason now to be happy. For the sure Word of God shows that these present wicked conditions are certain evidence that we are living near the time when Almighty God will completely remove this system of things, and preserve alive those who serve him.—Matt. 24:3-14; 1 John 2:17.
Then will be fulfilled God’s sure promise to humankind to “wipe out every tear from their eyes, and death will be no more, neither will mourning nor outcry nor pain be anymore. The former things have passed away.” (Rev. 21:4) Truly how grand it will be to live completely free from any threat of this dreaded plague—heart attack!—Contributed.
[Diagram on page 17]
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THE HUMAN HEART
(Viewed from the front; arrows depict direction of blood flow.)
To entire body
Aorta
Pulmonary Artery
To lungs
From body
From lung
Right Atrium
Left Atrium
Right Ventricle
Left Ventricle
From body
[Diagram on page 18]
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ATHEROSCLEROSIS
1. Normal artery
2. Beginning atherosclerosis
(fatty deposits)
3. Advanced atherosclerosis
(fatty deposits nearly blocking artery)
[Diagram on page 19]
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CORONARY THROMBOSIS
Thrombus, or clot, in artery
Area deprived of blood (infarct)