David Sovka had just returned from a cycling trip in Central America when he had a heart attack. In a five-part series, Sovka describes what it is like to suffer a heart attack and recover from one.
The typical man on the street is walking around with about 113,000 kilometres of blood vessels, the wee tubes that carry blood around our bodies.
With so many blood vessels, something is bound to go wrong. And this past spring, it sure did.
A small section in one of my 113,000 kilometres of blood vessels went very wrong, resulting in what doctors call a “myocardial infarction,” which turns out to be way less funny than it sounds.
There are many sound medical reasons for the expression “as serious as a heart attack,” as opposed to, say, “as wildly entertaining as a heart attack.”
At 51, I had just returned from an overseas cycling adventure and was probably in the best shape of my life (pear shape, with callused buttocks), so I didn’t expect to experience a serious heart attack. But heart disease doesn’t care that you cycle to and from work every day, lift weights three times a week, do not smoke and eat a pretty good diet.
There I was, on a sunny Sunday afternoon, pushing the lawnmower over the very last strip of uncut grass, when suddenly everything felt bad. I mean every part of me felt really awful.
Worse than on Monday mornings. At the time, I did not know what was going on, but given my family history — my father had a heart attack at 48 — I realized that my wife should be mowing the lawn, not me.
My heart attack was a complete surprise to me, and not the good kind. One minute, God’s in His heaven and all’s well with the world, and the next I’m the poster boy for warmed-over death: zero energy, grey pallor, pouring cold sweat. Let me say, just between us, I was scared and confused.
So I put the lawnmower away, and lay down on the floor of my office, hoping to feel better with the time-honoured application of complete denial to my situation.
After five long minutes, I didn’t feel better, so I moved to the living room and lay down there. This also did not help. I felt worse and worse, so much so that I eventually asked my wife to make the phone call you never want to have made on your account.
Everybody who suffers a heart attack has a uniquely lousy experience, with a few common signs that suggest all is not well with the old ticker:
• Chest discomfort — an uncomfortable pressure, fullness, burning or heaviness
• Upper body discomfort — jaw, neck, shoulders, arms, back
• Shortness of breath
• Ridiculous sweating
• Redd Foxx yelling: “This is the big one! You hear that, Elizabeth! I’m coming to you!”
If you experience any of these signs, call 911 and do exactly what the operator tells you to do, even though there is a good chance it will include dry-chewing a couple of aspirins.
Quite a few people in this situation have someone drive them to the hospital, or worse, drive themselves. This is a terrible idea. For one thing, you’re dying and need help now, not in 45 minutes when you finally find the car keys.
Also, when the ambulance brings you to the hospital with blinking lights and screaming sirens, you are seen right away, without the mandatory four-hour wait while being coughed on by terrible people. Finally, a couple of ambulances and a fire truck on the cul-de-sac will give the neighbours something to talk about other than the overgrown hedge that for sure I’m going to get around to trimming one of these days very soon.
Thank God for the solid, professional work of the paramedics. They arrived quickly, inserted various sharp things into me, and sticky things onto me, and then very quickly got this body across town and into the emergency room at the Royal Jubilee Hospital. I remember being gurneyed through emergency, where more sharp things and sticky things happened, and then up to the heart-catheterization lab, where even more things happened. It’s all a bit of a scary blur, to tell you the truth, but what I most want you to know is that at no time did I pee my pants. Please write that down and put it somewhere safe for future reference.
This is a series about what it is like to suffer a heart attack, and what it is like to recover. Warning: Do not have a heart attack! There, I thought I would just get to the point, for anybody who has other things to do.
But if you do have the time, in this series we’re going to cover basic heart function, what can go wrong, treatment and medications, heart-healthy eating, the importance of exercise and anything else I can think of.
You might be afraid of reading about heart attacks and heart disease in the newspaper, as though mortality is transferred via the eyeballs. This is a perfectly reasonable position to take, because the chance of you having frightening heart trouble some day is pretty good. According to the Heart Research Institute, every seven minutes, someone dies from heart disease or stroke in Canada. That’s 206 people dying every day. And speaking of dying, 29 per cent of all deaths in Canada are from heart disease, more than 33,600 people per year.
None of these are particularly comforting facts, but you can still look them up some day when you have the time. Or keep reading and let’s take a look at how the heart works, and then, just for fun, how it doesn’t.
Basic heart biology
The heart, blood and blood vessels are referred to by doctors as “the circulatory system,” and sometimes, like at the end of a long shift when they are more prone to be candid: “complicated and icky.”
The heart itself is an organ like the brain, kidneys and liver. Five out of five doctors believe the heart is critical to human life, citing the fact that when the heart stops beating, so do you.
If you use an average of 80 beats per minute, the heart beats 4,800 times per hour or 115,200 times per day. Over the course of a year, the heart beats 42,048,000 times. If you live to be 80 years old, your heart will have beaten 3,363,840,000 times, which, if you do the math correctly, is a lot.
The heart is located in prime chest real estate, elegantly left of centre, and consists of four chambers:
• two upper chambers called atria that receive blood
• two lower chambers called ventricles that discharge blood and complain about all the noise upstairs.
The right side of the heart receives low-oxygen blood from the body and sends it to the lungs to get more oxygen; the left side of the heart receives high-oxygen blood from the lungs and pumps it to the rest of the body. The left and right side of the heart work together in a rhythm electrically co-ordinated by the sinoatrial node, the body’s natural pacemaker.
As anyone who has watched a scary movie knows, the heart makes a distinctive “lub-DUB” sound right before a shark and/or heart attack. After a heart attack, it is the sound that you pay the most attention to, late at night in your dark and lonely room, worrying.
The classic “lub” sound is caused by blood turbulence during the closure of mitral and tricuspid valves at the start of systole, when the ventricles squeeze blood. The second sound, “DUB,” is caused by the closure of aortic and pulmonary valves at the end of systole.
I include these details because each of them can go terribly wrong in multiple, frightening ways. Here are the main ways:
Coronary artery disease
Coronary artery disease is the most common heart problem. It is what I have. Sometimes doctors refer to it as “ischemic heart disease.” Anyway, the heart’s job is to pump blood around the body. It’s a serious muscle that never, ever rests until you do (forever). Like all muscles, it needs oxygen to burn, which arrives via coronary arteries that snake around the surface of the heart. Alas, these wee coronary arteries can get blocked, plugged, choked, crammed, jammed, wadded, packed, stuffed and otherwise constipated with a buildup of cholesterol and crap called plaque.
Sometimes, the hard plaque ruptures and its softer inside leaks out — like the goo in a Cadbury Caramilk chocolate bar — and your body treats the whole scene as if you just cut your finger in the kitchen with a paring knife: It tries to clot what it thinks is a wound. When this happens in a coronary artery, the clot blocks all blood flow to the muscle, and you suffer a heart attack. When it happens in the brain, you suffer a stroke. Isn’t the body fun?
Atherosclerosis, or hardening of the arteries, is the culprit, which itself is caused by high blood pressure, smoking, high cholesterol, and being related to people who like country music. I’m kidding about that last one, but my point is that stress is not good for you.
In B.C., the proportion of people with coronary artery disease has remained relatively stable in the past decade, with a rate of 6.9 per cent in 2016.
Happily, the mortality rate (by which doctors mean “dying”) for coronary artery disease actually decreased from 20.6 per 1,000 people in 2001 to 14.7 per 1,000 people in 2016.
I am told this is because today we have improved health behaviours, such as not smoking or going off to fight in the trenches on the Western Front, as well as having better treatment options, such as medicine instead of leeches.
Heart valve disease
The heart has four sets of valves that open and close to direct blood flow, somewhat like B.C. Ferries deck hands, if people actually listened to them. Defects in the valves can block the flow of blood, or backwash it, or generally make them open and close the way my sock drawer doesn’t. Minor valve problems can be treated with medication, but major problems require surgery involving animal parts, or robot parts, or other worrisome procedures that at the very least give you a good story to tell at parties.
Arrhythmia means “irregular rhythm,” the generic name for a boatload of problems where the heart’s normal “lub-DUB” tempo takes on the rhythm and style of an older, white male at a dance club. Tachycardia is too fast a beat. Bradycardia is too slow a beat. Arrhythmia can even happen to people with healthy hearts, but I wouldn’t bet on it. Call your doctor if you feel something unusual — it’s no big deal to check it out, despite the part of your brain that wants to convince you that “checking it out” is the same thing as “bringing it home.”
This is a progressive — a happy-sounding adjective that doctors use to mean “worsening” — disease of the heart muscle, or myocardium. The muscle’s ability to pump blood is less efficient than it should be because it is abnormally enlarged, thickened or stiffened. It’s a serious condition.
Inefficient pumping can cause heart failure and the backup of blood into the lungs and rest of the body.
There are many possible causes of cardiomyopathy, including chemotherapy damage, as if that’s all you need to worry about after surviving cancer.
Congenital heart disease
Sometimes things go wrong with the heart before its owner is out and about breathing air, filling its pants and crying for no good reason at all. I’m talking about babies. Even in the womb, a newly forming heart can develop problems that might not be discovered for years. The most common problems are called septal defects, holes in the wall that divides the left and right sides of the heart. Believe it or not, surgery can fix this problem.
Part 5: Grow up and eat your vegetables