Joan was in the garden hanging out the washing, she did the laundry as regular as clockwork. Her life was normal, and had been so for the last twenty years. She was looking forward to seeing her grandchildren later that week. It was a sunny summer afternoon, so the clothing would be dry in no time.
Joan felt a twinge of pain in her chest, it seemed to run down her arm.
“Hmmm”, she thought, “I must have stretched a bit too far”.
Joan, like many of my patients is starting to feel cardiac (or heart) pain, but like a lot of people who get it for the first time, she doesn’t recognise it as such. Instead she puts it down to overstretching, a touch of indigestion, or something that will go away on it’s own. Like many of my patients Joan doesn’t consider herself to have any problems with her heart – it has beat healthily for nearly 80 years without a fault, why should it be failing now?
Little does Joan know, but she is going to be one of the 275,000 people in the UK to have a heart attack this year.
But what is a heart attack? The heart is a muscular pump, that continuously works to pump blood around the body. All the muscles and other organs of the body need a constant supply of oxygen. Blood carries the oxygen around the body to the organs, the blood then returns to the heart where it gets pumped to the lungs to pick up more oxygen, before going back to the heart to repeat the process.
Without oxygen, the tissues of the organ die.
As mentioned, the heart is a muscle, and the heart itself needs oxygenated blood. So as the oxygen carrying blood leaves the heart, some of it is used to bring oxygen to the heart tissue itself. Should the heart get it’s supply of oxygenated blood cut off, then the heart itself starts to die.
What happens in a heart attack is that one of the arteries carrying oxygen rich blood gets blocked off, and the heart muscle around that artery dies. The medical term for this is a ‘Myocardial Infarction’.
Myocardial means the muscle of the heart, while Infarction means a reduced blood supply leading to tissue death.
For short we call it an M.I.
We used to think that it was just the lack of oxygen to the tissues that caused the injury, but what actually happens is that the lack of oxygen activates disease fighting white blood cells and these then release a range of toxic substances (mainly free radicals) into the tissue, thus damaging and killing it .
Joan’s pain was getting worse – it was as if someone was sitting on her chest. She’d had a cup of tea, but that hadn’t helped at all. She was considering a sip of brandy, the bottle had been untouched since Bill, her husband had died five years ago. Maybe it would go away if she ignored it.
Perhaps a cigarette would calm her down, she swore she only smoked ‘for her nerves’, so perhaps it would help get her through the pain.
But what causes one of these arteries to get blocked?
Early in life we get small blobs of fat sticking to the inside of our blood vessels, with a healthy diet these don’t get much larger. With an unhealthy diet these blobs of fat (called Atheroma) get larger and larger, often collecting up different types of material. These effectively narrow the blood vessels of the body, causing a decrease in oxygenated blood reaching the tissues supplied by the affected blood vessel.
What can happen to cause a heart attack, is that this atheroma plaque can break off the wall of the blood vessel, sending a clot (or thrombus) around the body. Blood starts to clot around the fatty plaque and the clot gets bigger. If the clot ends up blocking one of the arteries of the heart, then the blood flow is blocked, the part of the heart supplied by that artery gets no oxygenated blood, and it dies.
Joan is a smoker, which means that she is at least five times more likely to have heart problems caused directly by her smoking. Smoking reduces the bloods ability to carry oxygen to the organs that need it, partly because the carbon monoxide that is part of cigarette smoke is 400 times more likely to be carried by the blood than the oxygen that the organs of the body crave.
Also, smoking increases the one of the proteins that causes blood to clot, so the blood becomes more ‘sticky’, this helps form the plaques that can burst, sending them floating around the body all ready to cause a heart attack. Smoking also increases the amount of ‘bad’ cholesterol in the blood. It is this bad cholesterol that attaches itself to blood vessel walls in the first place to cause the atheroma plaques.
The cigarette wasn’t helping too much. The pain was still there, and she was finding it hard to breathe.
“Perhaps I better call an ambulance”, she said to herself, reaching for the phone.
…to be continued…
End of Joan, part 1. Please let me know what you think, it’s hard to balance heavy medical stuff with making it easy to understand, and there are probably medical people reading this, tearing their hair out at what I’ve just written…