The Story of a Heart Attack (An excerpt from The No Bull Book on Heart Disease: Real Answers to Winning Back Your Heart and Health) by Joel Okner, MD and Jeremy Clorfene, PhD

Heart attacks do not come in "one size fits all." Heart attack victims experience a wide range of symptoms ranging from minor physical discomfort to intense, attention-grabbing pain. The story told here describes a typical heart attack similar to that experienced by many of our patients. It is told from the point of view of a male cardiac patient, although many women have similar cardiac experiences. In fact, heart disease is the number one killer of women. (See chapter 10 for a discussion of many of the unique problems women encounter when battling coronary artery disease.)

What's in a Name?

Myocardial infarction. Coronary thrombosis. Angina pectoris. Hypertrophic cardiomyopathy. Pulmonary stenosis. For you, they all add up to waking up in the middle of the night, and you don't feel right. You're sweating, short of breath, and have a pain in your chest. You get out of bed and go downstairs. You still feel bad. Maybe it's a little indigestion. You take two antacid tablets and wash them down with a glass of cold milk. You stick your head outside the kitchen door to get some fresh air and you feel a little better. You're not sure what's going on with you. Maybe it's anxiety about the big meeting you're going to the next morning. You walk upstairs and get back in bed. You toss and turn and can't get comfortable.

Now your wife wakes up because you've ruined her sleep. She asks what's bothering you. You say you just don't feel well. She looks at you and says, "You know what? You look terrible. Let's call 911." You say, "No, no, no. Just drive me to the hospital and I'll be fine."

Halfway there you say, "You know what? I feel a lot better. Let's go back." She says, "We're going to the hospital."

What to Do If You Think You're Having a Heart Attack

If you have even the remotest inclination that something is wrong with your heart, even a 1 percent chance, there are four things you should do in this order:

1. Chew two to four aspirins immediately. Don't swallow them whole. They're going to taste awful but chew them anyway and then swallow. This simple step can be lifesaving.

2. Call 911. Yes, it's going to be embarrassing. The children, the neighbors, the dog, everyone's going to wake up, but this is a life-and-death situation.

3. Do not convince your spouse to drive you to the hospital instead of calling 911.

4. Stay in bed and let the paramedics do their job. This is not the time to start testing yourself to see what brings back the chest pain back (for example walking up and down stairs, or going outside in the cold air).

Common Symptoms of a Heart Attack

oLeft-sided chest pain (sometimes the entire chest and right side is affected as well)

oDull, aching, or toothache-like pain

oPressure-like something big is sitting on your chest

oA squeezing sensation-like someone is squeezing your chest

oNausea

oVomiting

oProfuse sweating

oDizziness

oShortness of breath

oPain may spread to the left arm, right arm, neck, or back

In the emergency room you're nervous and don't know what to tell the triage nurse. You finally blurt out, "I'm having some chest pain." She says, "OK, we'll take you to a room and get you checked out. Can you walk twenty feet?"Absolutely. No problem. You're a guy.

By the time you walk the twenty feet you're drenched in sweat and the pressure in your chest is a lot worse. You take off your clothes, put on a hospital gown, and lie down. You really don't feel good.

You have now stepped out onto the floor and begun "the dance." You're going to be dancing to this music for a long time with many partners. You're going to be passive and follow their lead for a lot of it.

The emergency-room doctor comes in, asks you some questions, and writes a bunch of orders. While you're wheeled out and given a barrage of tests, your wife sits in the corner of a cramped examining room holding a plastic bag with your belongings. It's clear that she feels displaced and left out.

A while later, you (now called "the patient") return to the examining room, followed by the doctor, who tells you what's going on: "Mr. Smith, we got the results of your tests. Your troponin is positive, and your CPK isoenzymes are negative. We did an EKG, and this is somewhat borderline. We're going to do some more tests, OK?"

You don't understand one word he's said, but you're too terrified to say anything, so you just shake your head yes.

Getting a Stent

Before you have a chance to calm down a little, a new team of doctors and nurses file in to take you to your cardiac catheterization (a procedure where a thin plastic tube is inserted into a leg artery in the groin area and advanced into the heart or coronary arteries to make another bunch of tests). You're medicated and pain-free and actually feeling pretty good.

You're chatting with the team on your way to the catheterization lab, and your wife is following behind the gurney. You say good-bye to her before you disappear through the double doors.

In the lab you're lying on the table naked except for a little towel covering your groin. Lights are blaring, music is playing, and people are walking all around. The towel is whisked off, and the right side of your groin is scrubbed, shaved, and covered with a sterile blue drape. You're sedated and the cardiologist performs the procedure.

Next thing you know, you wake up in the recovery room. It's likely you've been slotted for one of three treatment paths:

1. Drugs, because you may have been found to have minor artery blockages and require medical therapy.

2. You may be the proud owner of a stent, a small metal tube that is inserted into a blocked artery to hold it open and allow blood to flow to the heart

3. You're on your way to the operating room for coronary artery bypass grafting ("CAPG" to the medical profession; "bypass" to the man on the street).

Your old life is gone. Welcome to your new one, and get ready, you'll need a good roadmap for this one.

You're back in bed and hooked up to an IV that's dripping chemicals into your veins. The doctor comes in. You've been waiting all morning for this guy, and now he's standing beside your bed. You're looking up at him, scared stiff. He's looking down at you, and he says, "Let me tell you what we found."

You need a decoder to figure out what he's saying. "We did an angiogram last night at about three o'clock when you came in with accelerated unstable angina. The ejection fraction is about forty-five percent, which puts you borderline for heart failure. We actually found two different blockages in the mid-LAD and distal circumflex artery and put in a rapamycin-coated stent, and you should do just fine." He gives you a prescription for nitroglycerin and says, "Take this if you need it and I'll see you in two weeks. Do you have any questions?"

Do you have any questions! You've got a million of them, starting with "What the hell did you just say?" But all you can get out is "How do we arrange for the visit?"

Just as the doctor opens the door to leave, he turns and says, "Oh, Bob, until I see you again I don't want any driving, no sex, no work, no lifting more than ten pounds, and no exercise. And to answer your question, the discharge nurse will help you make the follow-up appointment with me. Take care." Crazy with anxiety, you and your wife watch him go.

What You Cannot Do After an Angiogram

For the first forty-eight hours you should take it easy: no running, climbing, sex, exercise, driving, or lifting weights over ten pounds. These activities won't hurt your heart, but they could cause bleeding problems at the angiogram site in your groin, which takes about two days to heal.

You are discharged from the hospital later. Until the appointment with your cardiologist, you feel at sea, set adrift with no paddles, rudder, or workable sails.

Bypass Surgery

In many cases stenting the coronary arteries, as described above, is a suitable option. But for many cardiac patients, open-heart bypass surgery is the appropriate treatment. In this case here's how the scenario might play out.

After you awake from the catheterization, the doctor walks in with your wife. By the look on their faces you have a sneaking suspicion they've already spoken to each other and she knows what's going on. You are clueless.

Here are Some Basic Definitions to help you decode what everyone is saying to you:

Angioplasty: A procedure where small, specialized balloon is inflated in the blocked (or partially blocked) coronary artery in order to open it up.

Stenting: After angioplasty, a very small metal scaffolding is inserted in the artery at the site of the blockage. The stent looks like and is about the same size as a spring at the end of a pen. This helps keep the artery open long-term.

Open-heart bypass surgery: A surgical procedure where your breastbone (sternum) is cut in half and new blood vessels are put in around (i.e., bypassing) the original blocked arteries, providing a new blood supply to the heart.

"Well, Bob," announces the doctor, "it looks like we can't treat the blockages with stenting or angioplasty, so you're going to need bypass surgery. We'll get that set up, probably tomorrow morning."

Next, a surgical nurse comes in and gives you all the details, 99 percent of which you're never going to remember because you stopped listening when you heard the words open-heart bypass surgery.

What to Expect After Bypass Surgery

It's now a day after the surgery and you're in the intensive care unit. Here's what you should expect for the next two to seven days:

oYou will stay in intensive care for days one and two. This is an anxiety-producing place, with machines all around you, making an incredible amount of weird noises. You hope they're good noises, but you can't be sure. The electrocardiogram machine beeps nonstop; you're worried that if it stops you're going to die, or if it beeps too fast you're going to die. Tubes are stuck into places you never imagined tubes could get into. You are totally miserable. You feel like you've been run over by a truck.

oDays three and four are a little better. You're out of intensive care, and most of the tubes that were in bad places (like your chest and bladder) are out, but you're still sore and not sleeping well. The trite, comic complaint is all too true-every time you fall asleep a nurse wakes you up to see if you need something.

oOn days five, six, and seven you get ready to go home. This is good; you feel you can do this. The nurses walk with you in the hall, working on your lungs and strength. A discharge planner works with you and everything is going really well.

oThen suddenly it's time-you get to go home. Leaving the hospital is a double-edged sword. On the one hand you're happy to go home; on the other hand, you're a little nervous about being cut loose from the constant medical attention you've been receiving. As you leave the hospital it's almost as if you've been reborn. You have become a "patient-citizen" living in the medical world where you're dependent on family, staff, and doctors. It's a totally different world, and you have to adjust to it.

What to Expect When You Get Home

At this point, you should be prepared to confront a number of issues.

oYour wife doesn't know how or where to touch you, and treats you like a fragile piece of crystal. This pisses you off.

oYour wife and children are scared because they've never seen you so sick and weak, and they don't know how to act. Your wife is also angry because you screwed up her life.

oYou can't work for four to six weeks. Don't even think about it. And you can't drive or lift. You have all kinds of new medicines, new side effects that you have to figure out, and you're monster tired.

oYou're undoubtedly going to be depressed. If you had a problem before the heart attack, it's going to blow apart now.

oThe surgical site in your leg where the catheter was inserted hurts more than your chest.

The First Post-surgical Doctor's Appointment

Now it's time for your first doctor's office visit, and you're psyched up for it. You've been home one or two weeks, and although you're feeling a little bit better, you're still not sure about what you can and can't do. Your wife constantly yells at you, saying, "They must have told you five times in the hospital what your limitations are!"

The two of you walk into the doctor's office fifteen minutes early. You have fears and anxieties-and an hour's worth of questions. Your wife told you to write them down, but, of course, you didn't because you're a guy, you can remember these things. But no one ever told you that after a bypass you might have memory problems

The Most Common Questions I Hear After Bypass Surgery (Dr. Okner)

1. When can I go back to work?

2. When can I start having sex? (Why do women patients never ask this question?)

3. When can I start exercising (even though the guy has never exercised before in his life)?

4. When can I drive?

5. When do I see you again?

The Questions I Should Hear After Bypass Surgery

1. How's my heart?

2. How did the surgery go?

3. How long do I have to take these new medicines?

4. How long will it take my breastbone to heal?

5. What can I expect my life to be like in the next three to six months?

6. What can I do so I never have to experience this again?

Some of the Most Common Fears and Anxieties Expressed After Bypass Surgery (Dr. Clorfene)

1. I can't take care of my family. I'm going to lose my job.

2. I have lost the respect of my spouse. My family treats and looks at me differently.

3. I don't know how to get back to "normal life."

4. I am damaged goods. I am never going to get better.

5. I can't make the lifestyle changes the doctors want me to make.

6. I'm going to look damaged and ugly because of my scars.

You expect to be the first patient. The receptionist will greet you with a big smile; the nurses will embrace you and take you to a room where the doctor will answer all your questions. You're going to have a great day.

Instead, you find out there are ten people ahead of you in the cramped waiting room. You finally get a seat when somebody moves his coat off of a chair. You notice that although you have been waiting for forty-five minutes, the two people who came in after you are taken in ahead of you. All you can hear are sounds of merriment and laughter coming through the glass door that separates you from where you want to go. You're starting to sweat and your chest hurts. Or are you imagining it?

You begin to hate the other patients and office staff for complicated reasons. You hate your fellow patients because they're your competitors, even though you may never see them again. You want to get to the doctor and then get the hell out of there, and they want the same thing. Then there's the staff, the insensitive dolts who are laughing and having fun while you're sitting there in the waiting room, feeling anxious, fearful, and in pain. In your anger, all you can think about is killing the people sitting next to you and those behind the glass window.

At last a nurse calls your name. It feels like you've won the lottery because you're so excited to see the doctor after waiting an hour and a half. But do you see the doctor then? Yes, but only for a moment, as he passes you in the corridor on his way to another patient. Meanwhile, you've been led into a small examining room and are told to take off your clothes. A triage nurse takes your blood pressure, does an EKG, and asks you about all kinds of things you already answered on the form you filled out when you first came into the office.

You wait half-naked in a hospital gown for another thirty minutes, and then the doctor materializes. Here's your chance to get all your questions answered. But guess what? You've forgotten everything you wanted to ask. All of your questions about your fears and concerns are suddenly gone and . . . you're done. The doctor has hurried off to his next patient in the next examining room.

You walk out and your wife grabs you and says, "Tell me everything the doctor said!"

You say, "He said I should come back in three weeks." At this, she wants to murder you. You want to do the same to her because you know she was right about writing down your questions.

You go home and have to call the doctor and say, "You know what, I forgot to ask you some questions." The doctor does not call back immediately and you and your wife are mad at each other all over again.

And, as the saying goes, the rest is . . . for another day.

To read more of The No Bull Book on Heart Disease: Real Answers to Winning Back Your Heart and Health, published by Sterling Publishing in Jan 2009, contact your local bookstore.

About the Authors:

Dr. Okner received his B.S. in Biochemistry from the University of Michigan and M.D.

from the University of St. Andrews and University of Glasgow, in Scotland. He is American Board Certified in Cardiovascular Disease and American Board Certified in Internal Medicine. He served as Director of Cardiac Cath Lab at Condell Medical Center from 1998 to 2002 and has been the Medical Director of Condell Medical Center (MCHI) since 2000.

He completed his internship and residency and was chosen as Chief Resident at Rush

University Medical Center in Chicago, Illinois. He has been in clinical practice at Condell Medical Center for approximately 14 years.

Dr. Okner is a practicing cardiologist and devoted to his community by being involved in

many outreach programs such as the cardiomyopathy screening program for high school

athletes.

Dr.Clorfene is a licensed practicing clinical psychologist, specializing in health

psychology and psychotherapy.

He treats people with heart disease, diabetes, obesity, chronic pain, depression,

stress/anxiety disorders, and smoking cessation. He is the Director of Psychological

Services for the New Direction Weight Management program at Condell Medical Center

and head psychologist for the same hospital's Phase II Cardiac Rehabilitation program.