Published on February 24, 2022

Is It A Heart Attack?

Explaining heart attacks

Shailesh Nandish, M.D., a cardiovascular disease specialist and the Medical Director of Enloe’s Structural Heart & Valve Center, talks about heart attacks and heart health.

Daniela Contreras, host: Every 40 seconds someone in the United States has a heart attack, according to the CDC. While 1 in 5 heart attacks are silent, many show symptoms. Do you know what they are and would you know what to do?

Hi, everyone. I’m Daniela Contreras. Today I’m with Dr. Shailesh Nandish, the Medical Director of Enloe’s Structural Heart & Valve Center, to answer those questions and more in honor of American Heart month. Let’s get started. Thank you, Dr. Nandish, for being here.

Shailesh Nandish, Cardiovascular Disease Specialist: You’re welcome. It’s my pleasure.

DC: So we hear the term “heart attack” a lot, but a lot of us may not know what it actually means. Can you tell us more about what it actually is to have a heart attack?

SN: Yeah, so a heart attack, it’s just kind of broad term, but the underlying problem is the heart muscle is lacking blood flow. It’s starving for oxygen, and that’s because there’s a blockage. Whether it’s from a plaque or whether it’s from a blood clot, the underlying problem is lack of blood flow. So a blood vessel supplying the heart muscle can get blocked with either the plaque or the blood clot and cuts off the blood flow to the heart muscle, and that’s what’s really a heart attack really means and what’s happening underneath.

DC: So what are the symptoms of a heart attack?

SN: So typically most people have significant amount of chest pain. It feels like they have an elephant sitting on their chest. That’s the usual description. But it varies. Some people can come with these kind of intense symptoms and some people come in with just being short of breath.

But a lot of them have chest pain, pressure, heaviness, tightness, they can have their jaw hurting, they could have their arm hurting or they could just be, you know, just like light-headed and dizzy, nauseated with a lot of heat burn. So it just varies in different people.

DC: OK, so as I understand, some heart attacks may not even have symptoms. Can you tell us about the ones that don’t?

SN: Yeah, so there’s also some terminology, which is called a “silent heart attack,” and it affects almost like 45% of people. And it’s really what it means is they don’t present with the classic symptoms I just described.

They may not have that intense chest pain or intense chest pressure. They don’t have that elephant sitting on their chest. They may just blow it off because they felt maybe a little ache and pain in chest, or they got short of breath or they just maybe got a little nauseated and they may have heartburn and they may just say, “Well, it’s probably nothing. I have had this before.”

So those are the ones, which are kind of a little concerning because when they have it and they have risk factors they may want to just get this checked out rather than wait on it.

DC: And who are the people who are at like most risk of getting a heart attack?

SN: In the past we’ve always thought like, “OK if you’re 60, 65, you’re at higher risk of having a heart attack.” That’s true, even today. The older they are, there’s a higher risk of heart attack, but we’ve also seen this pendulum switch a little bit. We can see those younger people have heart attacks nowadays, even going down to like 40s. And we’ve seen people who come in in their 30s with heart attacks. So I would not categorize as an age group anymore. Although it’s more seen in people who are older, but it can be definitely seen in people in their 40s and 50s anymore.

DC: Is there something we can do to lower our risk of a heart attack?

SN: Absolutely, yeah. The underlying problem is inflammation, high cholesterol, plaque buildup leading to heart attacks or leading to compromised blood flow. Now anything we could do to take care of that, reducing inflammation, reducing cholesterol in the body, reducing risk factors, which means reducing blood pressure issues, managing blood pressure very well, taking care of the diabetes if there is a, you know, someone’s got diabetes, really controlling diabetes well that’s very, very critical and basically having a good healthy lifestyle.

Now we’re also talking about lifestyle. We’re looking at cutting smoking, reducing maybe even alcohol excessively. You know, eating healthy, eating healthy means really minimizing all the inflammation-causing foods, which includes oils, dairy, red meat. A lot of these things can cause a lot of inflammation in the body. So any of those things will add to your well-being, not only just reduce your risk of heart attack but in general your risk of high blood pressure goes down, diabetes goes down. In turn, you’re also going to benefit from not having a significant problems with your heart blood flow.

DC: What should people do if they think they or a loved one is going to have a heart attack or is having a heart attack?

SN: The one last thing you should do is to drive to the ER yourself. You should call 911. Get the right people and get the EMS people to come into your house wherever you are so that they can get your treatment started there, get you on the right medications, get you going, get you stabilized and that way you could be brought to the emergency room and taken care of right away.

The last thing you want to do is you, yourself, want to drive there because a lot of things can happen from then on until you get there, which you don’t want to do. And the family also has to be careful because there’s a lot of things going on, and you know it’s life-saving when somebody like 911 or EMS comes there and then gets them on the right medications right away and in the hands of professionals who can take care of you until you get safely to the emergency room, where they could be taken care of.

DC: So, Dr. Nandish, when someone has a heart attack speed is very important. Can tell us what happens here at Enloe. How do we take care of them?

SN: So our goal is not just how we take care of them in the hospital, but how soon can we get to the patient outside? How soon can we pick them up? How soon can we treat them right there? We bring them to the emergency room and then straight from there we take them to the cardiac cath lab.

Once they’re in the cath lab it’s a matter of minutes. We’re in about 10 minutes to 15 minutes, we’re in there to open up the arteries by then. And that’s the key. So our goal is to open those blockages within 90 minutes of arriving in the emergency room. But really speaking — we want them to have this done from the time they have their symptoms to the time we take care of them by opening up the arteries — we want to keep that in 90 minutes to 120 minutes.

DC: So as I understand Enloe is a STEMI Receiving Center? What does this mean and how else do we excel here at Enloe?

SN: So STEMI basically means someone who’s got a 100% blockage in their heart blood vessel. The critical thing to do is to open up the artery right away, and we have the capability and expertise to open up those blockages and that’s why we are one of the STEMI Receiving Centers.

And it not only applies to people who just walk in the door to our emergency room also for people who get transferred from surrounding community hospitals to our center either by air or by ground. They can be transferred to us, we receive them and we take care of them right away.

DC: So, Dr. Nandish, what are some of the newer procedures that are offered here at Enloe, for instance TAVR?

SN: Yes, so we started our TAVR program just about less than two years ago, and we are doing this in a minimally invasive way. And we go through the groin or through the neck, and take care of the diseased aortic valve. We don’t take out the valve. We put a new valve in its place of the old valve, and the old valve will be pushed to the side and people do great. And they go home in one to two days after the procedure.

DC: So let’s say someone already had a heart attack. What does life look like after in terms of recovery?

SN: The majority of people in these days do well after a heart attack. In terms of how they recover, it all depends on how well the heart muscle is pumping. But majority of them, if they do the right thing, if they eat right, if they do that lifestyle changes, quit smoking, take all the medications as prescribed, follow up with their cardiologist, they do well.

And the one important thing we also do after their discharge is get them involved in cardiac rehab. Enloe has a cardiac rehab, really excellent program, really beneficial. Everyone who’s been there tells that they’re really glad they made it to it. I think it’s about six to eight weeks long. They do it three days a week. There’s a lot of people together talking about how to take care of themselves, how to take care of their health, what to do, supervised exercise program, that’s the key to recovery.

DC: And after that, can they go back to having an active lifestyle or do they have to be more mellow?

SN: Yep, so most of them what we suggest is for five to seven days to take it easy and after that there’s really no restrictions. Unless there is another issue, we caution them not to do it, but the majority of them they should be able to get back to their life and start living their life the way we want.

DC: And how often should people see their doctor and think about their heart health?

SN: You know, if somebody has a known problem, I think they’ll absolutely have to see their cardiologist once in three to six months, depending on the situation. But if they’ve never seen one, if they don’t have any risk factors, then I think at least seeing a family doctor once in a year minimum is important.

Get a cholesterol level checked out, evaluate your risk, look at the family history and see where you stand. It’s best to prevent a problem then to take care of or treat a problem later on. So I think the prevention starts early on and that’s where you go and meet your family doctor and see OK this is my family this is my risk factors. How do I minimize my risk of having a heart attack? That’s going to be the biggest thing.

DC: Wow, that’s all great and fantastic information. Thanks again for joining us, Dr. Nandish, and thank you all who tuned in.

We hope you found this information helpful, and if you want to learn more about heart health visit or talk to your provider. And if you want to hear the inspiring story of an Enloe patient who was diagnosed with coronary artery disease, the most common of the heart diseases, and is now thriving, check out Enloe’s podcast Health Matters. We’ve placed a link to it in the comments field. Thanks for joining us. Goodbye.