Heart Attack Archive

A high pain tolerance may account for some "silent" heart attacks. But failing to recognize atypical symptoms is a more likely explanation.

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Nearly half of people who have a heart attack don't realize it at the time. These so-called silent heart attacks are only diagnosed after the event, when a recording of the heart's electrical activity (an electrocardiogram, or ECG) or another test reveals evidence of damage to the heart.

What's behind this surprising phenomenon? One explanation may be a higher-than-average tolerance for pain, as a recent study suggests (see "Does a high pain tolerance mask heart attack symptoms?"). Other people mistake their symptoms as indigestion or muscle pain. Still others may feel pain, but in parts of their upper body other than the center of the chest.

Sometimes it's hard to tell the difference between a heart attack, heartburn, and lung problems.

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Many kinds of health problems can cause chest discomfort, with symptoms so intense that you rush to the hospital. "I see older adults with chest pain or something related to it every time I work in the emergency department," says Dr. Kei Ouchi, an emergency medicine physician at Harvard-affiliated Brigham and Women's Hospital.

The big fear

You may worry that chest pain is due to a heart attack, which occurs when blood flow to the heart is blocked, typically by a blood clot and narrowed arteries. Classic symptoms include pressure or squeezing in the chest, lightheadedness, and pain in the shoulder, arm, neck, jaw, or back.

Stressful experiences are hard to avoid and impossible to predict. But taking steps to bolster your resilience may help.

The palpable stress stemming from the COVID-19 pandemic has made things once considered stressful — such as deadlines or traffic jams — seem pretty trivial in comparison. But while you may not be able to avoid the stressful situations that come your way, there are ways to mitigate your body's response to those events.

So far, the evidence that stress management strategies can protect your heart is limited but growing. Yet there's no doubt that stress contributes to heart problems. "The link between stress and cardiovascular disease is well established," says cardiologist Dr. Ahmed Tawakol, an associate professor of medicine at Harvard Medical School.

Research we're watching

Most home blood pressure monitors sold in Australia are not carefully tested for accuracy, according to a study published online April 10, 2020, by the journal Hypertension.

Because more than 90% of the devices the researchers studied were purchased from international online platforms such as Amazon and eBay, that means many devices purchased in the United States and elsewhere might give inaccurate readings, the authors say.

Research we're watching

A yoga-based rehabilitation program may be a safe alternative to conventional cardiac rehab, a new study suggests. A customized program of exercise and education, conventional rehab helps people recover from heart-related problems.

The study included nearly 4,000 heart attack survivors in India, where cardiac rehab programs are uncommon. Half took part in a program featuring 13 weekly sessions of gentle yoga exercises. The other half received standard care, which included three sessions of advice and handouts.

Research we're watching

People with clogged arteries in their hearts (coronary artery disease) or legs (peripheral artery disease) face a high risk of having a heart attack or stroke, particularly if they also have diabetes. For such people, a combination of clot-preventing drugs lowers the risk of those dangerous outcomes, according to a study published online March 28 by the journal Circulation.

The study included just over 18,300 people with coronary or peripheral artery disease; about 38% also had diabetes. They all took low-dose aspirin daily, but half also took 2.5 milligrams of rivaroxaban (Xarelto) twice daily while the others took a placebo. Like aspirin, rivaroxaban helps discourage blood clots, but through a different mechanism.

Can boosting testosterone levels improve your sex life?

The hormone testosterone plays a big part in men's health, but perhaps its most meaningful role is to fuel sex drive and performance.

Testosterone levels tend to decrease with age. They peak by early adulthood and then can drop by up to 1% per year beginning around age 40. Sometimes an abrupt fall occurs because of an injury or illness (such as an infection), chemotherapy or radiation treatment, or certain medications.

Here's what the numbers mean — and strategies to lower your cholesterol if it's too high.

For some women who've had normal cholesterol readings all their lives, that changes at menopause. "Going through menopause often results in lipid and cholesterol changes for the worse," says Dr. Samia Mora, an associate professor of medicine at Harvard Medical School and a specialist in cardiovascular medicine the Brigham and Women's Hospital. Drops in the female hormone, estrogen, are associated with a rise in total cholesterol levels due to higher amounts of low-density lipoprotein (LDL), the "bad" cholesterol, and another blood lipid (fat) known as triglyceride. Over time this can raise heart risks, which is a reason for concern, as cardiovascular disease is the No. 1 cause of death in postmenopausal women, says Dr. Mora.

"So, it's especially important to track the numbers in perimenopause and the early years after menopause, as LDL cholesterol and total cholesterol tend to increase," she says.

These are the most effective ways to protect yourself.

Here are some alarming statistics about heart attacks:

• Every 40 seconds, someone in the United States has a heart attack.
• Every year, about 805,000 Americans have heart attacks, 75% of which are first-time attacks.
• The average age of a first heart attack among men: 65.

However, the most troubling fact about heart attacks is that many people don't take steps to protect themselves, says Dr. Deepak L. Bhatt, executive director of interventional cardiovascular programs at Harvard-affiliated Brigham and Women's Hospital Heart & Vascular Center. "Reducing your risk of cardiovascular disease is the best way to guard against heart attacks," he says. "There are simple ways to do this, but unfortunately, many people still don't follow them as they should."

Here's a look at five ways you can protect yourself from cardiovascular disease, and thus possible heart attacks, and avoid being another statistic.

Heart attacks are responsible for most cases of cardiac arrest. Know the warning signs—and what to if you witness a cardiac arrest.

Recently, a Harvard Heart Letter reader sent us an email asking about sudden cardiac arrest. This much-feared event occurs when the heart abruptly and unexpectedly stops beating. Each year, nearly 380,000 people in the United States experience cardiac arrest, and only about 10% survive.

"What are the causes and contributing factors? Are there early symptoms before the arrest occurs? And can it occur in a seemingly healthy middle-aged person?" she asked. Sudden cardiac arrest remains challenging to both predict and prevent. But there are definitely ways to lower your risk — and things that everyone should know (see "Recognize and react to sudden cardiac arrest").