Heart Attack Archive

For monitoring conditions that contribute to heart attack and stroke, virtual doctor visits are much more convenient than in-person appointments. Where is this trend headed?

Virtual doctor visits — when you talk to a physician on a video call instead of during an in-person office exam — have been available in certain places for years. But they never really caught on until the pandemic hit earlier this year. Almost overnight, virtual care became an indispensable tool for managing coronavirus infections and other health conditions during the crisis.

In 2019, virtual visits accounted for fewer than 1% of the appointments at Mass General Brigham, a large health care system founded by Harvard-affiliated Brigham and Women's Hospital and Massachusetts General Hospital (MGH). "But during the peak of the coronavirus surge in Boston, 80% of all visits were done virtually," says Dr. Lee Schwamm, director of the Center for TeleHealth at MGH and vice president of virtual care at Mass General Brigham.

Research we're watching

Ticagrelor (Brilinta), a drug that helps prevent blood clots, was approved in 2011 for treating people who had experienced a heart attack or acute coronary syndrome (a sudden loss of blood flow to the heart). Now, the drug can be prescribed to a broader group of people. In June 2020, the FDA expanded ticagrelor's approval to reduce the likelihood of first heart attack or stroke among high-risk people with coronary artery disease.

The expansion is based on results from a multiyear study of more than 19,000 people with coronary artery disease and diabetes at high risk for a heart attack. Participants who took aspirin plus ticagrelor were less likely to experience a heart attack, stroke, or death from heart disease compared with those who took aspirin alone.

Research we're watching

People with chronic pain may be more likely to have a heart attack or stroke than those without chronic pain, according to a study published online May 7, 2020, by the journal Pain Medicine.

From 2001 to 2005, researchers identified 17,614 Taiwanese people who had used pain relievers for at least three months. The most common causes of pain were spinal disorders, arthritis, and headaches; the pain relievers included both over-the-counter drugs and prescription opioids. For the comparison group, researchers used 35,228 people without chronic pain who were matched by age and sex to those in the first group.

If you have experienced a heart attack or undergone a heart procedure, don't neglect your mental health during recovery.

Recovery from a heart attack, heart failure, angioplasty, or heart surgery — what doctors call heart events — can be stressful. Depending on your condition, it may also involve cardiac rehabilitation. This medically supervised program focuses on exercise, diet, and lifestyle changes. While the primary focus is to help you physically, you also need to address your mental and emotional health.

"It's normal to have some anxiety and stress after a heart attack or heart surgery," says Dr. Christopher Celano, assistant professor of psychiatry at Harvard-affiliated Massachusetts General Hospital. "But how long these feelings linger, and whether they are also associated with symptoms of depression, can affect your rehab recovery success and potentially increase your risk of future problems."

Ask the doctor

Q. My husband is reluctant to get tested for sleep apnea. But I'm pretty sure that he has it, and I'm concerned because I've heard that it can contribute to heart disease. How are these two conditions connected?

A. As you likely know already, people with sleep apnea may snore loudly and may also periodically gasp for breath throughout the night. These explosive snorts often wake up bed partners or roommates — although not necessarily the person with apnea.

Ask the doctor

Q. A recent electrocardiogram showed that I have a right bundle branch block. My doctor says it's fairly common and nothing to worry about, but I'm a bit concerned. What is it, exactly? And what specifically can cause this problem?

A. Bundle branch block refers to a small glitch in the heart's electrical conduction system. The term "bundle" refers to a collection of nerve fibers that receive the "contract now" signal from the atrioventricular node and relay it to the ventricles, the heart's lower chambers (see illustration).

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

 Image: © digitalskillet/Getty Images

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.

 Image: © PeopleImages/Getty Images

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.