A man suddenly clutches his chest, feeling the weight of an elephant pressing on him, then keels over in pain. Doctors refer to this as a Hollywood heart attack.
But for many, the signs aren’t so dramatic. The symptoms may not even be sudden or severe. There may be chest discomfort that can feel like a squeezing or burning sensation. There may be pain radiating through the upper body, below the nose and above the navel. And there may be nausea, shortness of breath, a feeling light-headedness and a cold and clammy feeling.
Understanding how your ticker works — and what can go wrong with it — is essential knowledge for everyone, especially those who have heart disease or are at risk of developing it. The tricky thing about heart disease — a group of conditions that affect the heart’s structure and functions — is that people can find themselves in serious danger before noticing any symptoms.
Toronto cardiologist Dr. Beth Abramson routinely sees the look of dread and confusion on the faces of patients when they receive a diagnosis of heart disease. The most common condition is coronary artery disease, which occurs when blood vessels to the heart become blocked or narrow, restricting the flow of oxygen and blood.
Heart disease is a leading cause of death in Canada, which is why, after more than 20 years as a physician and more than a decade as a volunteer spokesperson for the Heart and Stroke Foundation, Abramson sat down and wrote Heart Health for Canadians: The Definitive Guide, in bookstores Jan. 22.
It’s a crash course in heart disease, looking at reducing one’s risk of heart problems; navigating the health-care system, through the various diagnostic tests (such as electrocardiograms, stress tests and angiograms); and finding available treatments to manage the disease.
“My goal with this book is to reduce people’s fears and misconceptions surrounding heart health,” says Abramson, director of the Cardiac Prevention and Rehabilitation Centre at St. Michael’s Hospital. “The book is a tool for pro-active health and gives Canadians a way to empower themselves through knowledge.”
Abramson, an associate professor of medicine at the University of Toronto, notes that she is taking cutting-edge concepts in cardiac care and breaking them down into simple components of what people need to know. The book is full of anecdotes about real patients, which makes the information more readily accessible to readers.
For instance, don’t do what some of her patients have done. Don’t ignore the signs of a heart attack and chalk it up to heartburn or indigestion, carry on with daily activities like taking your child to soccer practice or wait until you get home from vacation before seeing a doctor.
Canada’s growing aging population and the rise in obesity, inactivity and diabetes make this book especially timely, says Dr. Anthony Graham, a board member of the Heart and Stroke Foundation.
“The burden of this disease is staggering and the potential burden is even greater,” says Graham, a cardiologist at St. Michael’s Hospital.
With all the health information on the Internet, some of which can’t be trusted, Graham says he’ll definitely recommend the book to his patients, their spouses and their families. Abramson, he says, is up to speed on the latest research, and zeroes in on tests and treatments available in Canada.
Thanks to advances in medicine, in recent decades the number of people dying from cardiovascular disease has been declining – yet those living with heart disease and surviving stroke has been increasing. The disease, however, remains a top killer in Canada. According to Statistics Canada, about 27 per cent of deaths in 2009 were from heart disease and stroke.
Abramson, whose grandfather died after a heart attack, emphasizes prevention. Her goal is to encourage people to care of their health before they reach a crisis point. Studies show up to 80 per cent of heart disease is preventable if you quit smoking, eat a healthy diet, get active and maintain a healthy body weight, she notes.
Common risk factors for heart disease include a family history of the disease, high cholesterol, high blood pressure and diabetes.
Patients frequently ask about the role of family history. Interestingly, Abramson says risk doesn’t usually skip a generation. In other words, if your grandfather had a heart attack at 50, then there’s no risk in terms of family history. But if it’s your father who had a heart attack at 50 then there’s a concern.
“I often say that heart disease, to some degree, is due to bad luck, bad living and bad genes,” says Abramson. “We can’t change our genes, so we can’t change our family history. But knowing we’re at increased risk because of our family history we can change our luck by changing our lifestyle and our living. If you know you’re at increased risk for heart disease, all the more reason you need to pay special attention to lifestyle modification and, where appropriate, medication interventions.”
Baby boomers are at “prime risk for developing heart disease,” observes Abramson, noting heart disease in men typically starts after age 40 and in women after menopause, usually when they’re in their 50s. Beyond that, there’s little difference between the sexes when it comes to symptoms and treatment.
There is, however, a gender gap. Since the early 1970s, the number of women dying from heart disease and stroke has been increasing while among men it is decreasing. In the last decade, women have caught up to men and now their death rates are equal, says Abramson, whose specialty is women’s cardiovascular health. “It’s an equal-opportunity killer.”
She can’t explain this troubling trend, saying it’s not simply the result of an aging population. “It’s either biology or bias,” she offers.
Biologically, there may be a difference because women tend to be diagnosed with heart disease when they are older than men, which means they may have other health issues such as diabetes and high blood pressure.
Or, it could be bias, she says. Abramson suggests women are being treated differently than men, saying there’s recent Canadian data that points to care gaps. She notes that women are less likely to be treated by a cardiovascular specialist, transferred to a cardiac facility and undergo specialized tests.
When people think of diseases that afflict women, heart disease doesn’t spring to mind, says Abramson. “But it’s our leading health threat. Women, their spouses and family members need to be aware of that.”
She urges men to take this to heart: “If you’re lying in your bed at night and your wife has chest pains, you shouldn’t say, ‘It must be indigestion’ and turn away. You should say, ‘Honey, it could be your heart’ and call 911.”
By the numbers: Our heart health
- 80: Percentage of premature heart disease and stroke that is preventable.
- 30: Percentage of deaths worldwide from cardiovascular diseases— heart attack and stroke— making it No. 1 killer.
- 17.3: Number of people in millions who died worldwide from cardiovascular disease in 2008.
- 23.6: Number of people in millions worldwide estimated to die annually by 2030 from cardiovascular disease.
- 70,000: Number of heart attacks in Canada each year.
- 50,000: Number of strokes in Canada each year.
- 20.9: The annual amount in billions that heart disease and stroke costs the Canadian economy in health-care costs, medications, lost wages and decreased productivity.
- 21: The percentage of Canadians between 45 and 59 already diagnosed with heart disease, stroke or high blood pressure.
Source: Heart Health for Canadians: The Definitive Guide