Unfortunately, a heart attack is a condition that we hear about all too frequently. But, do athletes or those that are fit and athletic need to worry about heart attacks? Because last week I got a series of calls and text messages that one of our people that work here at IOHA, and we'll just call him my friend from here on out, was in the hospital with a possible heart attack. And this person was definitely fit and athletic.
So in today's video, we're going to talk about what actually occurs or happens with a heart attack, answer the question of, Do people who are fit and athletic actually have to worry about this? And if people actually do have a heart attack, can they recover enough to where they can participate in sports, run marathons, and participate in other physical activities again? It's going to be a heartfelt one, so let's jump right into this anatomical awesomeness. So let's start by utilizing this human heart to discuss what occurs during a heart attack, and of course we'll get into risk factors, And if people who are fit, athletic, or exercise consistently even need to worry about this stuff.
So as we know, the heart sits in the thoracic cavity between the two lungs. It sits in a pericardial sac and this outer portion that I'm touching with my finger is called the epicardium. Now this epicardium is mostly made up of epicardial fat, but how this differs from the heart that we have here on the tray is that we've removed the epicardium so that we could expose the thick muscular layer of the heart called the myocardium.
You can see we've made some incisions to look inside the ventricles. and we can look at those during a different video, but this myocardium, which literally translates to heart muscle, is what we really need to focus on with heart attacks. Now, heart attacks are technically called myocardial infarctions. We know what myocardial is referring to now, but infarction just means an area of dead tissue due to a lack of blood flow.
So areas of the myocardium, this heart muscle, can be dying off during a heart attack because it's not getting the proper amount of blood. So how does the heart... get its own blood supply?
Well, if we come back to this heart, we can see this huge artery right here called the aorta. I mean, look at this thing. This is the size of a garden hose, largest artery in the human body. But the first set of branches that come off of this artery actually go to the heart itself. So if you look here, we've got the right coronary artery, and you can see these branching onto the right side of the heart.
And then we've got the left coronary artery, and it's sending branches onto the left side of the heart. So the idea is that if we get a large enough occlusion or blockage in one of these arteries or branches, this could lead to a heart attack. But heart attacks just don't happen overnight.
They're preceded by the risk factors or other conditions and the big one would be atherosclerosis. Atherosclerosis is a fancy way of saying a development of a plaque on the inside wall of these arteries. Now, these plaques can exist on the spectrum meaning you can have very small plaques all the way up to very large and severe plaques. The smaller ones obviously are not going to block or occlude.
the blood vessels as much or these arteries and a lot of people just don't even know they have them because they won't develop any symptoms. So that's again another reason why it's important to stay on top of your annual physicals, blood work, cholesterol, just staying on top of your health. But as these plaques get larger and larger and larger, eventually symptoms will develop and one of the things that people can develop when they get to these larger occlusions or larger plaques is something called angina pectoris or also referred to as stable angina.
Angina pectoris just means chest pain, but why is it also referred to as stable angina? Well, that's because this chest pain can almost be predictable, meaning Let's say somebody starts to exert themselves. Maybe they have to hike up multiple flights of stairs, they start exerting themselves and then the pain comes on.
But then as they rest, the pain will go away and that's why it's referred to as stable angina because it's like again predictable, exert, pain comes, rest, pain goes away. And the reason for that is the blockage or the occlusion from that plaque is large enough that during rest actually it doesn't cause much of a problem because the heart's kind of beating at more of a resting state. But as soon as the heart has to work more, the heart needs more blood and that blockage does not allow that extra blood to get there during a exercising or more of an exertion type of a state.
Now, stable angina or angina pectoris is not technically a heart attack but obviously increases the risk of developing a heart attack in the future. Most of the time, a heart attack develops from when one of these plaques inside these blood vessels or arteries ruptures. And let me just clarify what I mean by rupture.
Because often when I say rupture in blood vessel or artery anywhere near each other, students visualize the artery rupturing open and bleeding out. That is not what's actually happening here. It's the inside lining where that plaque is built in. The plaque ruptures the outer layers of the blood vessel or this artery remain intact so there's no bleeding out.
So what happens though when that plaque ruptures, the response is a clot forms. And we already had a narrowing from that atherosclerotic plaque developing over time. But when that clot starts to develop from the rupturing, then that's going to build up relatively quickly and that would block off the blood vessel or the artery even more.
And let's say it happened right here on this branch right here. If that's starting to develop even more and it gets to the point where even at rest, this area of the heart isn't getting enough blood, then somebody will start developing chest pain and if this tissue starts to die off or get damaged, that's when the heart attack or the myocardial infarction begins. Now many of you have likely heard of the typical heart attack symptoms.
That central substernal chest pain that can radiate to the arm, up to the neck, it can even radiate to the upper abdomen and even the back. People can also experience diaphoresis which is sweating, also things like anxiety, nausea and various other symptoms. But what are the interventions that occur when somebody shows up at the hospital with a heart attack?
Well, almost every patient will be started on aspirin which is a type of a blood thinner. Many patients will also get initiated on medications called nitrates and these are vasodilators which can help open up the arteries that feed the heart and people can even be progressed on to stronger blood thinners or anticoagulation therapy which again makes sense to help slow the progression of that clot. There might be also like beta blockers and statins that get involved in this process but many people or most people who have a heart attack will have a date with what's known as the cath lab. The cath lab is the cardiac catheterization lab. I'm going to talk about what happens in the cardiac catheterization lab in just a second, but I do want to touch on this idea of a mild heart attack versus like a massive heart attack.
Now, you might have some ideas on some of the differences, what might actually take place with the arteries, but a mild heart attack would be one of these smaller arterial branches with a smaller clot possibly being blocked. It doesn't mean that we don't care about this area of the heart. The reality is it's just less severe than say like the widow maker.
The widow maker is kind of this nickname for when this large arterial branch called the left anterior descending artery, which is a branch off that left coronary, gets blocked all the way up here. And then everything downstream where this massive area of the heart goes without blood. And that can be life-threatening.
And so someone in that situation would likely get funneled into the cath lab ASAP. Whereas someone who's having more of a mild heart attack, they're responding well to like the blood thinners, the other medications, and their symptoms are going away. They would kind of get triaged to lower down the list. So there's obviously a triage. process with the severity of these and who goes into the cath lab first versus later on.
Now, the cardiac catheterization lab is where there's imaging called an angiogram. They'll use an x-ray machine with the use of dye and that dye will kind of light up the blood vessels or the arteries of the heart so the cardiologist can see them very clearly and the cardiologist will use something called a catheter and they will insert it into the actual radial artery. They can do it into the femoral artery too but they tend to prefer the radial artery and eventually they'll float it up or take it. upstream and get into the heart. Now, because of the imaging, they can see areas of the heart or these arteries that are potentially narrowed or occluded or blocked off and they can do what's called an angioplasty and or place a stent.
The angioplasty portion is where they will actually stretch the part of the artery that's been narrowed and then they can also place a stent in there which is typically like a metal mesh to keep that artery to stay open permanently and voila, we have re-established blood flow. And also, if people do have a heart attack, let's also talk about what their future in fitness and athletics could be. There are plenty of people out there that have had a heart attack, an angioplasty. A stent placed and then they participate in therapy and really decide they want to make some lifestyle changes, improve their fitness and then they do things like run a marathon. It's amazing to think that that type of recovery is possible and it makes sense, right?
There are few situations after someone has a heart attack where we wouldn't want to strengthen the heart or have them participate in healthy types of activities. And obviously, each individual situation needs to be addressed, how severe was the heart attack? Do they have other health conditions or other risk factors?
But again, For the most part, people can have quite the recovery and participate in all sorts of different activities. So let's bring this full circle. Obviously, the ideal situation is to avoid having a heart attack.
Yes, it's incredible that we have the treatment and that people can make remarkable recoveries, but prevention and reducing our risk of having the heart attack in the first place is what we want to focus on. And what we're really starting to focus on reducing our risk of is that atherosclerosis or that buildup of plaque. Because remember, it's silent. in the beginning especially because we don't get symptoms until the plaque has built up to a certain degree.
So we really want to reduce that risk of buildup during those silent stages. And so how do we reduce that risk? Well, you're probably not going to be shocked that it includes things like exercise, diet, and knowing what's going on with your body.
The data is pretty clear that exercise, especially cardiovascular exercise, reduces your risk of developing cardiovascular disease, including atherosclerosis and heart attack. When we exercise, the heart gets stronger. It also will develop tiny new blood vessels that we call capillaries that will penetrate into the muscle tissue of the heart so the heart gets a greater blood supply as it gets more fit.
Now, we don't have enough time to go into all the different types of cardiovascular exercises that can help with heart fitness but we do have two that you could check out that you might find helpful. One is called How the Heart Changes with Exercise and the other is the exercise you should be doing once a week. I'll link that to this video as well. And so you can check those out in the meantime, but we are going to continue to do future videos on this topic of like longevity and heart health. Now, the other thing I need to mention about fitness is how it influences four things I just want to briefly touch on and how those things contribute to your risk of cardiovascular disease.
For example, exercise can help reduce overall body weight. It can reduce cholesterol levels. It can reduce blood pressure, put it at healthy levels. We can reduce our risk of diabetes with exercise. All four of those things you want to consider.
when we're talking about this cardiovascular risk and atherosclerosis. And not only does exercise influence those four things I just mentioned, so does diet. Diet can be a little bit of a controversial topic. Sometimes people get very heated about the diet.
And what I'm about to say might be controversial to some people, but I'm going to say it. There is not one magic bullet, perfect diet that fits everyone. And if you kind of step back and think about that, most of you will probably think like, yeah, that makes sense.
There are plenty of diets out there that could be considered heart healthy and reduce things like body weight, could reduce cholesterol and help reduce your risk of these things that we talked about today like atherosclerosis and heart attack. So I'm not going to be up here and say you need to do this intermittent fasting diet, this keto diet, this vegetarian, this vegan, this meat eater diet. I'm not going to do it. What I am going to do though is include a link below that includes some heart healthy foods that you could incorporate into multiple different diets. Generally, some basic principles for any of these diets is that most of your foods should come from whole food sources.
You should probably reduce the overall amount of additional sugars that you add to your foods. It does not mean that you can't splurge every once in a while and have a cheesecake. I mean, just live a little people.
But I did mention cholesterol earlier, right? And that kind of ties into this whole idea of knowing what's going on inside your body. And what I mean by knowing what's going on inside of your body is knowing what's going on inside of your blood.
And that's really cool. Lab tests that would occur during like a routine physical with a medical provider. One of the lab tests that they would do there is a lipid profile which would include things like triglycerides and cholesterol.
And you can't have a discussion really about atherosclerosis without talking about its relationship with certain types of cholesterol because there are people who have an amazing exercise routine, have an awesome healthy diet, but unfortunately because of their genetics can still have elevated cholesterol levels that could increase their risk of developing atherosclerosis. And so I do think it's important in those situations that the person would have a discussion with their medical provider, discuss different strategies that they could possibly reduce their risk in certain types of cholesterol with maybe other lifestyle modifications, and sometimes they might even discuss medications. But again, I do think it's important for us to get that routine lab work so we know what's going on and do those annual or routine physicals. We can have the discussion about, yes, healthcare can be expensive. Maybe you don't have insurance.
I've definitely had times in my life when I didn't have health insurance. But if I really was honest with myself during those times... I really looked at things.
I could probably look at and see that I was spending some money on some stupid things that really didn't serve me. We've all done it before, right? But I probably could have redistributed some of that money into my health. So we all might have to have that moment where we look in the mirror and say, you know what?
Starbucks, you're just not as important as my cardiovascular health. Well, now that we've talked about reserving some of our finances for things that are good for us, maybe some of those finances could go to our learning and our brain health. Which helps me to have this nice little segue for me to talk about and say thank you to the sponsor of today's video, Brilliant. Brilliant.org is an amazing interactive online learning platform for STEM subjects. It's one of the best ways to learn math, science, and computer science.
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