Episode Transcript
Cassie Alvine (announcer):
This is the “Health and Wellness” Podcast brought to you by Sanford Health. The conversation today is about heart health and the question, what does a heart attack feel like? Our guest is Dr. Nayan Desai, interventional cardiologist with Sanford Heart Bismarck. Our host is Alan Helgeson with Sanford Health News.
Alan Helgeson (host):
A note for our listeners: At the time we recorded this interview, Dr. Desai was on his way to provide outreach care at another Sanford location, so you might hear highway traffic noise in the background.
Dr. Desai, thank you for joining us today and very important stuff that we’re talking about as we talk heart health, and let’s get right to it. People are always wondering, they’re always wanting to know about a heart attack. We hear so much about it, so let’s ask that question. It’s a big one, and we can dive into all the details. What does a heart attack feel like?
Dr. Nayan Desai (guest):
Sure, yeah. Thank you Alan for having me. My name is Dr. Nayan Desai, one of the interventional cardiologists here at Sanford Hospital in Bismarck.
When we think about a heart attack, it basically, in common terms what’s happening is the artery is getting clogged off with either a blood clot or a blockage, and that is causing low blood flow to the heart muscle itself. And that’s why some of the symptoms which you are feeling are coming from that. Symptoms or common problems which people will experience will include chest pain, chest tightness, shortness of breath.
Pain is kind of very nonspecific and pain differs in different individuals. Every patient has a fingerprint of their chest pain description in terms of where it’s going to go. Typically we hear the description of elephant sitting on the chest, but that’s not always the common feature when patients come into the hospital.
Alan Helgeson:
This is a question, kind of a follow up to that. How long does your body warn you before a heart attack?
Dr. Nayan Desai:
There are two variations of heart attack if you will. Some patients would have chest pain, chest tightness, or shortness of breath going on for a period of months. And if they ignore those symptoms, they would come into the hospital with the heart attack or in myocardial infarction if you talk it in medical terms.
The other variation of it would be suddenly somebody wokes up and has a heart attack. It’s very sudden and severe and acute.
Symptoms can vary. Some patients may just have minimal shortness of breath or chest pain. Indigestion is more frequent in women as well as men might describe that. I typically like to ask the question to patients is if you have had heartburn before, is this similar? There is always something different if that heartburn is coming from a heart attack, right? It does not feel the same reflux pain you have had before. And if that’s the case, you need to go and see your doctor. Get checked out.
Alan Helgeson:
This question, I know what the answer is, should I ever ignore symptoms?
Dr. Nayan Desai:
It’s human nature, right? I think to kind of chuck it off to something else, “oh, it’s just my heartburn. I’m going to take some antiacid medications and sleep and it’s all going to go well.” The downside of that is you might not wake up next morning. So if you are experiencing any symptoms from the jaw to the tightness right within that territory could be related to any pain in that area.
Typically, chest tightness is commonly described, but it does not always have to be chest pain. Yesterday I saw a patient with a heart attack had just throat pain and passed out at work. Sometimes it could be back pain. Men often describe it also as a pain in their arm. And again, it can go to both right or left arm, but left arm strikes more with common population thinking that, oh, if it’s going to the left arm, maybe I need to worry about it because it could be more heart related.
Sometimes, unfortunately, when we say silent heart attacks, people don’t usually recognize their symptoms and that’s why it’s silent. If you pay close attention to your body in that last two to three months when you’ve had a silent heart attack, there were some symptoms, but likely you ignored it. You just thought that I’m more tired, I’m more fatigued, I’m stressed. I could have had some chest pain, chest tightness. It could be my muscles acting up. I took something because I thought it was from the acid building up in my stomach.
So yes, there are some true silent heart attacks, which typically happen in patients with diabetes or in women. Women have atypical symptoms that men do. So I would say never ignore your symptoms with heart attack. Always, you know, Sanford Health has walk-in clinics, urgent cares, emergency room departments, as well as your regular clinic provider, always available to get you seen that same day.
We want to act fast on it. We want to get you to the right treatment and make sure that it is up to the experts for us to decide if it is your heart or not. And it’s OK to be wrong. It’s OK that you’re going to an emergency department or a cardiology clinic and they tell you that it’s not your heart, it’s likely your muscle or something else, but it’s OK for a medical personnel to make that decision rather than patients taking that decision on their own.
Alan Helgeson:
And I’ve experienced family members that have come in and they’ve had something like that where they’ve said, I’ve had some of these symptoms. The orchestrated medical team that comes in, I mean, they move like lightning in taking care of something like that. There’s no messing around with that and it’s something to see how they take care of things like that. So thank you again for reiterating the importance of that.
You’d mentioned early on when I asked you that question about times of day and seeing some things at various times. So I want to get right into that. Are there times of the day that are worse? And then a follow up to that, are there times of the year that are worse for heart attack?
Dr. Nayan Desai:
Most of the heart attacks do happen in the early morning hours. So typically from 5:00 a.m. to up to, I would say noon. And the reason for that is your blood pressure is higher that morning. Your cortisol, which is a stress hormone, is high in the morning and that predisposes the blood to clot more. So heart attacks are definitely more happening earlier in the day, but again, if you have ignored your symptom earlier in the day, you could present to the hospital much later in that evening or afternoon. So with the diagonal variation more common in the morning as compared to evening, but again, early morning heart attacks, it’s not uncommon for us to jump in our car and go to the hospital to take care of a heart attack patient, typically between the hours of four to seven.
And then when we think about the times of the year when a heart attack can happen, we’re right in the middle of the winter.
So heart attacks are definitely more common and more prevalent during the winter months. And the reasoning behind that would be the cold weather stress and activity like shoveling, contributing to a plaque rupturing, which means that a blood clot forming in those arteries in the heart and causing a heart attack. So more common in winters and more common during the early morning hours during wintertime.
As we’re right here we’re talking about should we shovel, what symptoms are we looking for? You know, if you’re trying to shovel and you smoke a cigarette before shoveling, definitely a no-no. Because that’s going to increase your risk of a heart attack. After a heavy meal, most of your blood circulation is going into your gut at that time and then it’s depriving the heart of some blood flow. It’s causing like a steel phenomenon.
So some of the “do nots” is when you’re trying to shovel, if you have any cardiac condition, I would recommend not extreme shoveling, especially when it’s freezing cold. Definitely no smoking cigarettes and not eating a heavy meal before shoveling. That would be some good common practice.
Alan Helgeson:
You’ve talked a little bit about times of day, times of year and we’ve talked a little bit about symptoms and more to come on that. If someone is having a heart attack, is there anything that a person can do or a loved one can do until medical help arrives?
Dr. Nayan Desai:
That’s an excellent question. If you are experiencing a symptom of heart attack the first response would be to call 911. This is not the time waiting for a family member to arrive, get you in a car and then drive you to the emergency department. This week I have taken care of at least five or six patients with heart attacks.
One patient comes to mind where, you know, he is at home, he’s a young man in his sixties having dizziness and some chest pain, not really your typical symptoms of a heart attack. Calls 911, fire arrives, his front door is open and they go ahead and shock, write him in and save his life. Comes to me, put a stent in his widowmaker and open up the blockages of his heart. So when you’re experiencing a heart attack, I would say call 911. Even if you have five minutes away from the emergency department, if you’re coding in the passenger seat, your wife or your spouse or your friend cannot help you. That’s why medical help is so important.
The second thing which brings you in is of course do not drive yourself. Right? That would be the worst thing you would be putting yourself and more importantly, others in danger. When you’re having active chest pain, we had a patient come in taking nitroglycerin in the car and driving to the emergency department. That’s a total no-no.
Medication wise, I think it’s more selective. It all depends on the patient’s bleeding risk. If you have an aspirin at home, it’s not a bad idea to chew it, but again, that depends on your individual risk factors. I’m not making a common advice for somebody to just start doing aspirin every time they’re having chest pain.
So while you’re having that, sit down, definitely if you are getting a strong urge to go to the bathroom and you’re super sick, that’s also a bad sign. Just wait there. People can pass out or die if they’re trying to pee or go to the bathroom when they’re experiencing a heart attack. Let the medical personnel come in and take good care of you. EMS medical people come and get you to the nearest hospital.
But recognize the symptoms. I think the biggest message I want to convey with this question is recognize the symptom that you’re having a heart attack. You have to come to terms with your own body and not be in a state of denial. We all, as humans try to always think that it’s not something significant, right? We think it’s my acid reflux, it’s my muscles, it’s my nerves, it’s not my heart. So patients usually, and you know, general population, know their body the best even more than their regular doctors.
If you’re aware about your body and if that symptom is not making sense, like this is not feeling like my heartburn, I’m just sweating profusely, something is not feeling right, my chest is, you know, knotting up, call 911 if that is happening, especially at rest.
Alan Helgeson:
Dr. Desai, are there any myths about heart attacks?
Dr. Nayan Desai:
That’s a great question. As I said, the most common myth is I was just having heartburn and not realize that.
Some of the other common myths are that every time the chest pain has to happen in the center of the chest and go to the left arm.
That’s also a common myth and that is something which people need to know about – men and women present differently with chest pain.
Americans, number one cause of death in our country is still heart attacks or myocardial infarction. And the main reason is not recognizing the symptom.
One of the myths about symptoms and as you were kind of alluding to, you’re going to dive into what about the treatments, right? If you are having a heart disease, what about the treatments? “I’m on a cholesterol medicine and a blood thinner. I could not have a heart attack.” That is not true. People can still have heart attacks if they are on cholesterol medications or blood thinners.
Some of the other myths: I have never had blood pressure issues or have not been a diabetic. I don’t smoke. I could not have a heart attack. That is not true as well. Heart attacks can affect any age of person. I have seen with a heart attack as recent as in their 20s.
Diabetes won’t cause heart disease. That’s the common myth: because I’m taking diabetes medication or trying to say that my diabetes is well controlled, I don’t have diabetes or my blood pressure is well controlled, I don’t have high blood pressure. That’s not why your blood pressure is controlled on medications. That is a strong risk factor for having a heart attack.
Taking vitamins and supplements. People believe in natural medications, believe in heart healthy diet is one thing, but trying to take supplements and thinking that, oh, I’m on this good supplement, it’s going to take my blood and clean up all my arteries and keep me free of any heart diseases.
I always tell my patients if something was so good, the FDA would’ve approved it as medication. So yes if you are believing in vitamin and supplements, make sure you know the contents but also recognize your symptoms. Just because you’re taking a supplement or over the counter pill. Or let’s go to a chiropractor or doctor because I think it’s more my muscle in the neck which is hurting me and it’s not my heart. Get it checked out first. Get a professional opinion and then do massages or something else once you have had a clear answer from your doctor that it’s not your heart.
Well, I have not smoked for years and now there is no chance that I’m going to get a heart attack. That’s also one of the common myth which men come in with and that’s not true either. Any history of smoking in your lifespan increases your risk of having heart diseases and heart attack. Heart attack is still the leading cause of death in men and women. So how can you prevent that is by taking appropriate precautions.
Alan Helgeson:
We learn all sorts of things on social media and I’m guessing as a physician you just roll your eyes probably 20 times a day when people come in and hear things, see things. But I got to ask you this question. Is there such a thing as a pre-heart attack?
Dr. Nayan Desai:
Yes. I would say pre-heart attack, what we call is an impending heart attack or something which is leading to a heart attack, right? And again, that those are symptoms which you would start experiencing a little bit of chest tightness with walking and now it’s getting worse. Initially it just started to happen with walking, but now I’m having chest pain, even going to the bathroom, I’m getting chest pain and I’m going to the kitchen. That’s a sign that something is getting worse, that you don’t need to ignore that heart attack or pre-heart attack warning symptoms.
Alan Helgeson:
Let’s switch gears a little bit and we hear about different things relating to men and women and their health needs. Let’s talk about specifically heart attack. Are there signs, symptoms that are different for men and women?
Dr. Nayan Desai:
Men, as we just touched briefly on in our prior questions, would have those typical symptoms, right? They would have that chest tightness, chest discomfort, a feeling of pressure in their chest associated with shortness of breath, sweating, as well as some nausea and vomiting. If they’re experiencing some bad air weakness, which means a bad electrical problem during their heart attack, they can pass out, feel dizzy.
Women typically don’t have the typical just pain symptoms. They would come in with, you know, feeling tired or fatigue related to physical exertion being more in the upper back or the jaw area, the throat becoming tight, heartburn symptoms, symptoms of having indigestion like pain in the upper part of their abdominal area. And then they would think like, oh, it’s maybe gallbladder, it’s my acid. But as we said, the heart pain symptoms can go all the way from their neck or the jaw to the middle of the abdominal. So any pain in that area is or should be ruled out for having a heart attack first before we label it to something else. And the reason to do that is that’s going to kill you versus some of the other things.
Alan Helgeson:
Let’s move on to risks. And we always hear about the health risk, about heart health, but it’s always good to talk about these things and go back into risks that increase a chance of a heart attack. You can never talk about this enough.
Dr. Nayan Desai:
Being an interventional cardiologist, I do procedures in the hospital and see patients in the clinic as well as educating patients every day about their risk of having a heart attack, right? And the main risk, which we think or talk about, it’s a combination: it’s lifestyle, it’s medical risk factors, it’s genetics and it’s something in the environment. And let’s kind of break these down because it’s just going to be a lot of good information.
Talking more about lifestyle. This is something new our patients can do on a day-to-day basis to prevent a heart attack. And that’s where lifestyle comes in as the most important choice. Every day, your goal should be, how can I live a heart healthy lifestyle? Right? What that means is no smoking, we talked about smoking, damaging the blood vessels, decreasing the oxygen supply to your capillaries, to your heart, increasing the buildup of cholesterol plaque in those arteries contributing to heart death.
So no smoking should be the key message in the lifestyle choice.
The next one is heart-healthy diet. We all know what is good for our body. Whatever is good for our tongue, as commonly said, is not good for our heart. But that’s not true all the time. High fat, saturated fats which are high in sodium content leading to obesity, high cholesterol and high blood pressure, those should be avoided. Common examples would be, I would say, seeing a patient in the clinic, just replace one bad habit. If you’re trying to have that ice cream bowl every night, replace that with nuts on the counter. If you’re having, you know, a cookie, replace that with some seeds like flax seeds, walnuts, pistachios, avocados, those are all heart healthy and good if taken in an appropriate amount.
Next is going to be physical activity. Trying to have a sedentary lifestyle is not helping your heart. Movement, you know, doing household chores, moving around the house, setting apart a regular time in your daily behavior. I’m going to be walking for 20 minutes or 30 minutes a day. Getting my heart rate up is good for your heart. Your heart being a muscle leads that exercise to work efficiently. And excessive alcohol consumption, excessive alcohol can contribute to, you know, high blood pressure, depression as well as leading to alcoholism.
So these are the four factors which I would like to highlight in the lifestyle factors. Trying to avoid smoking, trying to avoid alcohol, have a heart healthy lifestyle and walk and move more.
Next thing we would move on to, what about some of the medical risk factors we see which contribute to having heart attacks? That’s where comes in your diabetes, your cholesterol, blood pressure, as well as obesity. So getting a blood pressure checked, we have a fantastic program here at Sanford with heart screenings and that’s where we talk about this combination of factors, which is a prevention with heart screening, which means we want to screen the heart of healthy adults between the ages of 40 and 75.
Do a good examination of their cardiovascular system, get a good history, check their blood pressure in the clinic, check their cholesterol numbers, make sure they don’t have diabetes, and then if indicated do a special test to screen if they have plaque in their arteries of the heart. So medical conditions is very important.
Go to your regular doctor. High blood pressure can often be silent. If it’s not checked, you won’t know about it. Same thing about your cholesterol. You might think that you might be following a very heart-healthy lifestyle, but you might still have high cholesterol because of either genetic factors or from lifestyle choices and stress. Trying to take time away from work. Meditate. Stress level increases the risk of hormones in the body and also causes increase in the risk of heart attacks. So these are some of the modifiable factors, which means that you yourself can take charge of these factors and change it.
What about family history? That’s why we talk about non-modifiable factors. Your age, you cannot control that. If you’re a man or a woman, you’re not going to control that. Same thing about your family history. You cannot choose who your parents are and what genetics you inherited from that, but that’s a small proportion. If you are following a heart-healthy lifestyle, taking care of your risk factors, your risk of heart attack still decreases. Even though you have genetic history, you get older and as we know men have higher risk of having a heart attack.
Alan Helgeson:
Dr. Desai, what would you want someone to do if they think they’re having a heart attack?
Dr. Nayan Desai:
As we have talked about, if you are having any symptoms at rest – chest pain, chest tightness, shortness of breath – even if you don’t think it’s your heart, sit down and call 911. You might not have a lot of time left before making that call. If you are not prompt enough, call emergency services immediately. Do not delay seeking help even if the symptoms are mild or unclear. Any symptom at rest is not a good sign.
Sit or lie down in a comfortable position. Make sure your front door is open. If you are passed out or if you have died and your heart needs to be shocked, EMS and fire can come in and appropriately save your lives.
Take that aspirin 25 if you have it at home. I don’t want to get this message out routinely that people should be chewing aspirin, but taking an aspirin if you believe or think that it’s heart attack related, unless you have an allergy to that medication or if you have any bleeding issues. Then of course don’t take aspirin. If you have nitroglycerin at home and you have been prescribed that by your doctor, take it as per their instructions.
Avoid driving yourself to the hospital, stay calm, monitor for symptoms and call for help.
Alan Helgeson:
Can you talk about some of the recent advancements in the treatment and management of heart attacks?
Dr. Nayan Desai:
Sure. Sanford, being a leader in cardiac care, significant advances have been made in the treatment and management of heart attacks in recent years. These innovations have allowed us to make not only rapid diagnosis for our patients, but also improved treatment with personalized care.
And talking about some of the recent advances we have is if you come into our emergency department with any symptoms of chest pain, we just rolled out something called a high sensitivity troponin. It’s a blood test which tells us if there is any sign of heart damage and that makes us easy to have a diagnosis of heart attack early on and quickly.
AI is everywhere these days. AI and machine learning and EKG rhythm analysis, that also helps us to vastly improve the diagnosis of if somebody’s having a heart attack.
Pre-hospital care. Faster door to balloon time. And that’s the mantra which I strive for, is what is my door to balloon time? And to explain that if that is the time when somebody hits their door in the emergency department till I blow open the balloon in their artery, that is the time we are monitoring. We’re trying to make that time as shorter as possible because every minute wasted while somebody’s having a heart attack is going to increase the risk of heart damage. So that’s why we want to act fast. We want to act promptly, we want to make sure we decrease our door to balloon time which means we’re trying to open up the balloon in that artery.
So I would just run your, typically what happens when our patient comes in, they get an EKG. If the EKG is showing a sign of a heart attack, I get a call immediately. I and my team of our nurses and technicians in the cardiac cath lab are there in the hospital in 10 minutes, even in the middle of the night.
That’s how we have our system operated. We can even kind of have an EKG sent directly from the EMS or our referring outlying hospitals in our community right away to my phone without going the operator or without trying to figure out which doctor to call.
We have tried to make it easy for a community so that we recognize heart attack early on and then get them right away to my hospital or any nearby hospital, make sure they get that aspirin, they get a blood thinner and off we roll them to a cardiac cath lab. And what a cath lab is, is where we do a procedure with an X-ray machine or a camera, I put a small IV in their artery, in the wrist. Typically go up in their heart, check if there is a sign of a blood clot in their arteries and then open up for us to the balloon and then a stent.
Alan Helgeson:
At Sanford Health, heart screenings are an important tool in prevention when it comes to heart care. Could you explain what that is and who it’s intended for, Dr. Desai?
Dr. Nayan Desai:
The heart screening is a unique program which is rolled out by Sanford Health and it’s available to anybody who thinks or believes they need to take care of their heart or just need some more answers. So I want to emphasize heart screening is for healthy people. It’s for people in the age group of 35 to 75 and more importantly, trying to help them understand what risk factors do they have for heart diseases.
What we do in that clinic is anybody can sign up through any of our programs at any of the Sanford locations, you come in, you get examined by a nurse, you get your blood pressure checked, you get an EKG done at that time. The EKG is reviewed by the cardiologist. We go over talking about your risk factors, about checking your cholesterol number that same day. Of course getting your blood pressure as well as getting your sugars checked.
And then we make the personalized plan based on that factors. We put that in a calculator and try and estimate what is the risk factor of that individual patient. If that patient is at high risk, we offer a cardiac screening test called calcium score. And that is basically a specialized CT. It takes about 15 minutes. There is no prep required for that cardiac CT. You come into the hospital, go straight into the scanner, and 15 to 20 minutes you are checked out. That CT scan does not need any contrast or dye to be administered.
And in that, what we are looking for is if there is any plaque or cholesterol or calcium particles built up in their heart because any plaque in their arteries would be a risk factor for having a heart attack. We would like patients to have a score of zero, but we don’t live in a perfect world.
Some of our patients who are heart healthy have a score of zero. But if your score is not zero, then you get to see a cardiologist and we make a personalized plan about which direction we need to go with regards to your heart care. I would say everybody, I encourage you to get a heart screen at least once in your lifetime if you have not had it. And if you want to be in charge of your cardiac health, give this yourself as a birthday gift. Do it on your birthday.
Alan Helgeson:
Dr. Desai, as we come to a close, what would be that one thing you want someone to take away from this conversation on heart health?
Dr. Nayan Desai:
I’m going to say two things, Alan, instead of one thing. The first thing is recognize symptoms and get checked out immediately. There is not enough, which we can emphasize on this message. If you do not come and get medical attention, there is no way I’m going to know that somebody is having heart attack. They need to make that phone call and be in charge of their health. Any symptoms, do not ignore if you think are related or unrelated even to your heart.
And make a healthy lifestyle choice. Before getting to that heart attack phase, make sure you can do some preventive stuff as we talked about, trying to move more, no smoking, no alcohol, as well as eat a heart healthy diet.
Alan Helgeson:
We thank Dr. Nayan Desai, interventional cardiologist with Sanford Heart in Bismarck, North Dakota for joining us on this very important conversation on heart health.
Cassie Alvine:
This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, find us on Apple, Spotify, and news.sanfordhealth.org.
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