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Heart Attack and Cardiac Disorders

(26) Heart Attack and Cardiac Disorders

Tobacco Smoke & Heart Disease


Why is cigarette smoking the major coronary risk factor?

Fifty million Americans still smoke. Cigarette smoking is one of the four major coronary risk factors. If you smoke a pack of cigarettes daily, you have a risk of heart attack more than twice that of nonsmokers.


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(27) Heart Attack and Cardiac Disorders

High Cholesterol

National Heart, Lung and Blood Institute - Heart Disease Risk Factor - High Cholesterol


What is cholesterol?

Cholesterol is a soft, fat-like substance normally present in body cells, tissues, and blood. It is an essential component of cell membranes and is vital to the structure and function of body cells.


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(28) Heart Attack and Cardiac Disorders

 Syncope emergencies in the dental office


How is diabetes harmful?

Patient comment:

When you have diabetes, the most important thing you should understand is that diabetic people often do not have the usual symptoms of a heart attack. The chest pain that is the most common symptom of a heart attack in non-diabetics is often absent or minimal among diabetic people.

Instead, common symptoms may be unusual weakness, shortness of breath, or dizziness. The so-called “silent heart attack” is very common among diabetic people. Diabetes is the inability of the body (i.e., the pancreas) to produce or respond to insulin properly. If you are healthy, insulin allows your body to use glucose (sugar), but diabetes impairs this function. Adult-onset diabetes usually appears in middle-aged people, particularly those who are obese.

The risk of coronary artery disease, particularly a heart attack, increases with diabetes because the process of atherosclerosis speeds up, along with the bad influences on blood cholesterol and triglyceride levels (e.g., reduction of HDL cholesterol with elevation of triglyceride levels). Therefore, you should maintain your ideal body weight and normal or near-normal blood sugar levels with a proper diet and physical exercise. If the abovementioned management is not effective, a physician will prescribe insulin or other medications. If you are diabetic, it’s very important to be monitored by a physician to maintain proper blood sugar levels.

What are the harmful effects of stress?

Emotional stress can cause many harmful effects. Such stress is shown to be an important trigger for angina and other heart problems. Very intense stress may cause serious heart rhythm abnormalities (arrhythmias), heart attack, and even sudden death. Sudden stress increases the pumping action of the heart and the heart rate. Stress may constrict the coronary arteries and impair the blood circulation to the heart. The various heart rhythm abnormalities may become much worse, leading to life-threatening arrhythmias.

Stress can cause the blood to become stickier, predisposing to blood clot formation in the coronary arteries. It also can increase blood cholesterol levels, at least temporarily, and levels of homocysteine. Sudden intense stress causes high BP and can greatly increase preexisting hypertension.

Repetitive stress can disturb the human immune system and may cause depression, which in turn produces a variety of undesirable effects on blood pressure, heart rhythms, and blood clotting in the coronary arteries.

Very intense stress may cause serious heart rhythm abnormalities (arrhythmias), heart attack, and even sudden death.

What are the first warning signs of a heart attack?

Patient comment:

Everyone has heard of the chest pains that signal heart attacks, but many people don’t realize that the first warning signs of a heart attack may vary considerably from person to person. The warning signs may not be the usual chest discomfort or chest pain. Instead, you may experience marked shortness of breath, weakness, dizziness, numbness, or tingling sensation in the arms, and even a feeling of “indigestion” with or without chest pain. When you feel these symptoms suddenly, a possibility of a heart attack should always be considered, and immediate medical attention should be sought. This is particularly true if you are an older adult with any coronary risk factor.

A heart attack usually occurs suddenly, and it can occur at any time: at work or while playing a sport, while resting or in motion. However, nearly half of all heart attack victims experience various warning signs hours, days, or even weeks in advance.

Basically, a heart attack occurs in different ways. It can be preceded by angina pectoris (angina) for days, weeks, months, or even years. Or it can be sudden, without any warning signs, and result in sudden cardiac death.

Directly before a heart attack, you may experience various signs and symptoms of angina, but these symptoms are increased for hours, days, or even weeks before the development of a heart attack. The most important and common symptom is chest discomfort, including chest pain. The intensity of chest discomfort varies markedly among heart attack victims, so some people may experience little or no chest pain. The symptoms described for unstable angina may worsen. You may feel a sensation of pressure or fullness, or a squeezing pain in the chest that lasts for more than a few minutes. Chest pain may spread to your shoulder, arm, and back, and even to your jaw and teeth.

Prolonged episodes of chest discomfort may accompany upper abdominal pain that differs from other forms of gastrointestinal disorders. You might also experience dyspnea (shortness of breath) after even minimal physical exertion, and this could be followed by profuse sweating, nausea, and vomiting. You would feel markedly fatigued or weak and lapse into syncope, or even impending death.

Most likely, you would also feel palpitations and possibly indigestion, heartburn, and upper abdominal pain in place of chest pain. Actually, 10 to 15% (up to 30% in some medical reports) of all heart attack victims experience little or no chest pain in a silent heart attack.

Marked weakness can occur with or without chest pain. Among many cases of massive heart attack, the foregoing symptoms occur simultaneously. Needless to say, sudden cardiac death (usually from cardiac arrest) can occur, especially when the heart muscle damage is very large and multiple coronary arteries are blocked.

A variety of complications (various medical problems associated with an underlying or primary disease such as congestive heart failure; can be expected, even for those who recover from a heart attack under these circumstances. Again, the most important and common symptoms of a heart attack are chest pain (or any other form of chest discomfort), marked dyspnea, and unusually severe fatigue or weakness. Remember that more than 15% of heart attack victims die suddenly within the first hour after the onset of the symptoms. Thus, seeking medical attention immediately is extremely important.

Delay in the recognition of a heart attack and in obtaining urgent medical treatment can trigger serious complications and even death in many cases.

Nearly half of all heart attack victims experience various warning signs hours, days, or even weeks in advance.

Seeking medical attention immediately is extremely important


Syncope - loss of consciousness due to temporary cessation of respiration or circulation or very slow or rapid heart rhythm.

Palpitations - skipped heartbeats, heaviness, or rapid or irregular heart beating as a result of various arrhythmias

Complications - various medical problems associated with an underlying disease.



(28) What are LDL (or bad) cholesterol and HDL (or good) cholesterol?

LDL Cholesterol & HDL Cholesterol


LDL contains about 25% protein and 45% cholesterol. LDL cholesterol causes fatty deposits to build up in the arteries. Since the LDL level affects the risk of a heart attack much more than do total cholesterol levels, medical authorities commonly use the term bad cholesterol to describe LDL cholesterol.


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(29) Heart Attack and Cardiac Disorders

Very High Triglycerides "Do Not Eat" List


What is triglyceride?

Triglyceride is another kind of lipid. It is not as strong a coronary risk factor as cholesterol. Less than 200 mg/dL of triglyceride is desirable; 200 to 400 mg/dL is borderline high; 400 to 1,000 mg/dL is high; and above 1,000 mg/dL is very high. You can reduce abnormally elevated triglyceride levels by losing body weight, by eating a low-saturated-fat, low-cholesterol diet, by regular exercise, and by avoiding smoking and excessive consumption of alcohol.

What are saturated and unsaturated fats?

Saturated fats are usually solid or semisolid at room temperature. They are found mostly in foods from animal origin and in some dairy products. They are also found in tropical oils, such as coconut oil and palm oil. Foods from animals containing lots of saturated fats include various meats from four-legged animals (such as beef, veal, pork, and lamb), poultry fat, butter, whole milk, cheese, cream, bakery products, and ice cream.

These foods contain lots of cholesterol. On the other hand, unsaturated fats tend to be liquid at room temperature, and they mostly come from plants. These fats are usually found in common cooking oils. Whenever possible, you should substitute unsaturated fats for saturated fats to reduce cholesterol levels. You can do that best by selecting foods containing less saturated fats. Egg yolks and organ meats (e.g., liver and kidney) are particularly high in cholesterol. Sausage and bacon also contain lots of cholesterol.

Whole milk has more saturated fats and cholesterol than does low-fat or skim milk. Skim (nonfat) milk and low-fat (1%) milk have the same nutrients as 2% or whole milk but far fewer saturated fats and much less cholesterol. Butter, cream, and ice cream have even more saturated fats than does whole milk. In addition, many cheeses also contain lots of saturated fats (as much as ice cream). Thus, a healthy diet involves using skim milk or low-fat milk and eating less butter, cream, ice cream, and cheese. Low-fat cheeses, low-fat ice cream, sherbet, cottage cheese, and various butter substitutes are better choices than regular cheeses, butter, and ice cream.

One egg yolk contains approximately 213 mg of cholesterol, but egg whites contain no cholesterol. Since egg whites are good protein sources, you can use two egg whites for each egg yolk in many cooking recipes. The American Heart Association recommends eating no more than three or four egg yolks per week, including those used in cooking.

Basically, you should consume a minimum of cholesterol-rich foods. If you want to eat healthy foods, you should consume more fish, skinless chicken or turkey, egg white (instead of egg yolk), low fat or skim milk, and fruits and vegetables. Of course, proper physical exercise is also very important.

Is eating more fish a healthy way to reduce coronary risk factors? What are omega-3 fatty acids?

Patient comment:

Eating a lot of fish in place of red meat is a healthy way of reducing the risk of a heart attack. If you like raw fish, it is an excellent idea to eat sashimi or sushi at Japanese restaurants as much as possible for protein intake. Also, salmon and mackerel are good for you because these fishes contain large amounts of omega-3 fatty acids. On the other hand, shellfish like crab, shrimp, or oysters are not healthy foods for your heart.

Fish contains cholesterol, but it is very low in saturated fatty acids. Fish may be fatty or lean, but it is much better than meat from four-legged animals for reducing coronary risk factors. Fatty fish is usually found in the deeper parts of the sea and contains large amounts of omega-3 fatty acids. Omega-3 fatty acids are found to be protective against coronary artery disease, including heart attack.

Oily fish, such as salmon and mackerel, contain large amounts of omega-3 fatty acids. One study found that women who ate fish five times a week had a risk of deadly heart attack 45% lower than that in women who ate fish less than once a month. Another study reported that men with the highest levels of omega-3 fatty-acids had a risk of sudden cardiac death 81% lower than those with the lower levels.

Various shellfish, such as crab, oyster, lobster, shrimp, and crayfish, have more cholesterol than most other types of fish, but their total fat and saturated fatty acids are lower than those in most poultry and meat from four-legged animals. For a cholesterol-lowering diet, fish is better than lean red meat.


Omega–3 fatty acids - substances that are protective against coronary artery diseases, including heart attack.

What are the effects of obesity?

Patient comments:

If you think you are overweight, you should try hard to reduce your body weight because many overweight people have other risk factors, such as high blood pressure, abnormal blood cholesterol, diabetes, etc. But do it the right way, through controlling your diet and exercising-don’t fall for the diet pills and other “lose weight fast!” schemes you see on TV. Get your doctor or a nutritionist involved in your weight loss. When you reduce your body weight by eating healthy foods and exercising properly, other coronary risk factors can be markedly improved or even eliminated.

By definition, obesity means 30% extra weight, and about 60% of American people are obese. Obesity is one of the major coronary risk factors. Many obese people have high BP (hypertension), elevated blood cholesterol levels, and diabetes, and they have sedentary lifestyles. Obesity also causes high triglyceride levels and low HDL cholesterol. Abdominal obesity (fat in the abdominal area, called central-torso obesity or the “beer belly”) is a particularly strong coronary risk factor. Obese people with waist lines more than 36 inches and high triglyceride levels are at high risk for developing coronary artery disease within 5 years. In addition, obesity in children is a greater risk for future coronary artery disease than a family history of coronary artery disease alone.




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