Despite taking a beta blocker, aspirin and two cholesterol-lowering medicines, three years after her heart trouble began, Misty had a heart attack and collapsed. Nine days after her heart attack, she underwent triple bypass surgery at the age of 26 to reroute the blood flow around her clogged arteries.
Like most people under age 40 who have heart attacks, Baldwin has a significant family history of heart disease. Her grandmother died from heart-related problems at age 36, and her dad had a fatal heart attack at age 57.
"My dad's whole side of the family is just littered with really bad heart disease," Baldwin says.
All in the Family
A heart attack, technically called a "myocardial infarction," is usually caused by the blockage of a coronary artery, an artery that carries blood to the heart, which impairs blood flow. The blockage can be created by plaque buildup, a blood clot or a spasm in the coronary artery itself. Age is also a risk factor; the chance of having a heart attack increases significantly in men after age 45 and in women after menopause or age 50.
Though no hard statistics are available, in the United States, the prevalence of heart attacks in the relatively young is rare: only approximately 40,000 of the 1.2 million heart attacks reported every year strike people between the ages of 35 and 44.
Until a young person actually has a heart attack, there may be no signs of cardiac problems. Gerald Fletcher, MD, a cardiologist at the Mayo Clinic in Jacksonville, Flo., says if there is no strong family background of early heart attacks, you should have nothing to worry about.
"If your mother and dad and your grandmother and granddad are alive at age 80 or 90, it's very unlikely [that you will have an early heart attack]," Dr. Fletcher says.
Other heart attack risk factors that cannot be controlled include age, gender and race.
Preventing a Heart Attack
Even if you have a strong family history of early heart disease, there are many ways to decrease your likelihood of having a heart attack:
- Do not smoke
- Eat a healthy diet
- Reduce cholesterol
- Maintain a healthy weight
- Alleviate stress
- Drink moderately, if at all
- Decrease high blood pressure
- Manage (or avoid) diabetes
If heart disease runs in your family, it is imperative that you maintain the best possible overall health. Prevention can start as early as elementary school, if doctors tested childrens' cholesterol levels -- but most don't.
"We could treat these kids at 10 and 12 with cholesterol drugs if their [cholesterol levels are] high to prevent this terrible problem," Dr. Fletcher says.
Routine physicals do not detect CAD. A poor pulse in the leg or neck may signal something is wrong, but it is not definitive. Even an EKG or chest x-ray won't show clogging arteries. According to Dr. Fletcher, it could take up to $30,000 worth of coronary dye studies or MRIs to diagnose plaque buildup -- an expense that would not be out of line in a young person with a family background of heart disease, but an expense not likely to be covered by insurance.
After her heart attack, Baldwin redoubled her efforts to be healthy: Although she remains overweight, she does not smoke, which is the greatest predictor of subsequent heart attacks in young people.
But during one 10-month period, both her father and grandfather died and she started a new job. By late summer 2008, Baldwin says she believes that stress may have taken its toll, because her doctor found that her arteries were clogging up again.
Her total cholesterol is 130 mg/dL (less than 200 mg/dL is considered desirable), and her blood pressure is normal, leaving Baldwin discouraged. She says even her doctor doesn't understand why her condition is worsening. She refuses to live in fear of another heart attack, but she knows the warning signs all too well:
- Pressure or squeezing in the chest
- Pain or discomfort in arms, neck, back, jaw or stomach
- Difficult or labored breathing
- Cold sweat, nausea, dizziness
Both men and women are likely to have chest discomfort or pain, but women are also more apt to experience breathing difficulties, nausea and pain in the back or jaw. If you experience any of these signs or symptoms, call 911.
"The sooner you have medical evaluation, the better your chances are to avoid heart damage or severe consequences of the damage," Dr. Fletcher says.
"ABCs of Preventing Heart Disease, Stroke and Heart Attack." AmericanHeart.org. 20 Mar 2008. American Heart Association. 16 Sep 2008. <http://www.americanheart.org/presenter.jhtml?identifier=3035374>.
Gerald Fletcher, MD. Phone Interview. 25 Aug 2008.
"Heart Attack." TexasHeartInstitute.org. Aug 2008. St. Luke's Episcopal Hospital. 16 Sep 2008. <http://www.texasheartinstitute.org/HIC/Topics/Cond/HeartAttack.cfm>.
"Heart Attack (Myocardial Infarction)." rwjuh.edu. 2008. Robert Wood Johnson University Hospital. 16 Sep 2008. <http://www.rwjuh.edu/health_information/adult_women_hrtrisk.html>.
"Heart Attack, Stroke and Cardiac Arrest Warning Signs." AmericanHeart.org. 2008. American Heart Association. 16 Sep 2008. <http://www.americanheart.org/presenter.jhtml?identifier=3053>.
Misty Baldwin. Phone Interview. 15 Sep 2008.
Rallidis, LS, et al. "Long-Term Prognostic Factors of Young Patients (<=35 Years) Having Acute Myocardial Infarction: The Detrimental Role of Continuation of Smoking." European Journal of Cardiovascular Prevention and Rehabilitation. 2 Sep 2008. 16 Sep 2008. <http://www.jcardiovascularrisk.com/pt/re/ejcpr/abstract.00149831-900000000-99985.htm;jsessionid=LGpNn41Q0RkpvHxFflpFDJ3XJ9DmJRs3jSdDmth5hPfHqN2jm4ny!609209752!181195628!8091!-1?index=1&database=ppvovft&results=1&count=10&searchid=2&nav=search>. (subscription)