A few questions about heart attacks...

[Wendy_michigan]

Hi,

I have a few questions I'm hoping an expert can answer.

Generally speaking, does someone's cholosterol have to be elevated to have a heart attack? If my cholosterol is good and I don't have any problems with my heart, could I still have a heart attack?

Also - how long does someone cholosterol have to be high to cause a heart attack?   For example - in the documentary, Super Size Me a healthy man with presumably normal cholosterol started eating McDonalds for a month strait.  Would that be long enough to cause a heart attack or does it have to be sustained at high levels for a long time?  Can pigging out at Thanksgiving could it cause a person harm?

Thanks!

Wendy

[kenkeith]

With a low cholesterol level and no family history the probability of heart attack is slight.  High cholesterol causing soft plaque between the vessel lining can ruture into the vessel lumen and the clot can cause an acute heart attack with a total/partial artery block....also plaque within the lumen can break way and can cause the same result.  Usually, the plaque buildup from high cholesterol slowly blocks the lumen and gradually impairs heart performance.

It is worth noting that most acute heart attacks are caused by the soft plaque rupture and not plaque in the vessel's lumen. It seems there is a genetic component to how well one can tolerate poor diet, etc., but occasionally excessive eating and a fast food meal should not be of any concern...I would say it takes years of a poor diet, etc. and a month shouldn't be harmful for otherwise healthy person.  

[joanincarolina]

Good comments from grendslori. Let me add that there is also a component to heart issues predominantly occurring in near pre or post menospausal women where the larger common coronary arteries are clear, the heart chambers etc. itself looks great, but the tiny, tiny microvessels of the heart that are within the heart muscle appear to either develop placques, can spasm leading to arrhythmias and there is really no way that current technology can get a good look at these microvessels. MVD is frequently missed despite cardiac symptoms, especially SOB on exertion. Not unusual for a heart caths, echos, ekgs, stress tests to miss this. It's referred to as Cardiac Microvascular Dysfunction-MVD (or disease). Some literature and studies refers to this rather new field of research as Cardiac Syndrome X. I have it. And all I can add is that it's a very good thing that I had a very good healthy lifestyle and the rest of my body is fine. Enjoy Thanksgiving. Joan.

[grendslori]

You first need to understand exactly what a heart attack is; A heart attack is when the heart muscle does not recieve a blood supply. That can be caused by CAD (Coronary Artery Disease) or a Cardiomyopathy where the walls have outstripped the blood supply. CAD on average takes about 20 years to develop (transplanted hearts take about 5 years) Cardiac failure is a chronic form of heart disease, it does not take place in a few minutes time. People do not actually drop dead from a heart attack unless the ventricle wall, or other wall in the heart, ruptures. When a person starts to have a heart attack, it can go on for days, they may not even realize they are having a heart attack. What happens when a person dies is that the heart muscle that is not receiving the normal bloodflow becomes irritable and an arrhythmia develops and it is the arrhythmia that actually causes the death of the person. There is a very short window in which a person must be shocked out of that arrhythmia in order for them to survive. You hear about athlets who drop dead at 22 on the basketball courts; almost all of them have thickened heart walls (known as Hypertrophic Cardiomyopathy; HCM) ; the reason they drop dead is because the walls of their hearts is too thick and the blood supply has been outstripped. They are having heart attacks all the time; but they actually die as the result of an arrhythmia. Everyone has heard about the guy who goes in to see his doctor, is given a clean bill of health, walks out of the office and drops dead. Arrhythmias can be very difficult to catch, even in people with severe heart disease. In other words, it's the arrhythmia that is more the threat than anything else. Anything, too, that blocks your arteries is going to add to the problem. Pigging out for one day on Thanksgiving isn't going to do anything except make you not want to clean up the kitchen!    

[healthfreak40]

Truth is NO one has the slightest idea.
Lifestyle - No exercise, smokes, alcohol, Sugar, BP, HR etc. are known markers. LIPIDS form the blood markers. TMT, EKG, Echo are non-invasive tests. These form the majority of tests which will be performed at any hospital to assess the risk.
Non of them will reliably tell you if you are likely to have a attack.
These factors to a CERTAIN extent tell you if you are likely to have a HA. For eg: if you run high BP, are overweight, EKG is not too good, smoke etc. then you are a candidate. Logically, if your BP is good, Blood tests are good, TMT is good, weight is good, then you should not be in the risk zone. But there are any number of patients who have died on the spot due to severe cardiac failure despite having a VERY healthy lifestyle.
So the bottom line, have a healthy lifestyle. That way cardiac failure may not be necessarily avoided, just the guilt of having killed ourselves after the HA is avoided.
To answer your first question, I had a friend, who was paranoid about health for all his life, spend 2 hours in gym every single day, never smoked, and did cardiac checkups for 15 years in a row. Had no family history. He was 44, and died with severe cardiac failure before the ambulance could reach him (it reached spot in 8 minutes)
SO just enjoy that burger, just dont overdo it.