DR. HOOK- MI at risk? Heart attacks can sneak up

Six Feet Under is probably my favorite television series ever. The Fisher & Sons Funeral Home was not a fun place like a disco club or an amusement park, but it was a quite interesting. In the very first episode, Nathaniel Fisher, the father of the family, is driving his brand-new hearse and smoking a cigarette. His wife is on the phone with him, telling him that smoking will kill him. Then he's struck by a bus and killed while singing, "I'll Be Home for Christmas." What are the chances?

At the beginning of each episode, someone dies and makes it over to the funeral home. How they die is always– um— interesting. One lady sees pornographic blow-up dolls floating in the sky, runs out to see the "rapture" of angels, and is hit by on-coming traffic. One man is quietly eating breakfast when his wife takes a skillet, conks him on the head, and then eats breakfast. 

With coronary heart disease (CHD) being the #1 killer of American adults, don't you think Six Feet Under would have shown more people dying of a good old fashioned heart attack?

The Framingham Study that started in 1949 showed the world that a lot of people with symptom-free CHD end up having a myocardial infarction (MI– aka, a heart attack). Hold the mayo, Mel! Yes, about 75 percent of people with ischemia don't have symptoms such as angina or shortness of breath during activities. Ischemia means a lack of blood supply to the heart muscle, so that the cells don't get their fix of oxygen and nutrients. Ischemia of 20 minutes or more causes an MI because the heart muscle cells start to die. All those suffocating cells– sounds so Titanic!

The lifetime risk of CHD for men 40 years of age is about 49 percent, for women at that age, 32 percent. Hold the bacon, Blanche! In the past, women didn't appear to have as much CHD as men, but now we know that 10 years after menopause, women unfortunately start to "catch up" with men. In fact, more women die of CHD than of breast cancer, though women worry much more about the latter.

Why do doctors– like me– nag and complain, "Don't smoke! Exercise! Come in for your physical exams and have your blood pressure checked!"? I have quite a few patients who always ask me, "Why do I need to see you on a regular–cough, cough, hack– basis? I can't eat my triple decker cheeseburger and fries if I have to fast for my lipid panel— burp."

Sigh.

Do you know that a diabetic person has the same risk of having a heart attack as a person who has already had a heart attack? With two thirds of Americans being obese or overweight, we are seeing a lot more people at risk for CHD. Hypertension (high blood pressure), high cholesterol, and smoking are big risk factors for developing CHD. With the exception of smoking, hypertension and hyperlipidemia are silent things that aren't detected without having them checked.

An EKG can detect if a "silent MI" has already happened– yes, believe it or not, not everyone knows when they have had a heart attack. Hold the meat, Martha! 

Also conduction problems of the heart can be detected on an EKG. A good cardiac examination and history can also tip off the doctor to order a nuclear stress test to see if there is a chance CHD exists.

Yes, we all have to die of something, as Six Feet Under has demonstrated. Personally, I would like to die of a heart attack from the excitement of winning an Academy Award, but that won't happen in this lifetime. If Sissy Spacek is reading this, can I borrow your Oscar?

Do you have a medical question? Dr. Hook wants to hear from you!

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