Heart Attack Rule of Seven

Two weeks ago, my husband returned home after suffering a heart attack.

This was not his first "episode," as a friend called it, nor is it likely to be his last. Late on a Tuesday night, I drove my husband to the hospital and the following day physicians inserted a  heart catheter through Dan’s right femoral artery to see how his heart was functioning. Skillfully, they tackled the offending blocked arteries with two stints and a balloon. Thanks to this intervention, blood now flows freely. His mind is clear, he feels better, and he has healed well from the procedure. Fortunately, doctors say, there is no evidence of damage to his heart.

Dan has a condition known as arteriosclerosis. Fortunately, other blockages doctors saw during the heart catheterization are not as severe. But these roadblocks in vital arteries have plagued him for nearly three decades.  At age 35, he underwent bypass surgery, followed by angioplasty fifteen years later, and a heart attack at 55. This summer, he underwent an endarterectomy to relieve a blocked carotid artery. The bypass and stints of years past remain intact, and thanks to advances in medical science, doctors can see precisely what is happening in my husband’s heart and hopefully get the jump on any future heart ailments (and what they don’t know about his heart, our daughter and I can tell you).

This was our wake-up call: he’s re-committed to a heart healthy diet, although we would have insisted before this happened that we were already eating the right things.  His doctor prescribed medication to prevent blood clots and keep existing blockages from worsening. And he’s signed up for cardiac rehabilitation at a local hospital, with monitors and medical personnel on-site, a much more comforting scenario than walking the treadmill on our back porch.

And so we breathe a deep sigh of relief: he dodged another bullet.

As the shock of the experience wears off…and no matter what the outcome of a heart attack, it’s always a shock….I’m left with deep gratitude for the gift of life, made bittersweet by this keen awareness: his heart attack happened right before my eyes, and I did not recognize the signs. Truth is, people don't always keel over like they show in the movies.

For several days, Dan had complained about heartburn that ebbed and flowed, regardless of what he ate. Antacids didn’t help. He’d been stationed at our kitchen bar, tackling the year-end finance report for the local chapter of a veterans organization, and grew increasingly frustrated by two line items that wouldn’t balance. About 9 p.m., he got up to take a shower and talked about going to bed early so he could resume work in the morning with a fresh mind. That's when he mentioned pressure in his chest that started in the afternoon;  nitroglycerin failed to relieve the symptoms, and now he was noticing pain. And then he rubbed his back in the spot directly behind his heart.

This small movement triggered a memory: several years ago, a friend of ours tossed and turned all night long, then told his wife he couldn’t sleep because of discomfort in his chest and a pain in his back. She phoned their daughter, a physician, who told her to call an ambulance. He was having a heart attack.

Calmly, I asked, “Should I drive you to the hospital?”

“Sure,” he said, as though I’d asked him if he wanted a cup of hot chocolate before going to bed.

I dressed quickly, settled the pets down for the night, and we headed for the Veterans Administration hospital 30 miles away, his primary care facility. Along the way, we avoided the reason for our trip, and instead talked about a bluegrass festival we planned to attend the following weekend and the need to complete that pesky financial report beforehand.

I am a denialist, married to a denialist. The glass is always full, even when it’s only half full. We were each certain he’d be treated and released in a matter of hours, and we could get on with the business of life.

At the hospital emergency room, they took his chest pains seriously.

 Moments after our arrival, Dan was hooked up to monitors, x-rays were taken, and the results of blood tests were being awaited. The doctor on duty that night took a special interest in his case; his cardiac enzymes were high, she noted, and his blood pressure shot up to 200/100 – excessively high, even for a guy who consistently suffers from high blood pressure, despite a wide range of medications. The pain in his chest didn’t respond to nitroglycerine administered intravenously. She immediately ordered an ambulance that would transfer him to the nearest heart hospital, 45 miles away.

It was 2 a.m. when I trailed off down the turnpike, a legal distance behind the ambulance running lights and sirens down the dark, deserted road.  In our destination city, I was pulled over for speeding. Holding my driver’s license up for him to see, I did a poor job of hiding my agitation as I explained to the officer that my husband was in the ambulance he’d seen go by a few minutes earlier. To my everlasting gratitude, he offered directions to the hospital parking lot, wished me luck, and cautioned me to slow down. I found Dan in an emergency room bed, waiting to be admitted. A few hours later, he doctors confirmed he’d suffered a “small” heart attack.

As it turns out, Dan is believed to have experienced a series of small heart attacks before the symptoms seemed severe enough to warrant attention. Neither of us wanted to admit a connection between "heartburn" and his chronic heart condition. But now I know, from talking with his doctors and nurses, that there's no such thing as overreacting when a heart patient experiences unusual signs of pain or distress.  And so that brings me to this Heart Attack Rule of Seven, shared in the hope that bits of wisdom gleaned from lessons learned might someday save a life:

Rule 1: Be suspicious of heartburn that can’t be traced to food. If it gets worse or doesn’t pass in a reasonable length of time, the person may be having a heart attack. Assume this possibility in someone who has a history of heart issues, and work backward to a warm cup of milk and good night's sleep.

Rule 2: Don’t ignore sudden or unusual back pain located directly behind the heart. Dan suffers from chronic back ailments and had been sitting on a kitchen bar stool while working on the financial report, so it was easy to assume the pain was positional.  We all know what happens when we assume.

Rule 3: Keep a fresh supply of nitroglycerin tablets on hand at all times. They expire after 90 days. The bottle on our shelf was two years old. Of course, the good news was that he hadn’t needed them; unfortunately, that meant we didn’t refresh his supply on a regular basis. Don’t be a denialist.

Rule 4: Call an ambulance. Do not drive yourself or the patient to the hospital. It frightens me to realize I was driving my husband down a dark highway while he was having a heart attack.  Paramedics are equipped to administer immediate treatment en route. If I had a quarter for every doctor and nurse who offered this advice, I’d be drinking a Starbucks latte.

Rule 5: Consider every substance that enters the body in terms of how it will affect the heart. Just call me the Food Nazi, but no longer will I downplay the sodium and fat content on packaging. We’re cooking from scratch now. It tastes fabulous and is better for his heart. We may indulge sparingly with foods not on the healthy list, but never at the expense of reviving old habits.

Rule 6: Substances that enter your body include nicotine. After spending 48 hours under medical care, without taking a dip of chewing tobacco, Dan could have used a nicotine fix. His discharge orders indicated he should stop tobacco, and an enterprising nurse brought us articles that indicated nicotine was bad for his heart because it constricted blood vessels and could also be contributing to his high blood pressure. He hasn’t dipped in two weeks. His blood pressure is closer to normal than it has been in years. Enough said.

Rule 7: Live each day to the fullest. Carpe diem and all that implies.

Next time: Struggling with the heart healthy diet, one day at a time.