The before and after: Heart attacks, strokes and pulmonary embolisms

Each minute, more than one person in the United States dies from a heart disease-related or vascular disease-related event. Because these diseases encompass several types of heart and artery conditions, the outcomes vary greatly from person to person. Three of the most dangerous complications from heart and vascular diseases are heart attack, stroke and pulmonary embolism. Carl Tong, MD, PhD, FACC, advanced heart failure and transplant cardiologist and associate professor at the Texas A&M College of Medicine, and Mark Frakes, MD, family medicine physician at Texas A&M Health Family Care, break down the steps leading up to these life-threatening events—and what happens afterward.

What are the risk factors for heart and vascular disease?

For the most part, a single action or choice does not ultimately cause any of these outcomes. They mostly happen as a result of a variety of diseases that cause narrowed or blocked blood vessels.

“People have varying levels of risk for both heart disease and vascular diseases, so it is important to discuss your risk with your primary care provider,” Frakes said. “To name a few, some common risk factors include age, family history of heart disease, a history of unhealthy diets and lifestyles, uncontrolled high blood pressure, uncontrolled diabetes and smoking.”

Furthermore, Tong mentions people with high cholesterol, men and African-Americans are also at higher risk.

What is a heart attack?

A heart attack occurs when blood flow to a part of the heart is suddenly blocked. More often than not, a broken piece of plaque within the arteries triggers the formation of a blood clot. This blood clot is the reason for a heart attack. As the blood clot potentially restricts the flow of blood and oxygen to the heart, depending on the severity, the heart attack can cause sudden death. “The symptoms of a heart attack vary from person to person,” said Tong, who gave two presentations on November 17, 2019, at the American Heart Association Scientific Sessions in Philadelphia. “However, it is possible that the first presenting symptom of a heart attack is sudden death.”

Those who survive the initial blockage of blood flow may notice symptoms like pressure, tightness or pain in varying degrees of severity in their chest or arms. They may also experience cold sweat, fatigue, lightheadedness and shortness of breath. “Men and women often notice different symptoms,” Frakes said. “Women often experience symptoms like pain in the back, neck, jaw or throat. They also may notice feelings of heartburn or indigestion, nausea and vomiting. The same is true for individuals with diabetes.”

Expanding upon Frakes, Tong stated, for both men and women, a blockage of the right coronary artery can cause nausea and upper abdominal discomfort, which is often mistaken for a bad case of indigestion.

What should you do if you have a heart attack?

Call 9-1-1. “In the situation of a heart attack, the individual needs to get help immediately,” Tong said. “It can be very dangerous to go without blood flow to the heart for an extended period of time. Often, the faster they get the blockage removed, the fewer long-term complications they may experience.”

Depending on the severity and location, treatment may involve medication or re-vascularization, but most likely a combination of the two. Tong explained that a common re-vascularization option is a coronary angioplasty and stenting—also known as percutaneous coronary intervention, or PCI. During PCI, at least one stent is used to physically open and keep open the point of blockage. Another common re-vascularization option is a coronary artery bypass surgery. For this surgical option, Tong says the bypass allows the blood to flow around the blockage.

What is a stroke?

A stroke happens when the body experiences a sudden cessation of blood flow to the brain. Signs of a stroke can include sudden numbness or weakness of the face, arm or leg. A big sign of a stroke is if the numbness or weakness is located on one side of the body.

The National Stroke Association suggests using the acronym F.A.S.T. to easily identify if someone is having a stroke. Their steps are:

• Face: Ask the person to smile. Does one side of their face droop?
• Arms: Ask the person to raise both arms. Does one arm drift downwards?
• Speech: Ask the person to repeat a phrase. Does their speech sound slurred?
• Time: If you observe any of these signs, then immediately call 9-1-1.

What should you do if you have a stroke?

Call 9-1-1. There are many different kinds of strokes, and all require a different treatment and recovery. It takes time for the emergency room provider to determine the type of stroke and a treatment plan, so find help as soon as possible.

Ischemic strokes make up 87 percent of all strokes. They are caused by a blockage—often from a blood clot—in the artery that supplies blood to the brain. These strokes can be treated with a tPA, or tissue plasminogen activator. tPA can break down the clot causing the blockage, but the drug needs to be administered within the first three hours after the stroke.

tPA should not be given for a hemorrhagic stroke, or a bleeding stroke. “A hemorrhagic stroke happens when an artery in the brain leaks blood and puts too much pressure on the brain,” Tong said. “Because the issue with a hemorrhagic stroke is too much blood, tPA would increase the blood flow and be severely detrimental to the recovery of the stroke victim.”

What is a pulmonary embolism?

“A pulmonary embolism happens when the blood flow to the lungs or part of the lung is blocked due to a blood clot formed most often within the deep veins in the legs,” Frakes said. “Deep vein thrombosis is often the source of these blood clots.”

The National Heart, Lung, and Blood Institute of the National Institutes of Health conducted a study to find out what symptoms people feel during a pulmonary embolism.

• 73 percent of patients experienced shortness of breath
• 66 percent experienced chest pain
• 37 percent experienced a cough
• 13 percent coughed up blood

“If you are experiencing a pulmonary embolism, then you will feel a sudden onset of chest pain,” Tong explained. “The pain tends to worsen with breathing. You will also experience short breaths, weakness and fast heart palpitations.” He also notes sudden death may be the first presenting symptom of a large pulmonary embolism.

What should you do if you have a pulmonary embolism?

Like with heart attacks and strokes, call 9-1-1. The faster you get help, the higher the chance of a full physical recovery.

The primary treatments for a pulmonary embolism are anticoagulation with a medication that prevents clot formation and tPA. However, the combination of medication depends on the severity of pulmonary embolism and if you have any underlying conditions that my put you at risk for developing additional pulmonary emboli.

The big picture

Both Frakes and Tong encourage you to work closely with your health care providers and follow their instructions closely to prevent catastrophic occurrence of heart and vascular disease. The best way to manage these conditions is to prevent them. For example, simply lowering blood pressure by 10 mmHg reduces the probability of heart attack and stroke by approximately 50 percent for certain age groups. Ask your primary care provider or your cardiologist for help developing a lifestyle that lets you live your healthiest life.