The heart, explained
properly.

There is no such thing as “perfect health”. Healthy habits can substantially reduce cardiovascular risk, but they cannot make it zero. Genetics, inherited cholesterol disorders, certain inflammatory conditions, pregnancy-related conditions, and less common causes of heart attacks can affect people who otherwise appear healthy. This is why concerning symptoms should never be dismissed simply because someone is young, active, or does not “look like someone who would have a heart attack”.

The best place to start is by discussing your cardiovascular risk with your family doctor. Heart attack risk cannot be determined from a single “magical” number, but rather it can be assessed by reviewing your family history, your trends in blood pressure, your habits and other health conditions. Additionally, they can order important tests to assess your cholesterol and other cardiovascular markers. These may include LDL, HDL, triglycerides, ApoB and lipoprotein(a). Knowing your individual risk can help you and your healthcare team decide which preventive steps are most important (and relevant) for you.

Cardiovascular risk increases after menopause, in part because declining estrogen levels are associated with changes in cholesterol, blood pressure, body fat distribution, blood sugar regulation, and blood vessel function. These changes can contribute to the development of plaque over time. However, it is a myth that estrogen completely protects premenopausal women. Cardiovascular risk develops throughout life, and premenopausal women can and do have heart attacks. Women also have some cardiovascular risk factors that do not apply to men: early menopause and a history of pregnancy complications (such as preeclampsia or gestational diabetes) can entail a higher risk of cardiovascular disease.

Chronic stress can indirectly increase cardiovascular risk by affecting blood pressure, sleep, physical activity, smoking and other behaviours. Intense physical or emotional stress can also act as a trigger for cardiovascular events. There is also a separate condition called Takotsubo syndrome, nicknamed “broken-heart syndrome,” which can occur after intense emotional or physical stress and mimics a heart attack. However, it is a different condition and requires medical evaluation to distinguish the two.

No. Family history increases risk; it does not determine your future. Knowing your family history can be incredibly useful because it gives you an opportunity to start prevention earlier. Tell your healthcare professional if close family members developed cardiovascular disease (particularly at a young age) and ask which risk factors should be assessed.

Unfortunately, you cannot always tell on your own. Heart-related discomfort can sometimes feel like burning, indigestion, pressure or even relatively mild discomfort. Anxiety, reflux and musculoskeletal pain can also cause chest symptoms. Rather than trying to diagnose the cause yourself, ask: “Could this be my heart?” If the symptoms are new, severe, unexplained, associated with other heart attack warning signs, or simply make you concerned that you could be having a heart attack, call 911 or ask someone to assist you.

Yes. Heart attack symptoms can come and go and temporary improvement does not prove that blood flow to the heart is normal or that the danger has passed. Do not use waxing and waning symptoms as a reason to “wait and see.”

Yes. This is sometimes called an unrecognized or silent myocardial infarction. A person may have experienced symptoms that were mild or mistaken for something else. Evidence of the previous injury may later be discovered on an ECG, cardiac imaging, or another investigation.

Never perform CPR on someone who is conscious or breathing normally. This will hurt them and not solve the issue at hand.

CPR becomes necessary if the person becomes unresponsive and is not breathing normally, suggesting that the heart attack may have progressed to cardiac arrest. If that happens, call 911 immediately, start CPR as instructed, and use an AED if available.

A stent treats a specific narrowed or blocked area of a coronary artery. It does not remove plaque built up throughout the rest of your cardiovascular system or eliminate your future risk.

The stent treats the blockage; long-term prevention treats the disease.

Québec has many smoking-cessation resources, counselling and quit-support services. Please peruse our curated list on our available resources page.