There’s a point of confusion I often encounter that I’d like to clarify. It’s not uncommon for patients conclude a lengthy hospital stay for a cardiac condition in utter confusion about whether they had a heart attack or not. We have changed the definition of heart attack so dramatically over the years that doctors and nurses are just as confused as the patient.
A few years ago this was all very simple. A heart attack meant only one thing—your uncle Herb is out shoveling the snow one winter morning when he stumbles into the house clutching his breast and moaning as if an elephant decided to use his chest as a foot stool. He is pale, sweaty, and clammy, and rummages through his cabinets looking either for his nitroglycerin or his life insurance policy. Aunt Melba offers to take him to the hospital, but he of course refuses, claiming that it’s just gas and that it’ll pass. At this point his survival depends solely on whether or not he listens to his wife—a scenario that seems to play out on a daily basis even today and to me is proof that the common sense gene is not well represented on the male Y chromosome.
Back then there were only two types of heart attacks you could have: a regular heart attack or a massive heart attack. The distinguishing point between these two was only how much Uncle Herb could embellish his story a few weeks later. The term “massive,” by the way, doesn’t really appear in any medical text but it seems to be the usual modifier used to describe things like heart attacks, strokes and medical bills (you rarely hear of a “gargantuan” heart attack or a “colossal” stroke).
A few years ago blood tests were developed that can measure minute amounts of proteins that are released into the blood stream whenever heart cells are damaged. The ability to detect so-called cardiac enzymes to such a sensitive degree has made it so that even the slightest insult to a few heart cells results in an abnormal reading. Furthermore, the people who make rules regarding these things decided to redefine a heart attack as anything that results in any perceptible rise in cardiac enzymes. This is actually useful since it helps us catch coronary artery disease before it does meaningful heart damage. A small, transient clot in an artery could sneak under the radar 20 years ago but not today.
It’s not just clots that can cause heart cell damage. Put enough stress on a not-so-healthy heart and the enzymes go up. We obviously don’t treat that kind of heart attack the same way we treat one caused by an arterial clot. If you remove the stress on the heart (correct the blood pressure, cure the infection, fix the anemia, etc.) then the heart status improves.
These days, if you have stable coronary disease and get admitted for a particularly bad pneumonia, be prepared to potentially come away with the diagnosis of heart attack even if you never experience chest pain, and realize that the diagnosis may not mean what it used to. I would suggest pinning your doctor down on this one and make him/her explain how much (if any) damage your heart sustained and what sort of additional testing is needed.
And, if you end up with a colossal, gargantuan, monumental heart attack, at least you can one-up Uncle Herb for once.