A heart attack follows years of arteries closing up

July 16, 1991|By Gerri Kobren

A HEART ATTACK DOESN'T JUST HAPPEN OUT OF THE blue, says cardiologist Raymond Bahr.

A lifetime accumulation of atherosclerotic plaque would first have narrowed a coronary artery, reducing blood flow to the heart. A blood clot, forming in the artery, can then move into the opening, like a stopper in a bottle, closing it off completely and causing a heart attack.

But that's not always a sudden event either, according to Dr. Bahr. In the beginning, the clot can act "like a ball valve," in the vessel, he says; and this can cause the come-and-go kind of discomfort, the "stuttering" pain that might be telling you a heart attack is imminent.

Chest pain can also occur in the absence of a blood clot, when acoronary artery narrowed by plaque cannot deliver the amount of blood the heart requires; the discomfort is most likely to occur during periods of exercise or excitement, and is known as angina, or angina pectoris.

"With new-onset angina, the person should be seen and stabilized," Dr. Bahr says. After diagnosis, an angina patient may use nitroglycerin to relieve the pain. A predictable pattern of pain and relief is known as "stable angina."

But if that pattern changes -- if, for instance, there's no reason for it, or it's occurring more often than it used to, or the nitroglycerin does not relieve it -- your body might be telling you that immediate attention is required.

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