It’s Not Always Heart Failure… And How to Prevent That, Too

When it comes to heart issues, three medical concepts are often confused by the public, and that ambiguity sometimes leads to faulty reporting. Recent headlines about a 31-year-old father who tragically lost a child and then subsequently died during shiva suffered from this medical misunderstanding.

The heart, which is responsible for pumping blood to the entire body, is essentially a motor driven by electricity. While all heart cells conduct electricity, some specialized cells help the electrical system work best. To do its job, the heart requires a good deal of blood flow, which is supplied through a series of tubes called the coronary arteries; these arteries take blood just pumped by the heart, which is filled with oxygen and nutrients, and provide it to the heart muscle so it can work.

Heart failure occurs when the heart muscle is incapable of pumping enough blood. A person develops congestion in the lungs, shortness of breath, swelling in the legs, dizziness, weakness, and eventually, after a long time, the heart can no longer function properly resulting in death from heart failure.

Electric disturbances of the heart often occur in the presence of a structural, muscular problem. However, some cases are both hereditary and environmental, when electrical disturbances that can be life-threatening or life-ending occur in the absence of a structural problem of the heart. When those disturbances produce a life-threatening rhythm called ventricular fibrillation, and the patient passes away, that syndrome is called “sudden cardiac death.”

A heart attack is the third type of problem. A heart attack is the lay term for a myocardial infarction — damage to the heart muscle that is usually due to lack of blood flow in the arteries that feed the heart.

People who suffer from heart disease can pass away from one of three causes: 1) progressive heart failure, 2) an electrical disturbance to the heart causing ventricular fibrillation or 3) a heart attack where insufficient blood flows to the heart so it can no longer function. There is some relationship among these causes. Heart failure and sudden cardiac death usually occur in the presence of a structural problem of the heart.

There are three fundamental causes of a structural problem: 1) a heart attack, which did not cause immediate death, 2) a primary disease of the heart muscle, or 3) a hereditary disease of either the electrical or mechanical system of the heart. However, these are not always related since some patients may have only electrical disease, some may have mechanical problems, some may have both, and some may have neither. Consequently, it is important to distinguish among them.

What happened to Isaac Meir Weis, the 31-year-old father who tragically lost his infant son and then suddenly collapsed while sitting shiva?The facts suggest that Mr. Weis had sudden cardiac death due to an electrical disturbance, not a heart attack or heart failure. A final diagnosis will depend on the results of an autopsy and the release of medical records, if that occurs. But reporting what happened as “heart failure” is inaccurate.

Treatment and prevention of the various heart problems is also similar, but can be different. In all cases, avoiding disease of the coronary arteries by proper diet and exercise, and avoiding toxins such as alcohol and drugs that can damage the heart muscle, are crucial. However, in cases of hereditary disturbances or electrical disturbances that occur in the absence of structural heart disease, these preventive measures will not work, and others may be required. Thus, it is important to distinguish among heart attacks, heart failure, and electrical disturbances that cause sudden cardiac death. Better education will lead to better prevention.

Heart failure can be confused with an arrhythmia, which can result from a narrowing of the arteries. That’s why family history is very important in helping to avoid a heart attack. Depending on the cause of the arrhythmia, there are different methods for treating the condition. It is also important to note that while exercise is very good, sudden burst of exercise and/or stress in people who aren’t conditioned can be problematic. Moderation, as will all things, is usually advised.

Stress can certainly contribute to heart rhythm disturbances and “voodoo death.” This is uncommon, but it does occur in people who are subjected to sudden, severe stress, where the release of adrenaline can cause a hearth rhythm disturbance even in the absence of a bad structural problem of the heart.

There are a number of things that people should do to lower their risk of heart disease:

  • Check your blood pressure regularly and take steps to keep it within safe boundaries.
  • Control cholesterol and triglycerides
  • Maintain a healthy weight
  • Eat a healthy diet
  • Exercise regularly, not sporadically
  • Limit alcohol use
  • Don’t smoke anything
  • Try to keep stress to a minimum
  • Monitor and manage diabetes
About the Author
Dr. Alan Kadish is president of the Touro College and University System. He is also a renowned cardiologist.
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