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By Chauncey Crandall, M.DSPECIALREPORT

S

ince I became a cardiologist more than 25years ago, Ive witnessed many improvements

in the field o cardiology. We have moretechnology, better procedures, and ar more types omedication than we did beore.

We now routinely save people who would havedied in the past.

But what we, as doctors, no longer have is theluxury o time. The entire healthcare industryhas changed. These days were under much morepressure to see more patients in shorter periods otime. This means that most doctors arent able toorm the kinds o personal bonds with patients that

once were the norm.At the same time, though, patients need our

guidance more than ever. People are getting atterthan ever because we have a society that promotesrelaxation over physical fitness.

As a result, the rates o high blood pressure,diabetes, and obesity are soaring and threateningto wipe out all the progress weve made in fightingheart disease.

This is the reason why I created Dr. Crandalls

Heart Health Report. I wanted a orum where Icould share important new inormation about hearthealth, and, as I do or all o my patients, providesound guidance or transorming your overallhealth.

But, first and oremost, I wanted to give youthis special report, entitled, These Four ThingsHappen Beore a Heart Attack, so you can learn theall-important signs you must know to protect yourheart. So lets get started right away!

What Is a Heart Attack?First I want to explain what a heart attack is, so

you can understand why the symptoms occur.All o our organs, like the kidneys, liver, and

stomach, have different jobs. The hearts onlyjob is to keep blood moving through your bodycontinuously. Basically, your heart is a pump.

In order to accomplish this task, your body hasits own circulatory system, which is comprised othree main coronary arteries that descend, like acrown, rom the hearts main blood vessel, the aorta.These three main coronary arteries, which cover theoutside o the heart, are called the right coronaryartery, the lef circumflex coronary artery, and the lefanterior descending artery, or LAD.

These coronary arteries are not very wide. And,in act, they are rather delicate. Over time, they canbecome clogged with atty deposits, ofen calledplaque.

When this happens, it creates what is reerred to,variously, as heart disease, coronary artery disease,atherosclerosis, or hardening o the arteries.

Most heart attacks occur when this plaque

ruptures and blocks the flow o blood through thearteries to the heart muscle.

The Four Things That HappenBefore a Heart Attack

I will offer a complete list o symptoms you canexperience when youre having a heart attack later inthis report. Beore that, I want to ocus on the ourthings that happen most ofen beore a heart attack.

Over the course o my career, I have determined

These 4 Things HappenRight Before a Heart Attack


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health

rom a wealth o experience that these are the our most common signs that aheart attack is about to take place or is already in progress.

1chest painChest pain is the one symptom that we associate most ofen with aheart attack. And theres a good reason or that: It actually is the most

common symptom.

However, chest pain can mean more than one thing, and it can maniestitsel in many ways. There is one type o pain that occurs all over your chest.There is another type o pain that occurs just off to the lef side or the centero the chest. It can also start in the jaw and radiate down the lef arm.

The pain can also occur at different intervals and different intensities.It might come and leave very suddenly or last or a ew minutes or more.The discomort can be mild, or it can be severe, and it can also eel likeuncomortable ullness, squeezing, or pressure.

When this type o pain is severe, it can maniest itsel in what weve cometo nickname The Hollywood Heart Attack, because it looks like the dramatictype o heart attack we see on TV and in the movies. But its importantto understand that the pain doesnt have to be as severe as that; it can bemild, especially at first, and so you may not realize anything serious at all ishappening.

2shortness of breathWhile most people find chest pain alarming, they are not aware thatshortness o breath, even in the absence o chest pain, can signal an

impending heart attack.In act, one study, published in The New England Journal of Medicine,

ound that o 18,000 patients reerred or cardiac stress testing, those who

experienced shortness o breath were three-to-five times more likely to die.This included some patients who reported no chest pain at all.This shortness o breath can occur suddenly, right beore or even during a

heart attack. It can also provide you with an important clue that something iswrong with your heart that demands checking out.

One o my patients, Grace, was accustomed to being very active. In act,when she lived in New England, she loved to hike through the hills and evenchopped her own firewood. Gradually, though, she ound hersel becomingso winded she could no longer walk up her own driveway without becomingshort o breath.

Her kids told her to relax, she was just growing older. But Grace didnt

Dr. Crandalls Heart Health Reportis a publication of Newsmax Media, Inc., and Newsmax.com. It is published monthly at a charge of $54.00 per year and is offered online and in printthrough Newsmax.com.

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CEOChristopher Ruddy Associate PublisherTravis Davis AuthorChauncey Crandall, M.D. Contributing Editor Matthew Kalash Production/Art Director Elizabeth Dole

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2012 Newsmax Media, all rights reserved. Please note that this advice is generic and not specific to any individual. You should consult with your doctor before undertaking any medicalor nutritional course of action.

When chest pain is

severe, it can manifest

itself in what wevecome to nickname The

Hollywood Heart Aack,

because it looks like the

dramac type of heart

aack we see on TV and

in the movies.


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Special Report 3newsmaxhealth.com

eel right. Fortunately, she came to see me. I perormed some cardiac tests andit turned out it wasnt age at all; she was on the brink o suffering a massiveheart attack.

3indigestion or heartburnOne o the challenging things about chest pain is that it ofen doesnteel like chest pain. Sometimes it eels like indigestion, or even

heartburn.Take Jack, or instance. Hes a top-flight salesman with a heavy travel

schedule. He was in the habit o closing a deal by going out or a big dinner,with a couple o scotch-and-sodas ollowed by a thick steak. So he wasntparticularly surprised when he started experiencing indigestion. But onone occasion, it wasnt indigestion; this was the early warning sign o animpending heart attack.

How is it that pain rom your heart can be elt somewhere else? Becausewe dont actually perceive pain directly. Even i you stub your toe, thediscomort you eel is first interpreted through our central nervous system,which is comprised o the brain, spinal cord, and nerve cells.

Because the nerves in the stomach are located near the heart, its notsurprising that such signal conusion sometimes occurs in the case o a heartattack.

4nausea and vomitingNausea and vomiting are ofen classified as atypical symptoms o heartattack, meaning they dont usually occur. However, in the thousands

o patients Ive treated, I find that they are really not that uncommon at all.Nausea and vomiting can occur alone, but they ofen also occur with otherheart attack symptoms.

Obviously, having any one o these symptoms does not necessarily meanyou are having a heart attack. But i you believe you are having a heart attack,call 911 and ask to be taken to the nearest hospital.

Nausea and voming

are oen classied as

atypical symptoms.but in the thousands of

paents Ive treated, I nd

that they are really not at

all uncommon.

A P: CC P

Chest pain can have many

other causes besides heart

aack. People who have

coronary artery disease

oen experience a type ofchest pain known as angina

pectoris, or simply angina.

This occurs when the heart

has to work extra hard to

pump blood throughout

the body. Other symptoms

include pressure, heaviness,

or ghtness in the chest.


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Do not attempt to drive yoursel, or allow someone to drive you becauseyou could require emergency treatments that can be started in the ambulance.

Why Knowing These Four Things Is So ImportantMost people who have a heart attack will tell you it happened suddenly

right out o the blue. However, I can tell you rom experience (includingmy own near heart attack) that the vast majority o heart attacks dont happen

that way. In act, the symptoms o an impending heart attack can occurgradually, and stretch out over days, weeks, or even a month or two.

So you have to know this inormation in order to recognize the symptomso heart disease as early as possible. By the time you have a heart attack, itcould be too late.

While its true that most people do survive a heart attack, they also canexperience permanent damage to their heart muscle. Or, during an attack, theheart can go into an irregular rhythm, which can result in cardiac arrest orsudden death.

So dont wait or that heart attack learn the symptoms o a heart attack,

so, i they occur, you can seek medical help.

Additional Signs of a Heart AttackNow that Ive given you the Four Major Things that happen beore a heart

attack, heres a rundown o some other symptoms you might experience: Discomort that spreads to the shoulders, arm, back, neck, or jaw Indigestion, heartburn, or a choking eeling Prouse sweating Rapid or irregular heartbeat Dizziness, weakness, or lightheadedness Vague, general eeling o illness

Anxiety or a eeling o doom Passing out

The vast majority

of heart aacks dont

come on suddenly right out of the blue. In

fact, symptoms of an

impending heart aack

can stretch out over days,

weeks, or even a month

or two.

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Pq

T IyR

When fay deposits

start building up

inside the arteries,

the vessel narrows.

This buildup ofplaque reduces the

blood ow through

the artery and also

irritates the arterial

wall, resulng in

calcicaon or

hardening of the

arteries.

Nw AyN Ay


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Obviously, some o these are very general, and may indicate a less seriouscondition such as a respiratory inection or the flu.

But they can occur with the our symptoms Ive seen occur morecommonly in the people Ive treated over the years or heart attacks.

You should also know that i youve already had a heart attack, you are atincreased risk to suffer another. The symptoms o another heart attack maybe the same as the first, or they may be different, which is why its importantto consider symptoms careully, and not to assume that they are not comingrom your heart.

Pre-Heart Attack SymptomsAs I noted, heart attacks rarely occur out o the blue. In act, people may

experience symptoms our-to-six weeks beore an actual attack. In act, onestudy showed that 78 percent o those who suffered a heart attack experiencedone o these pre-heart attack symptoms a month beore the attack occurred.

Here are typical pre-heart attack, orprodromalsymptoms: Unusual atigue

Sleep disturbance Anxiety Pain in the shoulder blade or upper back Sweating Irritability

The Four Major Heart Attack Risk FactorsHeart attacks can occur in people who have no known risk actors or

at least they think they dont. Upon reflection, however, most heart attackvictims realize that they have one or more o the major risk actors.

I you do, this increases the possibility that, whether you experience one

o the Four Major Things that happen beore a heart attack, or one o the lesscommon signs, you are indeed having a heart attack, or one is in the offing.

A CyC

Chauncey W. CrandallM.D., F.A.C.C.,is chief of the cardiactransplant program at theworld-renowned PalmBeach CardiovascularClinic in Palm Beach

Gardens, Fla., where hepractices interventional,vascular, and transplantcardiology. Dr. Crandallreceived his post-graduatetraining at Yale UniversitySchool of Medicine,where he also completedthree years of researchin the cardiovascularsurgery division. Helectures nationallyand internationally on

preventive cardiology,cardiological healthcareof the elderly, healing,interventional cardiology,and heart transplants.Known as the Christianphysician, Dr. Crandallhas been heralded forhis values and messageof hope to all his heartpatients.

T Cy A

Three main arteries

descend, like a crown,

from the hearts main

blood vessel, the aorta:

the right coronary artery,

the le circumex artery,and the le anterior

descending artery.

Blockages in these arteries

are the main cause of

heart disease, and can

lead to heart aack, heart

failure, angina, or cardiac

arrest.

A

RCyAy

L Cx

CyAy

L ADAy


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Heres a rundown o the major risk actors, so you can use them toevaluate whether you are having a heart attack. Remember: even i youreuncertain, its always best to call or help first, rather than regret it later.

1high blood pressureHigh blood pressure, also called hypertension, is so common that itsnow estimated that 1 in 3 Americans have this condition. Its also known

as a silent killer because it can cause its damage without your ever noticingany symptoms at all.

Sometimes, high blood pressure can occur or no known reason, but ofenpeople who have it are overweight, have diabetes, smoke, or have a amilyhistory o the disorder.

Men tend to develop high blood pressure earlier than women, but the riskequalizes at about age 55. And afer the age o 75, women are at a higher risk.

Having high blood pressure means that your heart is working too hardto pump blood throughout your body. Because o this, the heart becomesenlarged and weakened. This condition also damages the coronary arteries,leading to heart disease and, ultimately, heart attack.

2diabetesPeople with diabetes have a metabolic disease that hampers their abilityto transorm sugar rom the oods they eat into energy. The result is

a buildup o glucose in the blood, which damages both the heart and thecoronary arteries, along with the rest o the blood vessels and organs in thebody, including the kidneys, the eyes, and more.

Diabetes doubles the risk o a heart attack in men, and triples it in womenThe rightening thing about diabetes is that, like high blood pressure, it

does its damage silently, ofen or years, beore its diagnosed. In act, its not

uncommon or people to learn they have high blood pressure, diabetes, orboth only afer theyve suffered a heart attack.Over the years, Ive helped scores o my patients not only manage their

diabetes, but even reverse it, by showing them a new way to eat and how tobuild exercise into their lives, both which I will share with you in upcomingnewsletters.

3high cholesterolA heart attack happens when plaque, which is a atty substance thatbuilds up in the walls o the coronary arteries, ruptures.

Those atty deposits occur when there is too much cholesterol in the

blood. Your body manuactures cholesterol, but you also get it rom the oodsyou eat.Eating a plant-based diet, not drugs, is the secret o bringing your

cholesterol level down to the lowest its been in years even possibly lowerthan when you were decades younger.

In uture issues o my newsletter, I will tell you exactly how to do that.

4stressMost doctors ocus on the role that physical conditions, such as highblood pressure, high cholesterol, and diabetes play in heart health, and

A S WF D

Diabetes can doubleor even triple yourheart attack risk. Butit does something elsethat is deadly as well:Diabetes damages notonly your bodys organs,it also damages yournerve endings.

As a result, diabetescan dampen the painsignals that you may

ordinarily have felt,including the warningsign of chest pain thatsignals you may bedeveloping heart disease,or even be in the midst ofa heart attack! Ill tell youhow to make certain yourdoctor keeps a close eyeon your heart, a factorthat, literally, can meanthe difference betweenlife and death!


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H Ak Sy W

Women can experience the same

Four Main Things that happen before

a heart aack as men do, but they

are also likely to experience dierent

symptoms. Thats why the 435,000

American women who will suer a

heart aack this year are less likely to

recognize it. Worse yet, their doctors

are less likely to recognize it, too!

Women can also experience

chest pain, but they are more

likely to experience symptoms that

are generalized and vague, like

indigeson, nausea, and fague. One

of the rst studies to recognize this

looked at 515 women, 43 percent

of whom felt no chest pain, and

the ones who did described it not

as severe pain, but as ghtness,

pressure, or an aching feeling upon

having a heart aack.

They also cited other symptoms,

including shortness of breath,

sweang, and pain in one or both

arms, although this study found

sweang more common in men.

The take-home message is this:

If you are female, at risk for heart

disease, and you are experiencing

symptoms, seek immediate medical

help, and make sure you are taken

seriously. Your life depends on it.

they tend to overlook the impact o stress.But, over and over, Ive seen stress trigger heart attacks in my patients.

Stress can contribute to atherosclerosis. The cascade o hormones yourbody releases when you are under stress can also trigger a deadly heartbeatirregularity.

So I always take stress seriously, and, in my newsletter, I will share some othe ways to reduce it.

Additional Risk FactorsReversing the our major risk actors Ive just outlined are key to your

protecting your heart and winning a victory over heart disease. But there areother important risk actors you can take control o as well. These include:

Obesity: Being overweight triples your risk o a heart attack. Obesity alsois a major actor in the cause o high blood pressure, diabetes, and highcholesterol. When these three actors occur together, it creates a conditionknown as metabolic syndrome. This greatly accelerates heart attack risk. Inact, having metabolic syndrome is almost a guarantee that you will suffer aheart attack.

Inactivity: Americans like to say they exercise, but a recent study usingpedometers to measure the amount o exercise that people actually did,ound that most exercise less than they say they do. A lack o exercise not onlycontributes to the development o high blood pressure, diabetes, and highcholesterol, but it is also a heart attack risk actor in itsel.

Smoking: We think o smoking in terms o lung cancer or lung damage, butsmoking also causes major damage to your heart. In act, it is a leading causeo heart attacks. Every time you inhale cigarette smoke, you draw into your

lungs a mixture o 4,000 chemical substances, many o which are poisonous.The only reason I dont list smoking as one o the Four Major Risk Factors

Being overweight triples

your risk of a heart aack.

Obesity is also a major riskfactor in the cause of high

blood pressure, diabetes,

and high cholesterol.

When these three factors

occur together, it creates

a condion known as

metabolic syndrome.

43%F N C P


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or heart disease is because o the recent decline in the rates o smoking. ButI do know that many people still smoke. In act, I see many o them in myemergency room!

My Near Heart Attack ExperienceTen years ago, I had just returned to Palm Beach, Fla., rom a speaking trip

in New York City. I had a pain in my shoulder, but I assumed I had strained it

carrying my luggage earlier that day.The pain didnt go away, though. In act, it continued to build. By the next

day, it had spread to my chest. I went or a walk with my wie, but I couldbarely make it home. Gasping, I told her I had to go to the hospital.

I was rushed to the cardiac emergency lab, where one o my ellowcardiologists perormed an angioplasty procedure on me, to widen my lefcoronary artery, to restore the blood flow to my heart, and save me rom whatwould have been a massive heart attack.

That experience taught me a great deal about heart disease. I learnedfirsthand that a heart attack doesnt necessarily eel like what people think it

does. It can begin like mine did, with a pain in my shoulder that elt exactlylike a pulled muscle.Yes, sometimes chest pain can be the great masquerader, so its important

to know all about your heart, and by subscribing to my newsletter, youvetaken the very first step!

Youve Taken the First StepIn the coming months, Ill provide you with all o the inormation you

need to take control o the health o your heart. Ill share with you my secretson how to prevent, manage, and even reverse the major causes o heart attacks

Ill share with you the joys and benefits o eating a plant-based diet, and

how you can get started on an activity plan that will lead you to a happier,more satisfied lie.

Ill also offer you tips on how to reduce stress and share with you moreo my personal story, including how prayer and belonging to a religiouscommunity gives me balance.

Also, through my newsletter, Ill show you a bit o the volunteer work thatenriches me, like the regular medical missions I lead to stamp out cholera inhurricane-ravaged Haiti.

Afer all, the secret to living a contented lie is more than just keepingtrack o blood pressure or cholesterol numbers. Rather, regaining andmaintaining your good heart health is the first step to living a vibrant, ull lieWelcome aboard. o

The secret to living a

contented life is more

than just keeping trackof blood pressure or

cholesterol numbers.

Rather, regaining and

maintaining your good

heart health is the rst

step to living a vibrant,

full life.

P :All informaon presented in D. C H H R is for informaonal purposes only. It is not specic medical advice

for any individual. All answers to reader quesons are provided for informaonal purposes only. All informaon presented in D. C H

H Rshould not be construed as medical consultaon or instrucon. You should take no acon solely on the basis of this publicaons

contents. Readers are advised to consult a health professional about any issue regarding their health and well-being. While the informaon found

in D. C H H R is believed to be sensible and accurate based on the authors best judgment, readers who fail to seek counse

from appropriate health professionals assume risk of any potenal ill eects. The opinions expressed in D. C H H Rdo no

necessarily reect those of Newsmax Media.

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