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Oregon Road Conditions & Cams Email Story to a Friend April 3, 2006 Heart problems unpredictable I appreciate the great cardiac care center we have at Rogue Valley Medical Center. That said, we still know that heart disease is our No. 1 killer. Why is it that most of us have to wait for that ambulance ride to the ER to find out what’s wrong, and to get something done about a heart condition? — Judy A., Ashland Physicians can do amazing things these days, but some conditions still appear without warning, says Dr. Rick Schaefer, a Medford cardiologist with 35 years’ experience. "There are always going to be things that you simply can’t predict," Schaefer says. Advertisement One of those "out of the blue" conditions is what cardiologists call "heart block." This happens when the nerve impulses that cause the heart to beat in a regular rhythm are blocked from reaching the ventricles, the main pumping chambers. Heart block is different from a heart attack. In a heart attack, the heart muscle itself is deprived of blood by one or more blocked arteries. In a case of heart block, the heart muscle slows because the signal to "beat" doesn’t arrive. "Unfortunately," Schaefer says, "there’s no reliable way at this time to predict when that’s going to happen." Severe heart block can be life threatening, and may be accompanied by severe shortness of breath, fainting or dizziness. The good news is that most people survive an episode of heart block. Heart block can be treated effectively by installing a cardiac pacemaker to keep the heart ticking at its normal rate. In theory doctors could eliminate heart block by giving everyone a pacemaker, but the cost would be prohibitive and the vast majority of people would never need it. Other heart problems are easier to diagnose and treat. Physicians and their patients often have to decide the most effective diagnostic test or treatment based on cost and likelihood the test or treatment will be effective. "Consider a middle-aged man who suspects he might have blocked coronary arteries," Schaefer says. "He may ask his physician to order a stress test, but a standard treadmill test can produce as many as 25 percent false positives and 25 percent false negatives." The stress test looks for coronary artery disease that limits the flow of blood, but "there has to be enough narrowing of the blood flow channel to restrict flow so you can see it on the test," Schaefer says. "Half of all heart attacks are caused by the sudden development of a clot or a narrowing that’s less than 50 percent. That amount of narrowing wouldn’t show up on a stress test until the attack begins. "It takes at least a 60 to 70 percent narrowing to limit flow and show up on a stress test," he says. "Doing stress tests on everybody wouldn’t predict what’s going to happen in a significant number of people." Schaefer says people who have a heart attack often have some warning beforehand, but choose to ignore it. Symptoms are often described as a "heavy squeezing weight" in the chest, or pain under the breast bone or the left side of the chest that radiates down the left arm to the little finger during exercise. Elderly people and women are more likely to describe their symptoms as shortness of breath or feeling sick or breaking out in a sweat for no reason. Schaefer says people who want to reduce their risk of heart problems should avoid smoking, eat a "Mediterranean" diet that emphasizes vegetables and low-fat foods, get regular exercise and control their blood pressure. Medications can help reduce risk dramatically. "People who do everything right," he says, "have about one-tenth the risk (of suffering a heart attack) of the people who do everything wrong." Physicians have a tool called the Framingham risk score that predicts the likelihood of having a heart attack on the basis of age, cholesterol level, blood pressure and other factors. (It’s easy to evaluate yourself. Just type "Framingham calculator" into any Internet search engine and go to any of the sites.) If you’re stricken by a heart attack, don’t despair. Southern Oregon has one of the most successful approaches to treating heart attack in the United States. Ambulances carry sophisticated equipment that can diagnose a heart attack and begin treatment. Patients are rushed directly to the hospital where cardiologists can treat them quickly. If you have a heart attack in Southern Oregon, your chance of dying is about 3 percent. In other parts of the country, the fatality rate ranges from 7.5 to 15 percent. That means 97 percent of the people in Southern Oregon who have a heart attack will survive. E-mail questions for the doctors to Heart problems unpredictable ">[email protected] or send them to Mail Tribune Ask the Doctors, P.O. Box 1108, Medford, OR 97501. 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