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My Life After a Heart Attack at 38 (nytimes.com)
108 points by onuralp 61 days ago | hide | past | web | favorite | 100 comments

Before kids nothing scared me. Not because I felt invincible but because I felt like uncalled code. If I were culled, there'd be sad family but everyone would move on. Nobody depended on me.

But now I have kids and they need me in a way I've never felt from anyone before. It's F@#$_ing terrifying because of just how vulnerable I realise I am.

Get 10 or 20 year term life insurance. Someone else has said this already but it can't be repeated enough.

Get enough to pay your spouses expenses until they are able to get income, pay off your mortgage if applicable, and if you can afford it get enough to cover future college expenses.

Age, health, term-duration depending it will cost you a something on the order of $100-1000 per year. It will cover you to that amount until your term expires, and then it's gone. It's a pure cost - unlike whole life, which seemed to me to be more of a tax reducing strategy for very wealthy people - but you will sleep much, much better.

"because I felt like uncalled code".

This is why HN is home.

I'm a father of 7- and 5-year-olds, and I constantly think of this.

I have some anxiety issues and frequently have mild panic attacks, which can have symptoms similar to heart attacks. I have vasovagal responses triggered by odd and benign things. I also have bad muscle tension in my neck and upper back, which can extend around into my chest. And to top it all off, because I have children, I am often sleep deprived and drink too much caffeine. Heart-related issues are on my mind so frequently that I've almost convinced myself that I'm going to die of a heart attack one day, despite me being in good health.

I spend a lot of time worrying, so if I could share my advice with others: if you are worried, just see a doctor. It's not worth being wrong. One day I had symptoms of a heart attack for hours and went to an urgent care facility and got an EKG and x-ray of my heart. They found nothing, and attributed it to musculoskeletal pain. Considering I've been worrying about my heart for many years prior, those tests gave me a strong sense of relief and allowed me to focus on learning how to control my anxiety without getting into a feedback loop (anxiety -> heart attack symptoms -> more anxiety from worry). I can now calm myself down pretty quickly.

This may seem obvious, but getting extra sleep and cutting out caffeine helps immensely with all of the above symptoms. Easier said than done as a parent whose kids don't even sleep through the night. :)

I have been experiencing these same symptoms. I started seeing a therapist again, which is starting to help me control and understand the trigger sources for my anxiety. Thank you for sharing such a personal thing, it helps me know I'm not alone in letting my brain trick me.

Guessing you’re all life-insured and critical illness insured? If not, make it happen. Money certainly isn’t everything but it’s a great deal.

Term life insurance helped me deal with this fear. Take care of yourself and know that there is no guarantee on tomorrow.

yes - it's relatively cheap when you're youngish (i.e. kids < 20) which is when your family would need it the most. Treat the premiums as a sunk cost (you know, actual insurance) instead of some sort of investment or convertible policy.

Same here. Took me totally by surprise. I was much more ready for death at 26 than I am at 56, because kids. It hits me pretty much every day.

care to explain? at 56 your children should be already adults, so while it would be sad they could move on

> at 56 your children should be already adults

People are having children at older ages these days.

> The practitioner there did an electrocardiogram and said the left side of my heart was slightly enlarged, but my discomfort was probably just gas. Don’t worry, I was told: “Your heart’s not just going to stop. You’re not going to drop dead tomorrow.” But that’s what almost happened.

This is worrying. The habits of doctors can kill. They're not cautious enough. My grand mother was misdiagnosed (not coronary but cardiovascular). My aunt was misdiagnosed and sent home. I had clear cardiovascular issues but got laughed at by half the people I talked to.

Non invasive diagnosis is one the few places where I do want tech to get one or two more decimals of precision.

Too much caution makes doctor advice useless. If they tell you to go waste time and money at the hospital every time there's a 1% chance of an issue, you won't actually go when it matters. That's one reason I try to ask doctors to estimate % risk.

On this note: WebMD is not a doctor but has the same issue. There's no differentiating between a real emergency issue and a CYA liability one.

That's why I'm asking for more non invasive diagnostics and not experience based "you're fine [and it would cost too much to check further]". I won't die because or someone's habits.

That's not a resolution to the disagreement, though; that's just one side of it. The disagreement is about how to balance the cost of false negatives against the cost of additional testing.

As an aside, an EKG is not remotely the most important part of diagnosis for myocardial infarction; that's the job of the person taking the history. (Myocardial infarction cannot be diagnosed purely from ECG.)

Cost is fallacious. Medical world is stuck in pre advanced electronics era where any device would cost a ton and they rely on companies to make new devices but it's a lucrative market with twisted incentives.

We need a musk like character to shake the medical diagnosis status quo.

ps: I don't want to spend my life obsessing about monitoring my vitals but I'd still prefer to have the option rather than relying on blind faith.

"Cost" is not purely monetary. The cost of additional testing includes patient's time spent traveling too and from additional appointments, additional patient stress waiting for results, additional infections or other side effects from the tests themselves. There are very few things that have zero risk. If you run something on a large enough population someone will have an adverse reaction.

The cost benefit trade off for additional testing isn't just about dollars spent performing the tests. Its about how many thousands of hours of people's lives will be spent in pointless worry and how many additional people will be made sick or killed by testing Vs the additional people that could be saved by additional testing.

>> We need a musk like character to shake the medical diagnosis status quo.

You first to trust your life and your loved ones to the SpaceX or Tesla of the medical world.

But - disruption! Fake it till you make it!

Tesla used to be very safety focused. Not that much since autopilot. SpaceX is still extremely impressive in terms of progress/accident ratio.

By cost, I don't mean money.

Do doctors have any training that would equip them to give a remotely accurate risk probability estimate?

In my experience doctors are terrible at this, although it's supposed to be basically their entire job. I really think they should get more training in it, or some type of Bayes-esque tool to make what they're thinking explicit.

> really think they should get more training in it, or some type of Bayes-esque tool

They have those online. If you're in your 30s and have a reasonably healthy lifestyle and don't smoke, then your risk of dying from a cardiac event over a ten year period is likely somewhere between 0.25% and 0.5%, depending on how much you exercise and genetic factors.

If anything, Bayesian logic is what leads doctors to ignore signs of heart attacks in young people in the first place.

But the reality is the patients don't understand the numbers, and in the OPs case a % risk doesn't mean much if it happens to you.

My wife's current psychiatrist is awesome at this - he quotes the scientific literature for relative risk levels when talking about medicine changes or interactions.

Historically, doctors were some of the most educated people in town and you and your entire family saw the same doctor for many years. They had a lot of context for what was going on in your life.

Now, people move around more, are less likely to see the same physician for years on end, are less likely to see the same physician as their relatives who may live elsewhere, etc.

I don't know how to fix it, but I think these changes are a very big part of the problem. I don't care how brilliant and dedicated you are, having less overall context is going to undermine your ability to draw accurate conclusions about what's really going on.

also, doctors in recent decades have been horrendously overworked, particularly with regard to pressure to see many more patients daily than was the norm a generation ago. Less time with patients = less chance for listening to background and contextual information that may be useful in evaluation.

That's true, social dynamics changed dramatically. More stress, less stable human relationships, more pollution, less activity .. what was working fine before probably need a revamp. Either that or we go back to slower and more local lifestyles (not bad in my book)

Perhaps so, but do we have any evidence that the frequency of diagnostic errors has increased?

No clue and it's entirely possible diagnostics have improved in some ways, in part due to improvements in testing and in part due to patients being better educated.

But I'm old-ish and I remember when it was pretty normal for Mom to show up with all three kids and a couple of their cousins and get them all treated at the same time. In contrast, in recent years, I routinely hear that people in the family pass the same crud around repeatedly because they get treated as individuals and it leads to recurrent or chronic issues. I've also dealt enough with chronic health stuff that I'm quite confident that when doctors decide "This is your normal. Just get used to it." it becomes self-fulfilling prophecy.

From what I gather, obesity and chronic health issues are vastly more common than they used to be. To my mind, that's probably evidence that something has gone very wrong with our health mental models/practices overall and the change in how we interact with physicians is probably just one grain of sand in a beach of changes. (However, it will also be confounded by medical advances leading to people malingering when, historically, they would have simply died. We often can't cure them, but we can keep them alive longer than we used to.)

But I'm sure that's a case of "Other people won't necessarily see what I see and if they don't, there will be no winning them over." (shrug)

"From what I gather, obesity and chronic health issues are vastly more common than they used to be."

Obesity, perhaps, but chronic health issues? Not really - and a tremendous number of those went untreated. A huge number of people in the past lived with perpetual pain and disabilities.

Historically, we didn't have the resources to "carry" a lot of disabled people. You had to pull your own weight in some way.

Because I'm disabled and the internet is a thing, I'm very aware of the existence of people on disability, on multiple meds and not doing much with their lives. Historically, we simply didn't have the resources to support such people.

I'm thinking of those folks -- not simply people living with pain and limitations, but people who historically would have simply died because if it was going to kill you to keep on keeping on, then you were going to die because disability payments, etc, simply did not exist like they do today.

Disclaimer: I'm a doctor

You say this because you are unaware of the risks of overscreening, overtesting and overdiagnosis. Pre-test probability is important to take into consideration. Getting patients worked up over a 0.00001% chance event causes undue stress.

Please elaborate. I understand that some test procedures (coronarography etc) are too heavy to be used randomly. What else ?

It's different for each test and intervention, and different again depending on why you're doing them. Balancing risk vs benefit is a major job of the doctor.

One example: the humble chest X-ray. You may think the main risk is radiation, but IMO you'd be wrong to think that. The main risk is finding something. We call them incidentalomas. You would never have found it if you didn't do the CXR. It would never have caused you worry or morbidity. But now we know it's there, you need to get a lung biopsy. And that leads to a pneumothorax. That leads to a longer stay in hospital. That leads to time off work. You end up with no benefit to a patient who now has less trust in the medical system because they got a pneumothorax for nothing.

I am not a doctor, just someone who reads too many medical stories, but the thing that convinced me was an explanation by Henry Marsh, one of the UK's leading brain surgeons.

A brain aneurysm poses a certain level of risk based on its size and location. So let's say you have an asymptomatic aneurysm with an annual mortality risk of 0.5%.

Now let's say you decide to randomly have a full body MRI and the aneurysm is discovered. A neurosurgeon tells you that you can have an operation to clip or coil the aneurysm with a 10% risk of fatality due to its location. Do you have the op?

Apparently most people do, despite the overall odds of immediate death. A 0.5% annual risk of death would ride most people out to their age of natural death rather than the 10% risk of the op, but people hate having even a tiny risk hanging over their head long term.

As such, there's a school of thought that you shouldn't have such types of screening (or at least to not know the results if they are minor) unless you are symptomatic.

tonnes of cancer screening; many biopsies.

It hurts to quantify it this way, but the pot to fund health care is not bottomless in either a pure public or privately insured system. It needs to be spread across the entire population, and across all of the potential issues an individual may face.

Or worse, intervening that itself has non-zero risks...

Do you have any medical training? There are at least two HN users commenting on this thread who do; one of them is a cardiology fellow(!). What they're saying seems to be getting drowned out by a lot of HN-style axiomatic reasoning.

Have you read much about overtreatment in cardiology? There's currently a minor scandal in the US about unnecessary cardiac procedures being performed. [cardiology overtreatment] is a good Google search term for this.

It's easy, on a message board, to say "I want the extra attention, damn the cost". That's especially true when you just read an article about a "widowmaker heart attack", so that the upside of excess attention is the only thing about the issue that's cognitively available to you. But these procedures can do harm as well as good.

You talk specifically about over treatment but what the previous comment seems to refer is about misdiagnosis. Diagnosis where because it's very unlikely, doctor simply prefer to ignore this possibility.

My SO nearly died because she was "too young" to have a thrombophlebitis, yet every signs pointed to that, yet they could have simply tested for it. She not only is incredibly lucky that a better doctor was not too far and heard her complains, she was incredibly lucky that even though it took so long for her to be treated correctly, that she still have her legs.

Maybe over treatment is an issue, maybe cardiology is an inexact science right now and it's impossible to get a good diagnosis. It doesn't change the fact that misdiagnosis is bad and we should do everything we can to improve this, in every side of the coins, including mentioning when doctor just prefer to ignore conditions, because it's unlikely.

You keep referring to "misdiagnosis" when I think you mean to say "underdiagnosis".

You have no idea about what it is to be a doctor and you are just reacting to one sided story

You have no idea about what it is to be a doctor and you are just reacting to one sided story.

On the other hand it’s ressonable as a patient not to care what it’s like being a doctor, your job as the patient is to be honest, give complete answers, and advocate for yourself. I’m not interested in a public policy perspective as dictated by the realities of insurance company profit, hospital profit, pharmaceutical company and medical device company profit, and so on.

It’s the same thing with letting an intern take their turn with the scalpal. If it’s someone I care about under the knife, I’m making sure the surgeon got enough sleep and no intern or first year resident who’s half asleep touches the person I care about. Arguments that “they have to learn somehow” are reasonable, but so is my reaction that it’s your problem, not mine. I don’t care about how you’re educated, or your burdens except as they impact results.

Life is unfair, utilitarian calculations must be made, but that sets up an adversarial relationship on one level, and only a fool ignores that. You feel free to fight for public policy, I’m fighting for the people I care about, not their doctors. That’s also part of life being unfair.

The problem with this is when what you think you're fighting for and what you're actually fighting for don't align.

I've encountered patient advocacy groups who are actively, and passionately, pushing for the wrong thing, that while emotively satisfying, will not help the problem they're trying to solve.

Sure, it’s hard to get right, and patient advocacy groups in particular can be wildly off target. By advocacy I mean one-on-one, for someone you actually have a connection to, and limited to issues you can reasonably understand. For some people that will be issues of comfort and other basics, for some it might have a more clinical element. Advocacy can be as simple as checking on an elderly relative to make sure they’re being cared for properly, checking a doctor’s background, or even getting another opinion from another doctor. In extremes it can mean diagnosis on your own, which you then verify with a doctor.

In that last vein, I’ve been in that position. A girlfriend from years ago had a nasty rash on her arm, and a series of dermatologists gave her a series of exams and creams. I did some research and concluded that it was probably an allergic reaction. I talked to her latest dermatologist who agreed it could be that, and I suggested taking s daily allergy pill. It worked.

Sometimes having the time and inclination to do research is more than a busy doctor brings to the table. If you’re skeptical, and understand that cherrypicking symptoms from a list and screaming “oh god it’s a tumor,” is unhelpful, then research is useful.

Partly true, I just saw too many errors. I don't blame people much. They're already doing a lot. That said I want a tad more, forgive me for that.

> Your heart’s not just going to stop.

A heart attack is not actually your heart stopping. It’s caused by a lack of oxygen to the heart tissue, causing pain and damage. It is often not immediately fatal.

It can lead, sooner or later, to cardiac arrest, which is when your heart stops completely, and often is fatal.

I started running aggressively last year and developed bracycardia for the first time. The change to my physiology was pronounced. I was faster and stronger than ever before (even compared to high school performance as I was almost breaking a 12 minute two mile) and my resting pulse rate was in the 40s. I was almost 39 then.

I learned some things from that were never clear before. It’s more about the journey than the goal. I was running on a treadmill and started after recovering from surgery. I started at an 8 minute mile pace and could barely run a mile. My goal was to increase the distance instead of speed and gradually worked up to a 10k (50 mins) 5 days a week. Then I was able to work on speed and resistance here and there. I have asthma and remember running through an attack on one occasion to make my distance goal and break from a performance plateau.

At the time I was eating a lot of fatty, greasy, meaty foods. The foods were heavy and high in cholesterol. I had tried the ketosis diet the summer before and lost 25 pounds, but I was not intentionally practicing any diet at this time I was running.

You don’t achieve performance over night. It’s similar to programming in that it takes practice solving hard problems and listening deeply to your environment. With enough practice and persistence you make goal and are changed as a result.

They are guessing based on memory and emotion. The industry is primitive. There may be relevant research published that could help your specific case but they will never see it. When they leave the room they aren't going back to the office to start Googling and thinking about what additional data to collect to diagnose and solve the problem. They are going to see the next patient and will not think about you again. If your problem isn't obvious or catastrophic, you are SOL.

Being SOL is nothing, what's worse is the slight authority play going on. Letting people going back home thinking there's nothing serious or nothing that can be done is criminal IMO. State it clearly: to my best knowledge I can't see anything, keep looking if you feel the issue is still there, here are some other names or places.

Sometimes there is something serious that needs further investigation. But others times it's nothing and following your advice would be feeding hypochondria. Additional testing and diagnosis is expensive, and often carries risks of its own. It's hard to know where to draw the line.

You see, I do wonder about my tendency to bias due to anxiety, hypocondria etc etc

But this is part of my tone in my above messages. I've seen doctors lie. I did have swollen ankles and hands. When mentioned to them, they'd say "yes that's a cardiovascular issue" just to switch stance the minute after.

They, too, have biases.

I had one at 40, just six months ago, and waited over 12 hours to go to the doctor for the same reason as the author (didn’t want to mess with the things my wife and kids had to do that day). I even drove my daughter to school while having the attack, which is both scary and stupid when you really think about it. Of course, denial had a lot to do too. Even though I woke up at 4 from the pain, I spent all day thinking it must have been something else. The only point of my comment is that if this ever happens to you, don’t delay going to the doctor. I guess my behavior that day is an example of normalcy bias? I don’t know...

A good rule of thumb, and something I learned while at medical school is that if something wakes you or interferes with your sleep; especially a headache, but would be applicable for anything else such as a cough, or pain somewhere in general; it would be in your best interest to go see a doctor about it.

I had similar experience. Had a quintuple bypass at 36. Lots of emotions and reevaluations of things. Will I see my kids grow up - things like that. I had to relearn walking.

But it also served as a good kick in the behind in terms of taking charge of my life. It motivated me to stop eating like a pig. To get rid of toxic people that were causing me stress. To start exercising and leading a healthy life. In a weird way, the bypass was a blessing in disguise.

reminded me of this: https://sivers.org/horses

>Of the 198 patients with CVD, 177 (89%) were adherent. Major cardiac events judged to be recurrent disease totaled one stroke in the adherent cardiovascular participants—a recurrent event rate of .6%, significantly less than reported by other studies of plant-based nutrition therapy. Thirteen of 21 (62%) nonadherent participants experienced adverse events.

So... heart disease can be attributed almost entirely to eating meat? That result seems too good to be true.

This is nearly pseudoscience..

Indians have one of the highest rates of heart attacks even though a significant population is purely vegetarian.

I think science has to be focused on biology and science, not social surveys and asking questions to a small bunch of uncontrolled strangers.

> Indians have one of the highest rates of heart attacks even though a significant population is purely vegetarian.

Ghee could be part of the cause of that, but I have no idea what to think of saturated fat any more.

You're right about Ghee. It is off the charts high in oxidized cholesterol. It's like butter on crack.

It wasn't a survey. Imagine calling something pseudo science without even reading the abstract.

I did read the abstract.

Most such research simply monitor the participants' diets through a questionnaire or some indirect mechanism. It's not a scientific, reproducible approach.

I am making a meta-point that such research has started to affect more and more of what we think of as science which is extremely disturbing.

The harder scientific work would be to analyze the effect of specific foods with how the heart works over a much longer epriod of time. Granted that there isn't a way to track or pursue this line of inquiry yet, but taking shortcuts isn't science IMO.

What are the likely dietary habits of people that have time for academic surveys

Just college kids and mechanical turk penny vacuums

So probably a little predictable

Or not...


This report reviews the outcomes of 198 consecutive nonsmoking patients with multiple comorbidities of hyperlipidemia (n=161), hypertension (n=60), and diabetes (n=23) who voluntarily asked for counseling in plantbased nutrition for disease treatment. These self-selected participants requested consultation after learning about the program through the Internet, the media, prior scientific publications, the senior author’s book (CBE Jr), other authors’ supportive comments, or word of mouth.2,13 A preliminary 25- to 30-minute telephone conversation established disease presentation and severity by eliciting reports of symptoms, history of MI, stress test and angiogram results, interventions undertaken, family history, lipid profile, and the presence of comorbid chronic conditions. In these calls, we outlined the program, established rapport, and documented the need for additional patient information. The Cleveland Clinic Institutional Review Board determined that these were acceptable outcome measurements to evaluate the nutrition program."

"Baseline characteristics of participants are shown in Table 1. (Two patients from the original group of 200 were lost to follow-up.) The remaining 198 participants for whom data were available had CVD, were mostly men (91%), averaged 62.9 years of age, and were followed for an average of 44.2 months (3.7 years). "

> mechanical turk penny vacuums

Wait, what's that?

Mechanical Turk is an (Amazon) crowd-sourcing site where one can post small jobs (such as surveys) to be completed for a small amount of money (often only $0.05-0.10). I assume "penny vaccums" here is a metaphor for people who complete a large number of tasks for the money.


OK, thank you.

So... heart disease can be attributed almost entirely to eating meat? That result seems too good to be true.

If it's the study I've seen, the improvement can be largely attributed to a tremendous drop in both calories and fat. Instead of their idea of a balanced diet being a bacon double cheeseburger in each hand with a gallon of ice cream for desert, it became rice and legumes and veggies. They shot for keeping fats to no more than 10 percent. They invited participants to dinners so they could experience good tasting, healthy gourmet meals and not feel like this was about deprivation.

Participants dropped tons of weight without trying and without having to try to control themselves. They could eat all they wanted every day and not get enough calories to remain clinically obese.

There is no correlation between fats and CVD. That's a very old belief (70s) that is debunked. Read this please: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793267/

Downvoters: Please just read the paper.

From your link:

SFA is now believed to play a much smaller role in CHD than was previously believed while that of sugar, whole grains, and cereal fiber have moved in the opposite direction.

Which is not the same thing as no correlation.

I'm sure it's vastly more complicated than just fat content, but the stuff I've seen indicated that one study of a vegetarian diet as post cardiac therapy explicitly set a goal of keeping fat content down to 10%. Prior to being put on a vegetarian diet, the typical diet of participants was much, much fattier. Participants were just blown away at being able to eat all they wanted for the first time in their lives and lose weight without even trying.

My personal experience: I dropped several dress sizes without intending to by completely ignoring both calories and fat percentage and focusing on consuming nutritionally dense foods to redress known nutrient deficiencies.

So I have absolutely no doubt that it's vastly more complicated. But I tend to get a lot of flak for talking about what I think about diet, the gut biome, medical stuff, etc. So I really wasn't looking to get into that.

I was only looking to add a little more information about such studies. The main takeaway as I understand it: they stopped being obese. There are people who eat meat who are not obese.

> Participants were just blown away at being able to eat all they wanted for the first time in their lives and lose weight without even trying.

Anecdotal, but this is me at the moment on keto. For the first time in my life (I have been obese since 5) I am not ravenously hungry all the time, to the point where I can just eat one meal a day without much struggle. I eat as much as I want now, the only difference is I don't want much at all. Oh, and I can't eat many carbs.

I can relate. As my nutritional status improved, I gradually ate less and less. I just stopped being hungry all the time.

How do we explain the vegans and the vegetarians who still get plenty of heart disease? If veganism were a silver bullet, I'd be the first one to jump on that bandwagon, today.

Because studies like this are sheer bullshit. There is no one "plant-based diet". Eating fat heavy (avacado, nuts, seeds, coconut, acai berry, olives etc...) and carb heavy (rice, fruits) diets and whether you eat few protein rich plant sourced (basically only beans) will have very different macronutrient, micronutrient profile and will have very different effect on human body. Same goes for animal-based diets. Moreover, people who were able to adhere to this study might have just been more disciplined and healthier. This study does not control other important risk factors such as alcohol, regular exercise etc. I find it very hard to believe we can really derive any useful information from "we forced people to eat plants".

As a meat-eater I think the most stupid strawmen vegans hit me with is the belief that I only eat meat. I think very few people advocate "only eating meat" (e.g. recent 0carb hype, which I think is clearly pseudoscience). You can still eat plants but supplement your diet with meat to get more protein and healthy fats. You can still get 75% of your calories from plants but still eat meat. Also, there will be a huge difference between highly processed meat (bacon, salami etc) and unprocessed, grass-fed meat. Studies like this simply ignore all these factors.

It means that there are other factors besides diet. Here's a relevant study https://www.ncbi.nlm.nih.gov/pubmed/707372

Because the health factors that cause heart attacks aren't exclusively attributable to diet.

Very few vegans eat whole foods, which is what was used in the study.

Or people who weren't disciplined enough to stick/adhere to the veggie diet, likely also had other parts of their life with less than healthy discipline.

The compliance rate was 89%, which is higher than that of statin drug therapy. If discipline was a factor, it was a very small one.

Well thats convinced me to switch my lunch plans for today.

No. That kind of heart disease can be cleared by not eating meat.

many heart diseases have nothing to do with blood chemistry.

source: i have valves turning to shit and never had a problem with blockages or high cholesterol.

Any advice from doctors here on what to do if you believe you're experiencing a heart attack?

Call 911. When they send an ambulance, take the ambulance.

Heart attack is tough, especially the first time someone has one:

- The pain is usually dull and can even be subtle

- The pain usually is better with rest and worse with exertion, so you can convince yourself that it was some minor thing that is passing

- The pain is usually not so bad that you'd think you'd have a problem driving, taking the subway, etc.

But, heart attack doesn't kill you via pain. It kills you via arrhythmia, which happens because that ischemic heart tissue is electrically active.

If you have a cardiac arrest from your heart attack and you're in an ambulance, they're going to defibrillate you. If you have a cardiac arrest from your heart attack and you're driving yourself to the hospital, you're going to crash your car and it's unlikely that anyone will figure out what happened in time to defibrillate you.

Now, people who have established angina with known coronary anatomy will get more specific advice from their doctors. But in general, if someone without known disease develops symptoms that sound like a heart attack, they need to be evaluated.

Call 911 and chew (chewing it up is important) 4 tablets of 81mg baby aspirin. If you don't have baby aspirin then chew up a regular 325mg adult aspirin.

Typical chest pain is on the left side but atypical chest pain often experienced by diabetics or women can be abdominal pain, right sided chest, vague discomfort, or can be completely silent/missed. Sadly not everything behaves exactly the same.

If you're very worried, you're having symptoms, and the EKG comes back reassuring, just ask for a set of cardiac enzymes. However, ED doctors often don't want to get enzymes because it means they have to do it 3x in a row spaced 6-8 hours from each other - so it might get you an observation unit stay.

Anyways, I'm not an ED doctor but I worked in one for a month during residency and I can assure you - there are plenty of providers who are not great at interpreting EKGs. There is pretty high variability in EKG interpretation skill between them. So if someone with weak EKG sensitivity uses that test to screen you out, then that's pretty poor care.

I've heard a 911 dispatcher say take aspirin if you can

And when you do it is important to chew it, which helps increase the speed in which it works.

I feel like in technology we talk so much about metrics, observability, having lots of logs and application metrics for _all_ of your infrastructure.

Yet, we don't seem to have anything similar for the human body. How many lives can be saved every year by having a system that grabs some data from your body and has some thresholds for warnings? Something doctors could simply hook into (pull based) or something you could give to a doctor (push based). Some "critical warnings" could call an ambulance straight away.

Do we need more IoT embedded systems to hook to the cloud? Is it a problem with regulation? Physics / biology deterministic measurement?

There are multiple companies working on this.

I've noticed a lot of health anxiety in this thread. I'd like to recommend "Overcoming Health Anxiety" by Davis Veale and Rob Willson, for anyone who feels they worry excessively about their health.

Similar thread from 2014 (lots of comments)


Are there any evidence-based efforts to monitor, diagnose these at an age where it was previously thought to be too early to have an heart attack? (Calcium score? CT scan?)

Most other diseases that killed vast populations at this age have been resolved or worked around, so looks like we are looking at one of the last remaining killer dieases.. would love to strap on Apple Android whatever devices if it will help diagnose or monitor such patterns.

You can get a sense of the age range from this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487339/

MI (heart attack) can happen at almost any age, but it is rare for it to occur before ~60. "Early-onset" MI is < 50 for men or <60 for women.

38 is extremely young. I know only a couple of folks that young who have had an MI, and I work at a quaternary referral hospital as a cardiology fellow.

> 38 is extremely young.

My Dad, his brother, and his father all had heart attacks in their late 30's and early 40's. I'm in my early 40's and very concerned.

Should someone with a family history like mine be more aggressive with testing? My family doctor does not think so.

Are there even tests today (like the "CT angiogram") that could detect (and prevent) a person with extreme family history from a 1st heart attack?

If you have access to a preventive cardiology clinic, it'd be worth getting a second opinion.

We need to develop a type of x-ray machine that can instantly identify blocks in arteries https://www.nhs.uk/conditions/angina/treatment/

The important question is how can one regular cardio vascular health?

My uncle who named me passed at 39 of a heart attack. This resonates.

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