The Big One!


Remember the TV show Sanford & Son when Fred was trying to gain sympathy from Lamont or avoid some consequence of his tom foolery by clutching his chest and saying, “It’s the big one, I’m coming to join you Elizabeth”? In my practice as a cardiac RN I find many people have misconceptions of what “having a heart attack” means. Often, people are surprised that, physically, it was such a minor event, they had no classic symptoms, or they didn’t realize that their weeks of stomachache, shoulder pain, and fatigue was leading up to a cardiac event. What is really going on with, what we call, a heart attack?


Your heart is the center of your physical and emotional being – all the poets say so. Well, scientists also agree. It is the very first discernible structure that appears after conception—it contains all the functioning and very essence of YOU!! It faithfully pumps oxygen rich, life-giving blood throughout your body. If your heart becomes damaged or fails, the consequences can be devastating. So, understanding how it works can help you protect it and enjoy a long, happy, life.


A simple pump made of muscle, the heart delivers oxygenated blood to every cell in your body. A certain type of blood cell called hemoglobin, carries the oxygen and drops it off where it is needed (which is everywhere). When all the oxygen is used up, the blood returns to the right side of the heart which pumps it over to the lungs to be loaded up with more oxygen. The newly oxygenated blood goes back to the left side of the heart which pumps it back out to the cells again. The heart muscle is very strong and resilient, but it also needs oxygen to stay alive.


The coronary arteries bring this oxygen to the heart muscle (called myocardium). If the coronary arteries become blocked or narrowed with plaque or blood clots, reducing the oxygen supply, the heart muscle begins to die causing, what we call, a heart attack (myocardial infarction or MI). The pain or ill feeling we may experience is because the heart muscle is trying to function without oxygen. Your body’s cells have two methods of metabolizing (doing their work)-either by aerobic (with oxygen-the preferred way) or anaerobic (without oxygen-very inefficient). The byproduct of anaerobic metabolism is lactic acid which causes the pain commonly associated with heart attacks. Anaerobic metabolism is like using watered down gasoline in your car – it will work for a while but with some very undesirable consequences to the engine.


If the heart muscle is without oxygen for long enough, the pump will suffer irreparable damage and stop. This is why it is so important to get help quickly if you suspect you may be having a heart attack (call 911). Denial is common when people are in early stages of myocardial infarction. So, the longer the heart is without oxygen, the more damage will be done. If there’s any question you may be having a heart attack, alert EMS immediately. Better to be safe than sorry. Do not drive or be driven to the hospital!! No matter how fast you think you can get there, only EMS has the lifesaving equipment you may need if you are having a heart attack.


If you begin to notice little changes in your physical abilities such as fatigue, shortness of breath, vague sensations or pain in your upper body (chest, shoulders, jaw) call your doctor. Cardiac causes of such symptoms can usually be confirmed or ruled out by simple, non-invasive, medical tests.


Fred Sanford may have been a fool but at least he knew the signs of heart attack and knew enough to tell someone that he was experiencing them. Remember, your signs may not be as dramatic. They may simply be difficulty doing things that were easy for you before, a nagging pain in your neck, back, or shoulder, indigestion or constant heart burn. If you have some of these, especially if you have risk factors for heart disease, let your doctor know. These could be signs that your heart is beginning to have difficulty getting oxygen to every area of the heart muscle. Preventing that heart attack could be the smartest thing you’ll ever do.

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