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The vast majority of people do not really
understand the difference between a HEART ATTACK and the entity known as HEART
FAILURE. The confusion is entirely understandable. It’s a bit complicated. So,
what exactly is the difference?
A heart attack happens when the blood
supply to the heart muscle itself is compromised. That blood supply comes from
the ‘coronary’ arteries and if one or more gets blocked sufficiently, the heart
muscle doesn’t get oxygen and portions of the muscle can die off if blood
supply is not restored in time (like within a few minutes). Thus, the term
‘having a coronary’ is the same as having a heart attack.
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| Coronary disease (credit: Mayo Foundation) |
When a muscle doesn’t get enough blood,
there is pain. Everyone knows about the pain of a heart attack: severe chest
pain, sometimes with radiation into the arms (left arm more than right) or
neck. ANGINA is the name for the same heart
muscle pain that happens before the muscle dies. This can go on for months
before an actual heart attack. When the muscle dies from lack of blood, it is
called an INFARCTION, or more specifically, a MYOCARDIAL INFARCTION. When that
happens, all you can do is try to heal and rehabilitate.
The causes of coronary heart disease are
well known: smoking, diabetes, elevated cholesterol and triglyceride levels,
other genetic factors and many less common causes.
HEART FAILURE is more about the strength of
the heart, not the blood supply. Heart failure happens when the heart muscle
becomes weak and cannot pump blood with enough force to keep everything humming
along. Instead of pain, heart failure causes symptoms of weakness and fatigue, swelling
of the legs, and swelling in the lungs which leads to difficulty breathing with
exertion or when lying down flat. The symptoms can worsen over months to years
until other vital organs are not getting enough blood. This leads ultimately to
organ failure and death.
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| Heart Failure (Credit: American Heart Association) |
What causes HEART FAILURE? The most common
cause is when enough of the heart muscle has died from one or more infarctions
during heart attacks that there isn’t enough strong heart muscle to pump
adequately. About 70% of heart failure in developed countries comes from prior
myocardial infarctions.
Other causes include high blood pressure, toxins
such as alcohol or cocaine, viral infections that affect the heart muscle
itself, and certain hormonal diseases. This is different from bacterial
infections that affect heart valves in a condition called endocarditis.
An important difference between heart
attacks and heart failure is that heart attacks can be reversed if treated soon
enough. If you are having symptoms of a heart attack, i.e. crushing chest pain
with radiation down one or both arms, the sooner you arrive at an Emergency
Department and receive anti-clotting drugs, the better your chances of not
killing off any heart muscle that could lead to heart failure.
Heart failure, on the other hand, once it
is established, seems to be relentless, worsening gradually to the point where
the only treatment is a heart transplant.
