Can you detect heart problems??

[The Swinging Monkey]

Ladies & Gentlemen,

I would be grateful if you could shed some light on a matter for me.

On thursday past, an extremely good friend and fellow military aviator died on the squash court (see mil aviation forum)

This dear, dear friend was only 41 and had never smoked in his life. He was not overweight at all, drank very little, kept himself very fit and ate very little in the way of red meat.

At his PM yesterday, the coroner said that he died because of chronic heart disease, and should already have had a by-pass operation. (I understand from his wife that 90% of his arteries were 'furred-up')

Now, without pointing fingers, could someone explain to me (in simple words please!) whether or not this sort of problem can be detected? and if it can then how it could have been missed?

Like all mil' aviators, he had an annual medical, with all the usual ECG blah, and yet there has never been any mention about a heart problem. How can that be? Can your heart be so badly damaged and yet NOT to be picked up on an annual inspection of ECG?

Myself, and no doubt a great many others who knew Paul, will be saying to themselves 'if it can happen to him, then it can happen, literally, to anyone' and it has worried me immensly since his death. Indeed, I ask myself about taking more exercise, losing a bit of weight etc. but I now question its' viability.

What do you think? Is Paul a 'one off' or is all this alledged 'good stuff' actually not that good for you?

Kind regards
The Swinging Monkey

[Lionel Hutz]

A good friend of mine is a cardiologist and I asked him about the effectiveness of ECG's a number of years ago.

Basically what he told me is that the ECG is very good at picking up one Kind of heart problem, cardimyopathy if I remember rightly but for every thing else it's a bit fuzzy.

What it boils down to is if you have a Normal ECG it means that at the time of the ECG you were probably OK but it is no indicator of what's going to happen.

When they do a cardio workup on someone the ECG is used in conjuction with all the other tests they do to build up the whole picture.

The JAA uses the ECG as the whole picture.

this link will take you to an incident report that happened on board a flight, the pilot involved had passed his ECG within the previous six months.

http://www.aaiu.ie/AAIUviewitem.asp?id=5782&lang=ENG&loc=1652

[BOAC]

I believe I heard in the 80's that autopsies on RAF fast-jet 'fatals' where the accident was due to 'other causes' showed marked coronary artery disease in most of the pilots, nearly all aged between 25 and 35.

I guess we all have it, fit or unfit, and no, it does not 'show' AFAIK.

[Northern Chique]

ECG's are a way of picking up abnormalities in cardiac tissue electrial conductivity. The heart uses its own manufactured electrical impulses to contract and operate the heart as a pump. Those electrial impulses must follow certain pathways and gates if the pump is to function properly.

One of the causes of loss or errant activity is tissue death or tissue change, for example scarring or gross enlargement. Chemical imbalances (such as dehydration) cause changes to the electrical activity as well. There are a number of other changes that may be picked up by ECG due to the way they change the conductive pathways in the heart, but if the condition is intermittant, there may be little chance the problem will be picked up on an annual medical. Such intermittant proplems may include palpitations (like when youve drunk way too much coffee or coke and you get that fluttering sensation from your heart and a slight breathlessness with it) and changes in rhythms.

Stenosis of the vessels (or blockages) in the major arteries feeding the heart tissue are usually the result of a number of causal factors. Vascular disease is found to be a result of lifestyle, current or past medical conditions and genetics. Cholesterol is a topic oft referred to as a major culprit. One specific type of cholesterol causing the biggest problem is Low Density Lipid (LDL) as the High density stuff has a number of roles in the bodies chemistry and is used by the body in a munber of ways. Abnormally high levels of anything are not good though. Any imbalances in the way a body deals with chemical balances, blood pressure, infection and so on may contribute to vascular disease. Other culprits are high blood sugar, high sodium (salt) diets, high additive diets (lots of processed foods) and so on.

These chemicals irritate, then start etching the cells away from the vessel walls. The body then treats these areas as it would any other injury. It send clotting factors, white blood cells and so on to repair the area. The result is a swollen part of the blood vessel. As a one off injury, it would repair and no effect would be noted by the vessels owner as body breakdown and repair processes are going on 24/7 in everyones bodies. The continuation of abnormal chemical levels continue to irritate the linings giving no relief. The area also picks up some of the colesterols and deposits the particals as plaques on and under the vessel walls, thus increasing the swelling to the artery. The blood flow no become contricted and like any good venturi, starts interferring with blood flow. Damaged red blood cells cannot carry oxygen as well as a normal cell.

An inflammed, plague laden artery cannot expand and contract like its healthy counterparts, so when placed under stress, pressure continues to errode and scar the lining of the vessel, impedes the flow of blood to the heart muscle, and thus anything down stream of the blockage suffers for lack of oxygen and nutrients initially, then, as the oxygenless environment continues, the acid waste as a result of cells operating without oxygen builds up and is not removed, thus further irritating the surrounding muscle tissue. If the process is allowed to continue, the heart muscle dies, and bit by bit, the pump is rendered useless. If no blood is pumped to the lungs for oxygenation, the body shuts down.

Seeming fit and healthy folks dying as a result of blockages within heart arteries are unnervingly common enough, some resulting from a clot that may have lodged in a narrowed artery, or a burst anuerism (weakened wall in the blood vessel causing a balloon and eventually a blowout something like a tyre inner tube), or gradual blocking of the artery. Some symptoms are usually evident prior to the heart attack such as a feeling of tightness or breathlessness upto a number of days prior. The pain is usually either exercise or stress induced. The clot related ones are usually very sudden. The pain may well not be recognised as being cardiac related as if youve never had heart related pain, youve not much to compare it to....

A close family friend aged 42, (read fitness fanatic!) was suffering a non specific type chest pain for 3 days before his ambo wife finally got him to tell her his symptoms and she rushed rushed him to hospital. He had a double bypass a couple of weeks later. He had put his pain down to a "flu".

His steady western diet mixed with genetics, factor in being a male, slightly above average blood pressure, and he was a recipe for risk. He was one of the lucky ones but now has to be on medication for the remainder of his life to stop clots, as the part of his heart muscle that died will now scar and not operate properly. That will now show up on any ECG...

The best advice to give is, if you or a friend develops breathlessness, a kind of washed out appearance, and aching within the chest cavity, then cease exercise. The pain does not usually change either on breathing in or out but remains fairly constant. The pain can appear to be in the left jaw, around the stomach area or the left arm. Ive had patients say they had nothing more than a back ache! It may go away after a few minutes rest, only to return unpon commencement of activity. If you do develop some of these symptoms or develop a sudden gripping pain, call an ambulance.. fast. Dont get someone to drive you as treament is commenced by the paramedic crew. The earlier intervention is achieved, the better the outcome for the heart tissue and thus the patient.

As a bystander, keep things simple, sit the patient down but dont lie them down unless unconscious (then they go in the "recovery position". Its far easier to breath while sitting upright. Loosen contrictive clothing. Get any details of allergies and current medications and keep an eye on the person for any changes in their condition.

[Hawk]

Thank you NC for your post. Your knowledge and emergency experience is valued.

:I believe I heard in the 80's that autopsies on RAF fast-jet 'fatals' where the accident was due to 'other causes' showed marked coronary artery disease in most of the pilots, nearly all aged between 25 and 35.

BOAC...Not only confined to the RAF unfortunately. You've potentially opened a can of worms with that post. :eek:

[zorin]

The 'arteries' refers to the four coronary arteries around the heart, as these become 'furred up' there are normally symptoms.
(The heart is deprived of blood , in a heart attack large areas of muscle can be damaged causing permanant loss of tissue .)

From personal experience these symptoms are:

General increase in blood pressure , Normal is 120/70 ish but increases with age. Above 140/90 see your doc.

Cholesterol level: Crew food is not ideal and the fatty deposits left around the system can clog up the arteries(atheroma) .
If you have a high level , more than about 5.5 see your doc.

As the blockage increases you would definately be aware of shortage of breath , possibly chest pains which feel as they could be indigestion.Especially squash, running etc.

A pilot reaction to this lot is often to try and ignore it and just work out harder!( The medical requirements, thoughts of losing the licence, personal 'failure' ..can't- -be -me attitude )

Age , well, 40's is early but if there is a family history then the furring up can start in the 20's .
Most problems occur in early 50's (recent BA 747 Capt. with stroke)

ECG . our little annual check is only a rough guide and often only provides information of an angina or heart attack that has happened, not an incipient one.
Other tests are stress ECG ,you are wired up on a treadmill, later on Electro Cardiogram, and best of all the delightful 'angiogram' where dye is inserted in the heart via a catherter, this is the definative check and it is possible to see the blocks.

Minor single blockages can be treated with a 'stent', a small metal tube inserted through the femoral artery, allowing normal bloodflow.
You need 6 months off and then subject to certain restrictions get your licence back unless re-furring has occurred.

More serious blockages may require you to be unzipped and the arteries replaced with handy spare ones from the arm or leg.
Again there are pilots flying with these.

I hope this is of some interest. in summary:

Family history
Smoking, smoking and smoking.
Overweight. Body mass over 25?
High Chol. National average 5.7 but ideal less than 4.
High Blood pressure.

Pain in chest with exercise
Pain in neck and arm
Generally tired
Tingling in fingers
Nasty indegestion with reflux,

May all be early warning signs.

Good Luck!

[The Swinging Monkey]

To you all, my sincere thanks.

I have taken comfort in knowing that Paul didn't do anything wrong, and that presumably it was just one of those tragic things.
I have since found out that his father died from heart disease, which confirms some of the things already said.

Northern Chique and Zorin, my special thanks to you for your lengthy and informative posts. I have enjoyed reading them, and I will certainly be making more effort with my own weight and fitness, and generally trying to take more care of myself!

We all know how precious life is, and no one will know that more than you medical people and it isn't until something of this nature occurs, that you realise just how fragile and uncertain that life is.

Could I perhaps suggest to the moderator that another thread/forum might be considered? One where the expert advice of NC and Z is more better highlighted? (until now, I had never even been on the medical forum before) Not only on this particular subject but perhaps on a more general 'look after your body' sticky forum (if there is one then apologies)

I have no doubt that all of us aviators would benefit from reading and understanding the comments of these two eminent people and others equally qualified in their own fields of expertise.

My thanks to you all once again.

Kind regards
The Swinging Monkey

[Rabid Dog]

excellent post Northern Chique.
Unfortunately, I see this sort of problem far too often.
My only addition - don't be like Bill Clinton (and most other middle-aged Anglo men!) and ignore chest pain, hoping it will go away, see a doctor!

[gingernut]

SM, sorry to hear of your terrible news. I hope that my colleagues posts go some-way to answering your questions.

You ask whether or not this type of problem could be detected. Well in most cases (but not all), the patients present with some warning symptoms, for example pains in the chest ("angina pectoris"), which lead us to investigate further, (for example angiography, a technique where the coronary arteries are illuminated, demonstratinig area's of blockage.)

In other cases we manage risk factors for patients. Lowering bp, stopping smoking and changing diet, are particually useful for those who are at high risk of developing heart disease, for example those with a strong family history.

In other patients, unfortunately we don't know there is a problem until it actually happens, and no amount of examination, or routine investigation, can predict a problem until it occurs.

Without knowing the full facts surrounding your friend's death, I guess that he may have fallen into this, last category, from the details you have posted. Hopefully the technology will develop further, so that, in the future, we can identify people like Paul, before a problem occurs. Unfortunately, at the moment, we don't have this technology.

You ask is it worth you continuing a healthy lifestyle. Well definately yes, as you will be loading the odds in your favour, although in preventative medicine, there is never a 100 % guarantee. it does sound like Pauls case, is relatively unusual, regards David

[The Swinging Monkey]

gingernut,

David, very many thanks for your kind words.
Paul was undoubtedly an outstanding aviator and an exceptional human being. His passsing will be a great loss to all who knew him, but his legacy of tolerance, mild-mannered and just being a bl00dy nice bloke will live on forever.

Once again, my sincere thanks to you all.
Kind regards
The Swinging Monkey

[air pig]

The detection of a pre existing Cardiac conditions such as Coronary Artery disease is very difficult. Patients maybe symptomless until the point of either Acute Myocardial Infarction ( Heart Attack), or tragically death.

The detection of Coronary disease is difficult but the use of exercise electrocardiograms which put the Heart under stress in a controlled situation is the usual starting point in the chain of diagnostic procedures. The development of Magnetic Resonence scanning for Coronary Artery disease will hopefully reduce the risk of future deaths by giving early warning, in people who are symptomless.

It is always so tragic to hear of a younger person dying of this disease, fortunately it is relatively rare.

Research from the Vietman war did show young soldiers of 19 to 25 developing the changes in artery structure which could lead to problems in later life