What are heart failure, heart attack and cardiac arrest?


— Singer George Michael died Christmas Day at age 53 when his heart “failed” him while lying peacefully in bed, his manager Michael Lippman said, according to the UK-based Press Association.

Typically, heart failure refers to the heart not working optimally but it can be treated. It does not mean the heart has stopped functioning completely, though in some cases it leads to that.

If Michael’s heart not only failed but also stopped beating completely, he would have had “just minutes — just minutes,” said Dr. Nieca Goldberg, a spokeswoman for the American Heart Association who had no direct knowledge of Michael’s condition or death.

“That’s why it’s very important for all of us to learn how to do cardiopulmonary resuscitation (CPR),” added Goldberg, who is also medical director of the Joan H. Tisch Center for Women’s Health at the NYU Langone Medical Center in NYC. “That’s the first step when someone collapses to help save their life.”

What is heart failure?

The American Heart Association describes heart failure as a condition that occurs when this important organ, essentially a pump, cannot effectively push blood out through the arteries and circulatory system to the body’s other organs and tissues.

Congestive heart failure, a worsening of this general condition, means blood flow from the heart through the arteries has slowed while blood returning to the heart through the veins has begun to back up and combined they cause congestion — a blood traffic jam — in the body’s tissues.

The result is edema, or swelling, usually in the legs and ankles, though edema can happen anywhere in the body. Heart failure also impairs the kidneys’ ability to dispose of water and sodium, causing even more swelling. When pulmonary edema happens, fluid collects in the lungs and interferes with breathing.

Conditions that can lead to heart failure include high blood pressure, diabetes, obesity and coronary artery disease — when plaque builds up in the walls of arteries causing them to narrow and increasing the difficulty of pumping blood.

Heart failure, then, is a medical condition that needs to be treated to prevent a life-threatening heart attack.

What is a heart attack?

“A heart attack is a circulation problem,” said Goldberg. When circulation is blocked or cut off in some way and blood is no longer supplied to the heart muscle, this can damage that muscle, she explained. Though commonly described as a heart attack, doctors refer to this condition as “myocardial infarction.”

Blocks causing heart attacks are mostly caused by a buildup of plaque in the arteries. Plaque forms when cholesterol combines with fat, calcium and other substances in the blood.

Combined, these separate elements harden into plaque, which can then rupture causing a blood clot to form. Large enough clots can completely block the flow of blood through an artery leading to a life-threatening result of a heart attack.

“People who are at risk for heart attacks are people who have a family history of heart attack, having high cholesterol, high blood pressure, diabetes, lack of exercise, cigarette smoking — the major risk factors we always discuss,” Goldberg said.

Another less frequent cause of a heart attack is a spasm caused by tobacco or possibly illicit drugs, such as cocaine, which then disables the heart muscle, according to the American Heart Association. A tear in the artery, though rare, can also result in a heart attack.

The association says heart attacks can be fatal, but they do not automatically lead to death. The group advises that immediate emergency medical help can often prevent a heart attack.

“And if you think someone is having an heart attack, call 911 — don’t wait,” said Goldberg, who explained that the reason it’s important to take an ambulance to the hospital instead of, say, hitching a ride with a family member or friend is they are equipped to treat cardiac arrest on the way to the emergency room.

What is sudden cardiac arrest?

While a heart attack occurs when circulation of blood is blocked, cardiac arrest is the result of electrical disturbances that cause the heart to suddenly stop beating.

“Sudden cardiac death is an electrical problem, where your heart’s rhythm is rapid and irregular and your heart can’t pump effectively so you suddenly collapse,” Goldberg said.

As you might expect, a sudden, unexpected loss of heart function results in an equally sudden loss of breathing and consciousness.

Survival is possible following sudden cardiac arrest with treatment. Once again, CPR, a defibrillator or chest compressions could save someone’s life until emergency personnel arrive.

One cause of sudden cardiac arrest is a heart attack.

“Sometimes people who are having heart attack have a complication of sudden cardiac death if they don’t get to the hospital soon enough,” said Goldberg. Yet, most heart attacks do not lead to sudden arrest, according to the American Heart Association.

Goldberg added that another risk factor for sudden cardiac death is a genetic predisposition to heart rhythm problems. In families where people are known to die suddenly, the family is screened and closely monitored, Goldberg said.

Symptoms and numbers

The most common warning signs of a heart attack are discomfort (sometimes pain) in the chest; lightheadedness, nausea or vomiting; pain in the jaw, neck or back; discomfort in the arm or shoulder; and shortness of breath. Some of these may occur more often among women, and others more often among men.

By comparison, sudden cardiac arrest strikes without warning: A person collapses and has no pulse, no consciousness and no breathing.

Overall, heart attacks are more common than cardiac arrest in the United States.

During 2014, for example, the American Heart Association calculated about 565,500 sudden cardiac arrests. By comparison, nearly 750,000 Americans have a heart attack each year, according to the association.

Worldwide, heart disease is the leading cause of death, accounting for more than 17.3 million deaths each year, a number that the American Heart Association expects to grow to more than 23.6 million by 2030. “Heart disease” includes all forms of possible heart troubles, such as heart failure, heart attack, sudden cardiac arrest, heart defects at birth, arrhythmia and cardiomyopathy (an enlarged heart muscle usually caused by genetics), high blood pressure and high cholesterol.

While any heart problem can ultimately lead to death, the most immediately life-threatening are heart attack and sudden cardiac arrest.

“I think it’s really important for us to focus on preventing people from having heart attack through lifestyle changes,” said Goldberg, who suggested not only good diet and physical activity but also the need to get routine checkups and, if necessary, treat any blood pressure or cholesterol problems.

“Interestingly enough, our rate of heart attacks in men and women have decreased over the last 10 years,” said Goldberg. “I think it will take time with the recent increase in all these risk factors to see if we are going to see a bump, but I can’t predict that.” Though hopeful, she sighed, adding: “That’s a concern of mine.”