How to prevent a heart attack

According to the Australian Heart Foundation, 55,000 Australians suffer a heart attack each year – so it’s a very real possibility for most of us.

I see many patients who report a family history of “bad hearts”. They will report that “Great Uncle So and So” had a heart attack at 85 years of age and dropped dead in the garden, to everyone’s surprise.

Strictly speaking this is a history of heart attack in the family, but it is not the “family history” that we are asking about as doctors. What we really mean by family history is if there has been premature heart problems or death in the family from the heart.

When we say premature, we are most concerned to find out if men less than 50 to 55 years of age or women less than 60 to 65 years of age have been affected.

If the relative is 85 years old at the time of their heart event, then we don’t generally feel this puts a patient at significant increased risk; after all, the relative has lived beyond average life expectancy.

If they truly are “young” relatives in the family who have had heart problems then we, as doctors looking after you, need some detail around the actual circumstances.

Was the problem related to the muscle of the heart? Conditions that weaken the heart muscle or thicken the heart muscle are fairly uncommon but can certainly run in families.

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Dr Bishop has a proactive approach to cardiac health

Was the problem related to an electrical malfunction of the heart? Electrical issues thankfully are not very common, but they are a very important inheritable set of conditions that can be the cause of death of children or adolescents.

Was the problem related to a valve? Luckily also relatively uncommon, but important to be aware of as valve problems on the whole are amenable to correction with modern surgical techniques. The priority then is to make the diagnosis so the treatment can be implemented.

Lastly and most commonly, build up of cholesterol in the arteries – called atherosclerosis and leading to coronary artery disease – runs in families.

This hereditary form of increased risk of coronary artery disease, or the most common cause of heart attack, is the situation I see most in my rooms.

In a significant number of individuals, there are high levels of cholesterol that run in the family in association with premature coronary events (chest pain or heart attack). The condition where high levels of cholesterol are passed through the family is called Familial Hypercholesterolaemia (Familial = in families, Hyper = high – cholesterol = cholesterol – aemia = in the blood; so “families with high cholesterol in their blood”).

This condition occurs in around 1 in 300 people in the population, so it is relatively common in the community. It is also very common in the patients who have had heart attacks.

The reason it is so important to diagnose Familial Hypercholesterolaemia is that it can be treated before a heart attack occurs. The use of cholesterol lowering drugs and monitoring through coordinated specialist and local doctor care can make a real difference to the life of people with this condition.

So, if there is premature coronary artery disease in the family and high cholesterol levels, get checked out and talk with you local doctor about it. With appropriate diagnosis and treatment, it is an opportunity to make a real difference – not something to be scared of or put off.

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CT scanning captures images of the heart's arteries to better assess a patient's risk potential

In some families, however, it is not always clear what the cause of early coronary disease is related to. These families may have a clear history of premature coronary events, but the cholesterol levels may not be particularly high, and other risk factors may not be obvious.

I see patients in this situation regularly in my rooms. They want to know if they are at risk as other members of their family have been. This can be difficult to sort out, but often I will speak with these patients about further testing to try to more precisely evaluate their risk. I will frequently discuss using Cardiac CT imaging to look directly at the arteries to help in understanding the health of their arteries.

This testing is not for everyone and currently is not supported by a Medicare rebate, however I have many patients who wish to undergo the testing for their own clarity around their cardiac health. I have written a book to give patients more information about this testing so they may discuss it with better understanding with their local doctor or even their specialist.

When it comes to familial heart conditions, often is the case that “the apple doesn’t fall far from the tree” and to be aware of an appropriate diagnosis (if present) and then implement appropriate treatment can be life saving.

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