It is Valentine’s Day, and people are thinking about hearts: pining, beating, breaking, loving. For a long time Dr. Richard S. Ross has taken a less romantic view of the subject. Dr. Ross, 53, is a cardiologist, a former president of the American Heart Association and at present dean of the Johns Hopkins medical school. His name has been linked with advances in heart research for nearly three decades, including the modern use of the heart catheter, and closed-heart massage—the chest-thumping procedure to reactivate the heart and keep the blood moving. Born in Indiana and a graduate of Harvard Medical School, Dr. Ross lives in Baltimore with wife Elizabeth, known as Boo, and their black poodle, Sam. Dr. Ross discussed sick and healthy hearts with Barney Collier for PEOPLE.
What is a healthy heart?
It’s an organ of muscle and valves that pumps about a gallon and a half of blood and beats on an average of 75 times a minute, every minute of your life. When it stops, you stop.
What is a heart attack?
A part of the heart no longer functions because of interference with the blood supply to a section of the heart muscle. The rest of the heart must do the damaged part’s work. But the heart has a lot of reserve. You can lose a big chunk of it and still carry on.
How can you be certain you are having a heart attack?
Often you can’t. Sometimes the symptoms of indigestion and heart attack are similar. Yet somehow people usually know they are having a heart attack, but they delay doing anything about it. They say, “No, this can’t be happening to me,” or, “I’ll get over it.” One of the first home remedies for heart attacks is Alka-Seltzer, which does not work, and neither does Gelusil. So people wait and wait. The average delay from the time the pain starts until the patient arrives in the coronary care unit is about five hours.
Why do victims wait so long?
It’s called “patient denial,” and most of the time is lost while the patient decides what to do. Men are most prone to coronary problems until women catch up after menopause, so we will use the term “he” in describing the case. He comes home from work, tired. There’s a tight feeling in his chest. He thinks, “Maybe it’s heartburn.” He takes an Alka-Seltzer. He takes a walk. He breathes deeply.
What does he feel?
Pain. It’s described as discomfort in the midline of the chest under the breastbone. Other words are “heavy,” “oppressive” and “crushing.”
What happens next?
The incidence of death is very high in the first 30 minutes and high during the first hour. If the patient gets past that, his symptoms continue. Then comes the most important single thing—he tells somebody how bad he feels, and he listens to the response. Say it’s his wife. Often she reinforces his natural tendency to deny it’s his heart. But if she says, “Maybe it’s your heart,” and gets him to an emergency room, the period of denial ends.
What are sure-fire symptoms?
If the pain and severe discomfort in the midline of the chest last more than two minutes, especially if associated with sweating and a feeling of nausea, though not necessarily so, it’s time to set off for the emergency room.
What happens in the emergency room?
You tell the doctor and he’ll order an EKG, watch you for a while and, based on blood pressure, pulse rate and tests, he’ll tell you about your heart. There’s no other way to do it. You can’t do it yourself. We may get a few people with indigestion coming in, but we also save lives.
What is angina of the heart?
It is a similar discomfort under the chestbone with pain, heaviness, a tightening sensation. But angina is clearly related to exertion. A man walks up a flight of stairs. Half way up he feels his chest tighten. He pauses, rests, the pain goes away, he continues. This may go on for years, without developing into a heart attack. Angina indicates there is a heart area to which the blood supply is not perfect.
Are angina sufferers more prone to heart attacks?
Yes. The clogging of heart blood vessels with fatty material is cutting off some of the blood supply. The patient with angina pectoris at some time in his life may have pain when at rest, or wake up at night with it. That may, and I emphasize may, mean he is on to the next stage.
What drugs are used for angina?
Nitroglycerine and a lot of others are used to manage angina. These drugs relax the veins in the arms and legs, causing the heart to work less. That eases the symptoms.
Are fat people more prone to heart attacks?
Not just because they are fat. However, fat people are associated with increased risk factors: cigarette smoking, high blood pressure and elevated cholesterol.
Is hypertension an important factor?
It’s terribly important, because a person can do something about it. He can get his blood pressure checked. There are very good drugs that help restore blood pressure to normal limits and may prevent a stroke.
Can you detect high blood pressure without a machine?
No, and let’s dispel a myth. A patient may seem calm, cool and collected, but inside he may be hard-driving, spastic and have abnormally high blood pressure. Conversely, a hard-driving, restless, pushy person may have normal blood pressure. Hypertension gets translated in the lay mind as pertaining to outward behavior.
What drugs are used to manage it?
There are drugs called beta-blocking drugs, which act on the nerves of the heart to slow the beat and thus decrease the force of contractions. There are also diuretics, which reduce the heart’s workload by making the patient excrete more salt. This lowers the quantity of water the body retains and thus the volume of blood the heart must pump. A low-salt diet does the same thing.
Have you ever had high blood pressure?
Yes. Once there was a transient elevation of my blood pressure. Stress can produce that, and then it gets back to normal. Blood pressure is almost always higher in a doctor’s office than it is at home. But remember, in everyday life you are also under stress, so don’t dismiss the message completely.
Is high blood pressure good for anything?
It is part of the chase and hunting response. It rises when we exercise and when we are frightened. It becomes abnormal only when it lasts while we are sitting quietly in the living room.
Does physical fitness help your heart?
It has never been proven that an exerciser has a healthier heart than a nonexerciser. But I believe that a person in good condition is better able to stand all sorts of circulatory stress, including a heart attack. Running and walking are the best exercises.
Is there a diet for heart health?
There’s no question that a population that eats less animal fat has less hardening of the arteries and fewer heart attacks.
What about cigarettes?
My last cigarette was in Peru in 1967. I stopped when it became clear to me that the cigarette smoker had a risk of heart attack three to five times greater than a nonsmoker. If you stop for a year, it’s about the same as if you’d never smoked.
Is an annual physical necessary?
There’s a big tendency to have an annual EKG on a treadmill. I’m not sure that the return is great enough to justify the cost and effort involved. Taking the blood pressure is most important.
What are big risk factors for women?
The Pill. Every woman on the Pill ought to have her blood pressure checked regularly. There’s no doubt that hypertension is a consequence of taking the Pill.
The heart bypass is now a very popular operation. Why?
It is miraculously effective at relieving the symptoms of angina pectoris. There are about 65,000 bypass operations a year in this country at an average cost of $10,000 each.
Isn’t relief from angina worth it?
The immense popularity of the procedure is at least in part due to the false assumption that, because pain is relieved so effectively, life must be prolonged. But I see no evidence that the operation makes a person less likely to have a heart attack. It will be several years before we can know.