HOME   HYGIENE LIBRARY CATALOG   CHAPTER 14

   The term "heart attack" is ambiguous and can be used to describe any sudden impairment of heart function which may or may not result in permanent damage to the heart muscle. A heart attack may cause complete collapse and sudden death or perhaps only temporary discomfort. References are made to "little" attacks or "silent" attacks where small sections of the heart muscle are deprived of circulation and perish, gradually depleting it without the victim being aware.

   The accepted medical definition is applied to a case when tests show that permanent damage (infarct) has occurred. There are two types of heart attack:

1. Where the heart muscle (or part of it) is deprived of blood supply perhaps stopping it completely or perhaps only impairing its action, causing collapse or perhaps just pain.
2. Where the heart's nervous center is affected, disrupting its rhythmic muscle co-ordination (fibrillation) and the victim collapses and dies unless defibrillation can be quickly employed.

   No doubt both occur together sometimes. In any case the victim is "set up" by blocked arteries, and the kind of attack will depend on the factor or combination of factors that precipitate it.

   Until recently, it has been thought that a blood clot blocking a coronary artery already partly blocked by atherosclerosis, was the cause of most attacks (coronary occlusion). However, in many cases at autopsy no clots have been found at all. Further, it has been noted that when clots are found, they occur more often in victims who have survived some time after the initial symptoms of the attack. It appears the clot could be a secondary effect in many cases, although perhaps the final "coup de grace".

   Vigorous activity or exaggerated movements can cause a plaque to dislodge from an artery wall, resulting in a massive attack.

   Coronary arteries almost blocked by atherosclerosis can still permit the heart to pump sufficient blood flow for moderate activity with the person quite unaware of impending disaster, although aware perhaps of having high blood pressure and perhaps other symptoms. The autopsy of President Lyndon B. Johnson revealed that of three main coronary arteries, two were totally blocked and a third was 60-80% occluded.

   Increased blood supply for greater body activity can be met by the heart working harder and increasing the pressure. In order to increase its output to the rest of the body, the heart muscle itself must have more blood, and when deprived, pain may be felt in the chest and perhaps in the arms. This is called angina.

   The demand may be increased in a number of ways. Exercise, concentration or digesting a meal are normal activities, and if limits are approached pain may be felt, but the activity is usually automatically restricted and no harm results. Sometimes the pain is mistaken for indigestion. Should the oxygen-carrying capacity of the blood be reduced or enzyme activity impaired, eg by smoking or alcohol, the demand is greater too. Should the blood thicken as happens with a heavy meal, or with stress (perhaps accentuated by smoking, caffeine, high sugar intake or alcohol) it may not pass sufficiently through an occluded artery or perhaps block it altogether.

   Furthermore, the condition of high blood viscosity tends to worsen as the flow slows. According to Dr Dintenfas, "When an artery is progressively constricted, blood flow will remain nearly constant until a critical stenosis is reached. Up to the point, a localized increase in flow velocity (due to the constriction) will cause a decrease in viscosity. Once the flow slows down blood will increase viscosity and the problem compounds".

   Many heart attacks occur during or after sleep following a fatty meal. After conducting a number of animal experiments, Dr D. G. Volheimer of Germany discovered the reason for this. As described in Chapter 10, the lymphatic system depends for its flow on a certain degree of movement in the tissues adjacent to the lymph vessels to squeeze the lymph fluid along. In Chapter 9 it is described how the absorption of fats after digestion (unlike other food substances) occurs by way of fat entering the lymph vessels to be emptied into the main bloodstream at a point just before the main veins return to the heart. Normal lymph will continue to flow even when the body is motionless in sleep but' if fat particles continue to pour into the lymph while a person sleeps, the fluid will become thick with it and the vessels will clog up. Should now the person stir or arise, the clogged lymph vessels will suddenly discharge their load of concentrated fat into the main bloodstream which is already too thick and turbid.

   The "peak hour" for heart attacks starts after midnight several hours after bedtime. This is easy to understand. Many people with already high blood fat levels, drink liquor before dinner, then perhaps wine with dinner, their heaviest, fattiest meal of the day, then follow up with coffee, cigarettes and perhaps more liquor. A few hours later their blood thickens like heavy paint and when pain occurs many think they have indigestion, at least at first.

   It has been noted too that temperature extremes increase blood viscosity and that in cold winters and very hot summers there is an increase in the rate of heart attacks.

   US Navy studies show the normal pilot heart rate to be higher on the approach and landing phase of a flight than in combat because of the greater stress of concentration required, particularly for deck landings on an aircraft carrier. In cases of airline pilot incapacitation or death through cardiac deficiency while on duty, the attack has almost invariably occurred on the approach and landing phase of the flight where the stress level is greatest. In some cases the incapacitation was temporary and involved a period of mental disorientation not quickly discernible by the co-pilot.

   It has confused the researchers that heart disease rates are apparently not always consistent with the accepted factors. This, I believe, is because the incidence of heart disease has been assessed simply by the incidence of heart attacks.

   Thus, it may appear that a certain ethnic group on a high fat diet but happy in a relaxed prosperous rural community do not suffer heart disease. This seems to be the case because they have a low incidence of heart attacks, say in the 40-60 age group, compared with elsewhere. In actual fact they doubtless are as badly diseased in the arteries as anybody else, but are fortunately without the stress situations which trigger heart attacks.

   Thus, if instead of flying his aircraft, the pilot just referred to had visited the rural community or even stayed home, he would not have had his attack. If his medical check had been that week he doubtless would have passed clean as he had for the past 50 or 60 checks or more, his by now severe heart disease still undetected. Should the happy rural resident suddenly be placed in a situation similar to the pilot making an approach on instruments into a busy airport in bad weather, his arteries would not cope either and the atherosclerosis that had slowly accumulated for 40 or 50 years would be suddenly apparent.

   Three ethnic groups whose diets appear to be highly conducive to cardiovascular disease and yet who are renowned for their apparent immunity to it, are the inhabitants of the small town of Roseto, Pennsylvania, the Masai natives of Africa, and the primitive Eskimos. It has been noted however, that many Roseto people who went to live in the cities subsequently suffered heart attacks.

   These cases are explainable and support the point I have been making. Roseto is a unique town inasmuch as it was founded by migrants from Roseto in Italy in 1882 and today the population there is still over 95% Italian. Thus--

1. The original lifestyle of an Italian rural village, simple and relatively free of stress remained virtually unchanged.
2. Although they consume a lot of fat and use more lard (animal fat) than olive oil for cooking, the traditional Italian food contained comparatively low levels of cholesterol.

   These people have enjoyed the advantages of the type B behavior described in Chapter 8 because of their placid environment. It is significant that since these observations were made over 20 years ago, Roseto has gradually become "Americanized" and the rate of heart attacks there is now approaching the average American rate.

   The Masai are a lean, proud, nomadic race. They are herdsmen and live almost entirely on a diet of milk, meat and blood taken from their cattle. They have been shown to display low blood cholesterol and an apparently low incidence of cardiovascular disease and heart attacks.

   Autopsies have shown that the Masai do indeed develop cardiovascular disease, but they have an advantage compared to Western man which is explainable by--

1. Their cattle are scrawny and "range fed" and so, although high in cholesterol, the meat in their diet contains much less fat.
2. Consumed uncooked, the food contains natural enzymes which, as described in Chapter 10, bring about more thorough digestion of fat and lower cholesterol levels in the blood.
3. The Masai walk about 25 miles a day with their herds and the exercise expands their arteries and collateral circulation, as well as lowering blood fats and blood viscosity.
4. Their diet contains no sugar or other refined carbohydrates.
5. They spend moretime in the sun.
6. Their lifestyle is relatively stress free.:

   The primitive Eskimos are similarly protected, and although they consume more fat than the Masai, the fat is eaten raw., in addition to which their circulation is assisted (as also described in Chapter 10) by the EPA contained in the fish they eat.

   It should be noted that, like the Eskimos, the Masai and the Roseto Italians are not renowned because of their longevity, but merely because they do not display cardiovascular degeneration as early in life as we do.

   The greatest confusion perhaps has been caused by the misconception regarding the effect of polyunsaturated fat which when substituted for animal fat in the diet, results in lowered blood cholesterol, an apparently beneficial effect. Unfortunately, it causes aggregation of red blood cells easily capable of causing a heart attack, and is therefore extremely dangerous.

   If a section of the heart muscle is deprived of blood supply for even a few minutes that section will perish and in time, scar tissue will form. This damage shows on an electrocardiogram, and is called an infarction.

   When similar damage occurs to the brain, it is called a stroke. A clot which lodges in the pulmonary artery between the heart and the lungs can cause sudden death and be mistaken for a heart attack. This is called pulmonary embolism.

   Disruption of the nervous control system by atherosclerosis in a critical area of the heart can trigger arrhythmias such as fibrillation or cardiac arrest and these cases are frequently without warning, sudden and fatal. Shock can also disrupt nervous control, causing similar attacks.

   When part of the heart is receiving adequate blood supply and another part is deprived, the deprived part will turn a bluish color because of oxygen lack. When this happens the heart may go into fibrillation, fluttering uselessly instead of pumping. In tests with dogs, the application of a clamp to one coronary artery instantly caused fibrillation which stopped when the clamp was released.

   Thumping the chest over the heart sometimes restores heart action. Coronary care units, besides having staff trained in such physical resuscitation, have special defibrillating machines to restore heart rhythm. They call them "crash carts". Cardio-pulmonary resuscitation (CPR) is a procedure conducted preferably by two people whereby the heart of the patient is rhythmically compressed to maintain circulation and the lungs are ventilated by mouth-to-mouth pressure until normal function returns.

   Severe stress, such as shock, over-exertion and/or overheating can cause ventricular arrhythmia even to people unaffected by atherosclerosis, apparently by raising the level of hormones in the heart to an excessive degree. Experiments with animals indicate that a physically fit person is protected against such excessive hormone levels. However, rare cases of sudden death have even occurred to highly trained athletes.

   Autopsies on a number of athletes have revealed diseased coronary arteries proving that endurance training alone is not full protection against cardiovascular disease.

   A recent survey of all the fibrillation deaths in Rhode Island over a five-year period showed that seven out of eight occurred to people jogging. These avoidable deaths occur because people start exercise programs unaware of the atrocious condition of their arteries and the fatty state of their blood.

Congestive heart failure

   This only occurs to a person with severe coronary artery disease which so limits the blood supply to the muscle of the heart's left ventricle (the main pump) that it cannot contract vigorously enough to pump properly. However, the right ventricle (small pump) continues to push normal quantities of blood through the lung circuit and on to the main pump, but the left ventricle is weak and cannot cope with all the blood from the lungs and so the blood begins to accumulate in the vessels of the lungs. As the process continues, fluid from the blood seeps out from the vessels and floods the air spaces of the lungs. Shortness of breath occurs.

   This condition of the lungs is called pulmonary edema. This impedance to circulation may cause fluid from the blood to leak from veins into the surrounding tissues, causing edema in various parts of the body. This is noticeable when legs and ankles swell.

Assistance to circulation

   Apart from administering oxygen to heart attack patients, direct assistance to the circulation can be given by EPCA, External Pressure Circulatory Assist, developed by Dr Harry Soroff of the Tufts New England Medical Center in Boston. It consists of an inflatable nylon bladder which is wrapped around the patient's legs. The bladder contains water and contracts hydraulically, synchronized to the heartbeat by electrocardiograph. It assists circulation by helping to fill the heart with blood between contractions. It reduced mortality in coronary care from 15% to 7%.

   Dr Wilfred Shute whose book, Vitamin E for Ailing and Healthy Hearts makes dramatic claims for the use of Vitamin E in benefiting stricken patients, described a simple therapy used by Dr Samuel Levine of Boston:

   "As early as 1952 Dr Levine was able to lower the death rates of acute Coronary thrombosis cases from approximately 40-60% to 9.9%, merely by taking the patient out of bed as soon as his pain had subsided, and putting him in a comfortable chair with arms and a seat which supported the buttocks and thighs evenly."

   Dr Shute laments that this discovery has been ignored ever since except by himself and adds that "There has been a similar lag between knowledge Of the effectiveness of alpha tocopherol (Vitamin E) and its use".

   Newly tested drugs such as Streptokinase (an enzyme), Urokinase (an enzyme) and Tissue Plasminogen Activator (TPA) injected into the bloodstream can quickly dissolve clots and restore circulation to victims of heart attack and strokes.

   Plasmapheresis, a new technique for removing cholesterol from arterial plaques, is presently being tested by the Pritikin Research Foundation in collaboration with physicians at a major US medical school. The process, similar to dialysis, removes low density cholesterol from the blood, and daily treatments are expected to substantially clear arteries in about 30 days.

   These procedures constitute "crisis medicine" and although life-saving, they are not the solution to the problem of heart disease. The real solution follows in the next chapter.

   The most important thing of all for the patient's recovery once they have survived the initial attack is to ensure that when well enough to take food, they strictly avoid all food containing fat and cholesterol, preferably adopting a diet along the lines of the Gerson or Pritikin regression diets. On this diet no supplementary vitamins or minerals are used, and in a few days oxygen transport is greatly improved simply because of a cleaner bloodstream.

Stroke

   A stroke is another manifestation of cardiovascular disease or more specifically, atherosclerosis of arteries supplying the brain.

   Should part of the brain be deprived of blood supply, the victim may collapse and if the condition lasts for more than a few minutes, that part of the brain will be destroyed. The victim has had a stroke, and according to the nature and degree of the damage, so will depend the subsequent incapacitation which will be permanent.

   When an impaired artery ruptures in the brain due to high blood pressure it may be called a cerebral hemorrhage, but is still classified as a stroke. This kind of stroke was once the most common, but the 3 to 1 ratio has reversed since oral drugs have been used to control hypertension. The patients now have lower blood pressure but a higher degree of atherosclerosis-induced strokes.

   A stroke caused by a partial blockage may not result in the destruction of brain tissue if there still remains enough blood flow to keep cells alive. In such a case improvement of the flow can restore brain function. If severe enough, both kinds of stroke can be instantly fatal.

   Arteries will rupture only if their walls are damaged by an aneurysm, ie. They first bulge out at a point corroded by the disease. Tests of dogs showed their healthy arteries could withstand enormous pressures. The dogs behaved normally with a blood pressure of 4000 mm! At 5800 mm their eyes bulged out, and at 6000 mm they died. Nevertheless none of their arteries ruptured.

   A Canadian study team headed by Dr H. Barnett of the University of Western Ontario reported after a seven-year study that aspirin taken four times a day reduced the incidence of stroke by 48%. It has previously been reported that aspirin tends to reduce blood clotting in surgery. Other reports suggest that aspirin may avert heart attacks. Dr Barnett says it interferes with the action of blood platelets whose normal purpose is to form clots, which of course is a vital natural protection against loss of blood. At the same time, aspirin is an irritant to the digestive tract and it does further harm by inhibiting the action of the white cells of the immune system on its way to kicking the kidneys around a bit. Great stuff, aspirin.