The condition in which the heart doesn’t receive enough blood is called myocardial ischemia. It occurs when the blood vessels around the heart that feed blood to the heart are clogged or blocked. Untreated myocardial ischemia can play itself out in three phases: angina (the general name for the condition in which the heart doesn’t get enough blood), heart attack (myocardial infarction), and sudden death.

In some cases (10 to 20 percent), angina is “silent”-that is, the patient experiences none of the usual symptoms. And angina can be stable or unstable. When it is stable, it is predictable. For example, exertion will always bring pain, and resting will always stop it. Unstable angina is more dangerous. Symptomatic pain may come when the victim is resting, or, if it comes during exer- tion, it may not go away when the victim is at rest. It is also more likely to lead to a heart attack.
But these distinctions aren’t essential to the patient. What is important is that he or she recognize the symptoms and seek appropriate care. Myocardial ischemia (the condition in which the heart does- n’t receive enough blood) can cause a heart attack, as you know. While angina is a symptom that the heart isn’t getting enough blood, in the case of a heart attack, the blood flow to the heart stops completely, and the part of the heart affected will die. The death rate for heart attack is estimated to be 8 percent to 10 percent, and may run higher.
Myocardial ischemia can-though only when there are rare complications-cause sudden death, and it’s common. The hear: goes into a dangerous arrhythmia (irregular beat) and then stops It is this kind of heart attack that’s most publicized by the medic. and that’s unfortunate. Such episode; happen, certainly, as we saw in the case of Reverend Johnson, but the’ are relatively rare. The damage don e by the wide publicity given to sue:’ cases, with all their drama, is the: people get a false sense of fatalisn. “See, nothing can be done. If it going to happen, it’s going to hal-” pen.” That’s one way we rationali: not taking care of ourselves.

The truth is that heart attacks usually follow warnings in f’ form of angina symptoms. And angina, when diagnosed ar. treated appropriately, usually has a good prognosis.

1.    Victims of heart disease usually die suddenly with no prior symptoms.

1.    If you have coronary artery disease there’s nothing you can do about it.

1.    Chest pains and discomfort or tightness in the chest are just signs that you’re getting older.

1.    Feeling tired all the time, or less energetic, is just another sign that you’re getting older.

1.    Once cardiac symptoms occur, there’s nothing you can do to reverse the process.

1.    If cardiac symptoms are ignored long enough, they usually go away.

If you answered false to all of them, you passed. These are all misconceptions that lead to delay in early diagnosis and treatment. They also lead to countless unnecessary deaths in all Americans, especially African Americans. Sure, it’s a misfortune to develop coronary artery disease. But it’s a far worse misfortune to ignore symptoms, which, when recognized, can point you toward treatment and recovery. All you have to do is recognize them early

DON’T IGNORE THE WARNING SIGNS Every day, across the United States, hundreds of African Americans die simply because they have ignored the warning signs of coronary artery disease (CAD). This is a message that has to be repeated over and over again. And, though we’ve touched on these signs before, they bear repeating:

• •    Pain in the center of the chest-or, mOJ,~ commonly, a pressure experienced as a tightening vice, or as an elephant sitting on the chest. This sensation is felt just under the breast bone, sometimes to the left side of the chest under the nipple.
•     Sometimes, a persistent pain in the left or right arm. Such feelings of pressure often occur while the victim is exercising, running, or out in the cold working, as Mr. Samson was. The pain can be urgent enough to require the victim to slow down or stop what he or she is doing.
•     Any chest pain or pressure that goes down the left arm or up to the throat, or jaw or back, or even to the lower back, and that lasts ten minutes or more.
•   Shortness of breath.

While these symptoms are common to most victims of heart disease, regardless of race, studies show that African Americans are less likely to attribute the symptoms to heart problems. True, the symptoms could simply be the result of an especially bad day or plain old age. But wisdom requires that, when the symptoms per-

sist, they be taken seriously. Only c. doctor, by an appropriate medica: examination, can determine hOIthreatening they are. The sooner thsymptoms are addressed, the bette: the chance of early diagnosis, medic, intervention, speedy recovery, an ;
extended life.

Shortness of breath, heavy breathing, and the feeling ofbeir: ~ hungry for air mean that the heart isn’t doing its job. And the> are other signs:

•   Swelling of the feet or legs
•     Feeling tired all the time and lacking energy
•     Loss of appetite

These last signs may be symptoms of Congestive Heart Failure, a condition we will take up in chapter 7. For the moment, it is enough to say that these symptoms of CHF mean your heart isn’t pumping as efficiently as it should. It isn’t doing its work properly because it isn’t receiving the blood it needs. It isn’t receiving the blood it needs because the arteries that supply the blood are dogged.
The causes of CHF are various. It can simply be a late stage of coronary disease, or the result of high blood pressure or valve problems in the heart. But it can also be caused by viral or bacterial infection or alcohol abuse. Its symptoms too can vary. vVeight gain, shortness of breatl: poor energy, and other unspecific symptoms can be indicators Unlike coronary disease, CHF does not provide such specific symptoms as chest pain. The essential point is that coronary disease results from a blocked artery or arteries, while CHF mean: the heart is not working well because some of the heart muscl: is dead.
But the most common reason for heart failure is underlyin; coronary disease, which is ignored by thousands who suffer fror; symptoms every day, particularly African Americans. Only third of African Americans who su=• fer from the symptoms we”. described will attribute them to tl: c heart, whereas half of the white pOi’” ulation will do so. Part of the prot• lem is lack of knowledge-which tl: book was written to address. B~’ there are other problems: fear of knowing the truth; a gener. paranoia about doctors, nurses, hospitals, and, indeed, a dee. mistrust of health care providers; and a lack of insurance or access to health facilities.

We address the fear and mistrust later in the book. Our 01′ attitude is that knowledge brings power. The earlier the diagn sis, the better your chances. The only way to know if the pain ‘. discomfort you experience in the chest area is a sign of corona .. disease is to get a complete medical workup-that is, a comple medical examination, including an EKG, a chest x-ray, the app:” priate blood or other lab work, and/or invasive or noninvas: cardiac testing. Such a procedure often means the differer . .: between life and death. Lack of knowledge, poor access to health. facilities, and paranoia among black Americans-though they can have real social and economic causeshave too often led to inadequate treatment, treatment that comes too late, and deaths that could have been avoided.
Let’s change that-starting here, starting now. Here’s another lesson that could help you to live a longer and more productive life. The heart is a muscular pump that, like all muscles and organs of the body, needs blood to survive. Blood vessels around the heart deliver blood to the heart muscle. When the heart doesn’t receive enough blood, heart symptoms occur.

ALEXANDER  didn’t feel well one January morning, but he had his pride. Over coffee he joked to himself: ”A man’s gotta do what a man’s gotta do.” And what he had
to do that day was take down the Christmas lights from the front of his house.

“Get someone else to do it and you stay here and help me take the tree down and clean up this house,” said his wife Judith. But no, he’d rather work outside, and alone.

By the time Alexander had lugged the ladder from the garage to the front of the house, he already was short of breath and felt a heaviness in the middle of his chest. But this was nothing new. He’d been tired a lot lately, and the trouble brea~hing and pressure in his chest were just part of that. He’d expected a livelier retirement, but he didn’t feel like doing very much. Anyway, why should he? He’d worked hard for thirty years. Why run around now? When neighbors or church members or his sons and daughters asked how he was doing, his answer was always the same: “Fine. I’m getting along just fine.” And in most respects he was. He’d never had a long illness or had to go to the hospital except for a few stitches to close up a wound he’d gotten at work. And though somewhere down the line a doctor had told him that he had “high blood pressure and a touch of the sugar,” he’d never done much about it.

Despite the hard job of lugging the ladder and climbing it Alexander felt the bitter cold. He hadn’t worked long before his chest began to hurt him worse than before and he couldn’t catch his breath. He came down the ladder to rest a little, but he wantec to finish the job, and before long he climbed back up, only to fee. the same discomfort again, this time more severe.

Now there didn’t seem to be any way around it. He wen: inside to tell his wife what he was experiencing. “Just let me lie down for a minute. I’ll be fine.” But no, she wouldn’t just let hin: lie down. Instead, she drove him to the local emergency room Events there moved fast. After the nurse took his blood pressure and listened to his chest, a doctor gave him a more thoroug.. physical examination. ”I’m sure you don’t enjoy all this fussin; over you, Mr. Samson, but we’ve got to do a couple of tests.”

First, there was an EKG-an electrocardiogram-that pre ~ vided a graphic display of each heartbeat. Then there were bloo tests, to determine if Alexander’s blood showed traces of tl. c enzymes released by the heart muscle during a heart attar. Finally, Mr. Samson was wheeled to the cardiac catheterizatie. lab, where a cardiologist inserted an intravenous (IV) tube in:
an artery in his left groin. “This way,” the doctor told him, “we G ~ct a picture of the arteries around the heart, to tell if they’re ?lugged up or not. It gives us a kind of roadmap of the arteries .hat feed the heart blood.”
“Oh my Jesus;’ Mr. Samson said. Despite his discomfort and
znxiety, he meant it. He’d been a machinist all his life, and these .iigh-tech gadgets and procedures impressed him.
They impressed his doctor in a different way. The tests :-cyealed that, although Mr. Samson hadn’t had a heart attack, the :”":1ajor arteries around his heart were blocked so seriously that he’d likely suffer a heart attack in the next few days if something wasn’t done to intervene. That heaviness in the chest and shortness of breath he’d been bothered by were early warning signs. His heart needed more blood than it was getting. Fortunately, in this case Mr. Samson and his wife had listened to the warning signs. Unfortunately, every day hundreds of African Americans die because they ignore these signs.