By Chauncey Crandall, M.D.

SPECIAL REPORT
S
ince I became a cardiologist more than 25
years ago, Ive witnessed many improvements
in the eld of cardiology. We have more
technology, better procedures, and far more types of
medication than we did before.
We now routinely save people who would have
died in the past.
But what we, as doctors, no longer have is the
luxury of time. The entire healthcare industry
has changed. These days were under much more
pressure to see more patients in shorter periods of
time. This means that most doctors arent able to
form the kinds of personal bonds with patients that
once were the norm.
At the same time, though, patients need our
guidance more than ever. People are getting fatter
than ever because we have a society that promotes
relaxation over physical tness.
As a result, the rates of high blood pressure,
diabetes, and obesity are soaring and threatening
to wipe out all the progress weve made in ghting
heart disease.
This is the reason why I created Dr. Crandalls
Heart Health Report. I wanted a forum where I
could share important new information about heart
health, and, as I do for all of my patients, provide
sound guidance for transforming your overall
health.
But, rst and foremost, I wanted to give you
this special report, entitled, These Four Things
Happen Before a Heart Attack, so you can learn the
all-important signs you must know to protect your
heart. So lets get started right away!
What Is a Heart Attack?
First I want to explain what a heart attack is, so
you can understand why the symptoms occur.
All of our organs, like the kidneys, liver, and
stomach, have diferent jobs. The hearts only
job is to keep blood moving through your body
continuously. Basically, your heart is a pump.
In order to accomplish this task, your body has
its own circulatory system, which is comprised of
three main coronary arteries that descend, like a
crown, from the hearts main blood vessel, the aorta.
These three main coronary arteries, which cover the
outside of the heart, are called the right coronary
artery, the lef circumex coronary artery, and the lef
anterior descending artery, or LAD.
These coronary arteries are not very wide. And,
in fact, they are rather delicate. Over time, they can
become clogged with fatty deposits, ofen called
plaque.
When this happens, it creates what is referred to,
variously, as heart disease, coronary artery disease,
atherosclerosis, or hardening of the arteries.
Most heart attacks occur when this plaque
ruptures and blocks the ow of blood through the
arteries to the heart muscle.
The Four Things That Happen
Before a Heart Attack
I will ofer a complete list of symptoms you can
experience when youre having a heart attack later in
this report. Before that, I want to focus on the four
things that happen most ofen before a heart attack.
Over the course of my career, I have determined
These 4 Things Happen
Right Before a Heart Attack
2 Special Report drcrandall.newsmax.com
health
from a wealth of experience that these are the four most common signs that a
heart attack is about to take place or is already in progress.
1
chest pain
Chest pain is the one symptom that we associate most ofen with a
heart attack. And theres a good reason for that: It actually is the most
common symptom.
However, chest pain can mean more than one thing, and it can manifest
itself in many ways. There is one type of pain that occurs all over your chest.
There is another type of pain that occurs just of to the lef side or the center
of the chest. It can also start in the jaw and radiate down the lef arm.
The pain can also occur at diferent intervals and diferent intensities.
It might come and leave very suddenly or last for a few minutes or more.
The discomfort can be mild, or it can be severe, and it can also feel like
uncomfortable fullness, squeezing, or pressure.
When this type of pain is severe, it can manifest itself in what weve come
to nickname The Hollywood Heart Attack, because it looks like the dramatic
type of heart attack we see on TV and in the movies. But its important
to understand that the pain doesnt have to be as severe as that; it can be
mild, especially at rst, and so you may not realize anything serious at all is
happening.
2
shortness of breath
While most people nd chest pain alarming, they are not aware that
shortness of breath, even in the absence of chest pain, can signal an
impending heart attack.
In fact, one study, published in The New England Journal of Medicine,
found that of 18,000 patients referred for cardiac stress testing, those who
experienced shortness of breath were three-to-ve times more likely to die.
This included some patients who reported no chest pain at all.
This shortness of breath can occur suddenly, right before or even during a
heart attack. It can also provide you with an important clue that something is
wrong with your heart that demands checking out.
One of my patients, Grace, was accustomed to being very active. In fact,
when she lived in New England, she loved to hike through the hills and even
chopped her own rewood. Gradually, though, she found herself becoming
so winded she could no longer walk up her own driveway without becoming
short of breath.
Her kids told her to relax, she was just growing older. But Grace didnt
Dr. Crandalls Heart Health Report is a publication of Newsmax Media, Inc., and Newsmax.com. It is published monthly at a charge of $54.00 per year and is offered online and in print
through Newsmax.com.
Our editorial ofces are located at 560 Village Blvd., Ste. 120, West Palm Beach, FL 33409.
The owner, publisher, and editor are not responsible for errors and omissions. Rights of reproduction and distribution of this newsletter are reserved.
Any unauthorized reproduction or distribution of information contained herein, including storage in retrieval systems or posting on the Internet, is expressly forbidden without the consent
of Newsmax Media.
For permission, contact the publisher at : PO Box 20989, West Palm Beach, FL 33416.
CEO Christopher Ruddy Associate Publisher Travis Davis Author Chauncey Crandall, M.D. Contributing Editor Matthew Kalash Production/Art Director Elizabeth Dole
To contact Dr. Crandalls Heart Health Report send e-mail to: askdrcrandall@newsmax.com. Subscription/Customer Service contact 1-800-485-4350 or customerservice@newsmax.com.
Send e-mail address changes to customerservice@newsmax.com.
2012 Newsmax Media, all rights reserved. Please note that this advice is generic and not specic to any individual. You should consult with your doctor before undertaking any medical
or nutritional course of action.
When chest pain is
severe, it can manifest
itself in what weve
come to nickname The
Hollywood Heart Atack,
because it looks like the
dramatc type of heart
atack we see on TV and
in the movies.
Special Report 3 newsmaxhealth.com
feel right. Fortunately, she came to see me. I performed some cardiac tests and
it turned out it wasnt age at all; she was on the brink of sufering a massive
heart attack.
3
indigestion or heartburn
One of the challenging things about chest pain is that it ofen doesnt
feel like chest pain. Sometimes it feels like indigestion, or even
heartburn.
Take Jack, for instance. Hes a top-ight salesman with a heavy travel
schedule. He was in the habit of closing a deal by going out for a big dinner,
with a couple of scotch-and-sodas followed by a thick steak. So he wasnt
particularly surprised when he started experiencing indigestion. But on
one occasion, it wasnt indigestion; this was the early warning sign of an
impending heart attack.
How is it that pain from your heart can be felt somewhere else? Because
we dont actually perceive pain directly. Even if you stub your toe, the
discomfort you feel is rst interpreted through our central nervous system,
which is comprised of the brain, spinal cord, and nerve cells.
Because the nerves in the stomach are located near the heart, its not
surprising that such signal confusion sometimes occurs in the case of a heart
attack.
4
nausea and vomiting
Nausea and vomiting are ofen classied as atypical symptoms of heart
attack, meaning they dont usually occur. However, in the thousands
of patients Ive treated, I nd that they are really not that uncommon at all.
Nausea and vomiting can occur alone, but they ofen also occur with other
heart attack symptoms.
Obviously, having any one of these symptoms does not necessarily mean
you are having a heart attack. But if you believe you are having a heart attack,
call 911 and ask to be taken to the nearest hospital.
Nausea and vomitng
are ofen classifed as
atypical symptoms.
but in the thousands of
patents Ive treated, I fnd
that they are really not at
all uncommon.
Angina Pectoris: Classic
Chest Pain
Chest pain can have many
other causes besides heart
atack. People who have
coronary artery disease
ofen experience a type of
chest pain known as angina
pectoris, or simply angina.
This occurs when the heart
has to work extra hard to
pump blood throughout
the body. Other symptoms
include pressure, heaviness,
or tghtness in the chest.
4 Special Report drcrandall.newsmax.com
Do not attempt to drive yourself, or allow someone to drive you because
you could require emergency treatments that can be started in the ambulance.
Why Knowing These Four Things Is So Important
Most people who have a heart attack will tell you it happened suddenly
right out of the blue. However, I can tell you from experience (including
my own near heart attack) that the vast majority of heart attacks dont happen
that way. In fact, the symptoms of an impending heart attack can occur
gradually, and stretch out over days, weeks, or even a month or two.
So you have to know this information in order to recognize the symptoms
of heart disease as early as possible. By the time you have a heart attack, it
could be too late.
While its true that most people do survive a heart attack, they also can
experience permanent damage to their heart muscle. Or, during an attack, the
heart can go into an irregular rhythm, which can result in cardiac arrest or
sudden death.
So dont wait for that heart attack learn the symptoms of a heart attack,
so, if they occur, you can seek medical help.
Additional Signs of a Heart Attack
Now that Ive given you the Four Major Things that happen before a heart
attack, heres a rundown of some other symptoms you might experience:
Discomfort that spreads to the shoulders, arm, back, neck, or jaw
Indigestion, heartburn, or a choking feeling
Profuse sweating
Rapid or irregular heartbeat
Dizziness, weakness, or lightheadedness
Vague, general feeling of illness
Anxiety or a feeling of doom
Passing out
The vast majority
of heart atacks dont
come on suddenly
right out of the blue. In
fact, symptoms of an
impending heart atack
can stretch out over days,
weeks, or even a month
or two.
Blood Flow
Blood Flow
Plaque
The Infammatory
Response
When faty deposits
start building up
inside the arteries,
the vessel narrows.
This buildup of
plaque reduces the
blood fow through
the artery and also
irritates the arterial
wall, resultng in
calcifcaton or
hardening of the
arteries.
Narrowed Artery Normal Artery
Special Report 5 newsmaxhealth.com
Obviously, some of these are very general, and may indicate a less serious
condition such as a respiratory infection or the u.
But they can occur with the four symptoms Ive seen occur more
commonly in the people Ive treated over the years for heart attacks.
You should also know that if youve already had a heart attack, you are at
increased risk to sufer another. The symptoms of another heart attack may
be the same as the rst, or they may be diferent, which is why its important
to consider symptoms carefully, and not to assume that they are not coming
from your heart.
Pre-Heart Attack Symptoms
As I noted, heart attacks rarely occur out of the blue. In fact, people may
experience symptoms four-to-six weeks before an actual attack. In fact, one
study showed that 78 percent of those who sufered a heart attack experienced
one of these pre-heart attack symptoms a month before the attack occurred.
Here are typical pre-heart attack, or prodromal symptoms:
Unusual fatigue
Sleep disturbance
Anxiety
Pain in the shoulder blade or upper back
Sweating
Irritability
The Four Major Heart Attack Risk Factors
Heart attacks can occur in people who have no known risk factors or
at least they think they dont. Upon reection, however, most heart attack
victims realize that they have one or more of the major risk factors.
If you do, this increases the possibility that, whether you experience one
of the Four Major Things that happen before a heart attack, or one of the less
common signs, you are indeed having a heart attack, or one is in the ofng.
About Chauncey
Crandall
C
hauncey W. Crandall,
M.D., F.A.C.C.,
is chief of the cardiac
transplant program at the
world-renowned Palm
Beach Cardiovascular
Clinic in Palm Beach
Gardens, Fla., where he
practices interventional,
vascular, and transplant
cardiology. Dr. Crandall
received his post-graduate
training at Yale University
School of Medicine,
where he also completed
three years of research
in the cardiovascular
surgery division. He
lectures nationally
and internationally on
preventive cardiology,
cardiological healthcare
of the elderly, healing,
interventional cardiology,
and heart transplants.
Known as the Christian
physician, Dr. Crandall
has been heralded for
his values and message
of hope to all his heart
patients.
The Coronary Arteries
Three main arteries
descend, like a crown,
from the hearts main
blood vessel, the aorta:
the right coronary artery,
the lef circumfex artery,
and the lef anterior
descending artery.
Blockages in these arteries
are the main cause of
heart disease, and can
lead to heart atack, heart
failure, angina, or cardiac
arrest.
Aorta
Right
Coronary
Artery
Lef Circumfex
Coronary
Artery
Lef Anterior
Descending
Artery
Blood Flow
6 Special Report drcrandall.newsmax.com
Heres a rundown of the major risk factors, so you can use them to
evaluate whether you are having a heart attack. Remember: even if youre
uncertain, its always best to call for help rst, rather than regret it later.
1
high blood pressure
High blood pressure, also called hypertension, is so common that its
now estimated that 1 in 3 Americans have this condition. Its also known
as a silent killer because it can cause its damage without your ever noticing
any symptoms at all.
Sometimes, high blood pressure can occur for no known reason, but ofen,
people who have it are overweight, have diabetes, smoke, or have a family
history of the disorder.
Men tend to develop high blood pressure earlier than women, but the risk
equalizes at about age 55. And afer the age of 75, women are at a higher risk.
Having high blood pressure means that your heart is working too hard
to pump blood throughout your body. Because of this, the heart becomes
enlarged and weakened. This condition also damages the coronary arteries,
leading to heart disease and, ultimately, heart attack.
2
diabetes
People with diabetes have a metabolic disease that hampers their ability
to transform sugar from the foods they eat into energy. The result is
a buildup of glucose in the blood, which damages both the heart and the
coronary arteries, along with the rest of the blood vessels and organs in the
body, including the kidneys, the eyes, and more.
Diabetes doubles the risk of a heart attack in men, and triples it in women.
The frightening thing about diabetes is that, like high blood pressure, it
does its damage silently, ofen for years, before its diagnosed. In fact, its not
uncommon for people to learn they have high blood pressure, diabetes, or
both only afer theyve sufered a heart attack.
Over the years, Ive helped scores of my patients not only manage their
diabetes, but even reverse it, by showing them a new way to eat and how to
build exercise into their lives, both which I will share with you in upcoming
newsletters.
3
high cholesterol
A heart attack happens when plaque, which is a fatty substance that
builds up in the walls of the coronary arteries, ruptures.
Those fatty deposits occur when there is too much cholesterol in the
blood. Your body manufactures cholesterol, but you also get it from the foods
you eat.
Eating a plant-based diet, not drugs, is the secret of bringing your
cholesterol level down to the lowest its been in years even possibly lower
than when you were decades younger.
In future issues of my newsletter, I will tell you exactly how to do that.
4
stress
Most doctors focus on the role that physical conditions, such as high
blood pressure, high cholesterol, and diabetes play in heart health, and
A Special Warning
For Diabetcs
D
iabetes can double
or even triple your
heart attack risk. But
it does something else
that is deadly as well:
Diabetes damages not
only your bodys organs,
it also damages your
nerve endings.
As a result, diabetes
can dampen the pain
signals that you may
ordinarily have felt,
including the warning
sign of chest pain that
signals you may be
developing heart disease,
or even be in the midst of
a heart attack! Ill tell you
how to make certain your
doctor keeps a close eye
on your heart, a factor
that, literally, can mean
the difference between
life and death!
Special Report 7 newsmaxhealth.com
Heart Atack Symptoms in Women
Women can experience the same
Four Main Things that happen before
a heart atack as men do, but they
are also likely to experience diferent
symptoms. Thats why the 435,000
American women who will sufer a
heart atack this year are less likely to
recognize it. Worse yet, their doctors
are less likely to recognize it, too!
Women can also experience
chest pain, but they are more
likely to experience symptoms that
are generalized and vague, like
indigeston, nausea, and fatgue. One
of the frst studies to recognize this
looked at 515 women, 43 percent
of whom felt no chest pain, and
the ones who did described it not
as severe pain, but as tghtness,
pressure, or an aching feeling upon
having a heart atack.
They also cited other symptoms,
including shortness of breath,
sweatng, and pain in one or both
arms, although this study found
sweatng more common in men.
The take-home message is this:
If you are female, at risk for heart
disease, and you are experiencing
symptoms, seek immediate medical
help, and make sure you are taken
seriously. Your life depends on it.
they tend to overlook the impact of stress.
But, over and over, Ive seen stress trigger heart attacks in my patients.
Stress can contribute to atherosclerosis. The cascade of hormones your
body releases when you are under stress can also trigger a deadly heartbeat
irregularity.
So I always take stress seriously, and, in my newsletter, I will share some of
the ways to reduce it.
Additional Risk Factors
Reversing the four major risk factors Ive just outlined are key to your
protecting your heart and winning a victory over heart disease. But there are
other important risk factors you can take control of as well. These include:
Obesity: Being overweight triples your risk of a heart attack. Obesity also
is a major factor in the cause of high blood pressure, diabetes, and high
cholesterol. When these three factors occur together, it creates a condition
known as metabolic syndrome. This greatly accelerates heart attack risk. In
fact, having metabolic syndrome is almost a guarantee that you will sufer a
heart attack.
Inactivity: Americans like to say they exercise, but a recent study using
pedometers to measure the amount of exercise that people actually did,
found that most exercise less than they say they do. A lack of exercise not only
contributes to the development of high blood pressure, diabetes, and high
cholesterol, but it is also a heart attack risk factor in itself.
Smoking: We think of smoking in terms of lung cancer or lung damage, but
smoking also causes major damage to your heart. In fact, it is a leading cause
of heart attacks. Every time you inhale cigarette smoke, you draw into your
lungs a mixture of 4,000 chemical substances, many of which are poisonous.
The only reason I dont list smoking as one of the Four Major Risk Factors
Being overweight triples
your risk of a heart atack.
Obesity is also a major risk
factor in the cause of high
blood pressure, diabetes,
and high cholesterol.
When these three factors
occur together, it creates
a conditon known as
metabolic syndrome.
43
%
Felt No Chest Pain
8 Special Report drcrandall.newsmax.com
for heart disease is because of the recent decline in the rates of smoking. But
I do know that many people still smoke. In fact, I see many of them in my
emergency room!
My Near Heart Attack Experience
Ten years ago, I had just returned to Palm Beach, Fla., from a speaking trip
in New York City. I had a pain in my shoulder, but I assumed I had strained it
carrying my luggage earlier that day.
The pain didnt go away, though. In fact, it continued to build. By the next
day, it had spread to my chest. I went for a walk with my wife, but I could
barely make it home. Gasping, I told her I had to go to the hospital.
I was rushed to the cardiac emergency lab, where one of my fellow
cardiologists performed an angioplasty procedure on me, to widen my lef
coronary artery, to restore the blood ow to my heart, and save me from what
would have been a massive heart attack.
That experience taught me a great deal about heart disease. I learned
rsthand that a heart attack doesnt necessarily feel like what people think it
does. It can begin like mine did, with a pain in my shoulder that felt exactly
like a pulled muscle.
Yes, sometimes chest pain can be the great masquerader, so its important
to know all about your heart, and by subscribing to my newsletter, youve
taken the very rst step!
Youve Taken the First Step
In the coming months, Ill provide you with all of the information you
need to take control of the health of your heart. Ill share with you my secrets
on how to prevent, manage, and even reverse the major causes of heart attacks.
Ill share with you the joys and benets of eating a plant-based diet, and
how you can get started on an activity plan that will lead you to a happier,
more satised life.
Ill also ofer you tips on how to reduce stress and share with you more
of my personal story, including how prayer and belonging to a religious
community gives me balance.
Also, through my newsletter, Ill show you a bit of the volunteer work that
enriches me, like the regular medical missions I lead to stamp out cholera in
hurricane-ravaged Haiti.
Afer all, the secret to living a contented life is more than just keeping
track of blood pressure or cholesterol numbers. Rather, regaining and
maintaining your good heart health is the rst step to living a vibrant, full life.
Welcome aboard. o
The secret to living a
contented life is more
than just keeping track
of blood pressure or
cholesterol numbers.
Rather, regaining and
maintaining your good
heart health is the frst
step to living a vibrant,
full life.
Please note: All informaton presented in Dr. Crandalls Heart Health Report is for informatonal purposes only. It is not specifc medical advice
for any individual. All answers to reader questons are provided for informatonal purposes only. All informaton presented in Dr. Crandalls Heart
Health Report should not be construed as medical consultaton or instructon. You should take no acton solely on the basis of this publicatons
contents. Readers are advised to consult a health professional about any issue regarding their health and well-being. While the informaton found
in Dr. Crandalls Heart Health Report is believed to be sensible and accurate based on the authors best judgment, readers who fail to seek counsel
from appropriate health professionals assume risk of any potental ill efects. The opinions expressed in Dr. Crandalls Heart Health Report do not
necessarily refect those of Newsmax Media.