Massive chest pain. Shortness of breath. It feels as if there's an elephant crushing your chest. The pain may radiate to the left arm and/or the jaw.

A heart attack is the layman's term for a myocardial infarction, which is damage to the heart caused by a blocked coronary artery resulting in an area of heart muscle becoming starved of oxygen and nutrients.

This is one of the biggest causes of death worldwide.

When I was in my first year of grad school at Indiana University, my next door neighbor in the dorm was a woman named Cathy. She was a cute, slender 23-year-old who didn't drink, smoke or do drugs and who regularly worked out.

And she had a heart attack over spring break.

She was swimming at the university's gym when she started having severe chest pains. Worried, she dried off and drove herself to the hospital, where the doctors discovered she was in the middle of a myocardial infarction.

The doctors were mystified by her heart attack. She has no family history of heart trouble, and she was young and healthy. At first, they thought it might have been caused by her swimming in cold water (this makes the blood vessels constrict and could cause a clot.)

But then they discovered that her arteries were clogged. She later told me, "The doctor said I have the kind of plaque in my arteries that you expect to see in somebody three times my age."

So the doctors did an angioplasty -- the ran a little balloon on a catheter up from the vein in her leg to the clog and inflated the balloon to try to open the artery. It didn't go well; she had more chest pains and had some spasms. They discovered that she had a clot in her heart.

One of her doctors, C.A. Pinkerton, is a well-known cardiac surgeon. He decided to try what was at the time an experimental procedure: another angioplasty, but this time the balloon carries with it a little spring, very much like the spring inside a retractable ball-point pen. When the balloon is inflated, it puts the spring into the artery, and the spring stays there to keep the vessel open.

The procedure worked, and Cathy was out of danger. She ultimately spent several weeks in the coronary care unit at St. Vincent's in Indianapolis, which I have been told is one of the best facilities of its kind in the nation.

So far, she is doing okay. The last time I talked to her she told me the doctors think she'll be able to live a full life. They decided she'd either inherited a bad gene or had a mutation that caused her to have extremely high blood cholesterol; as a result, she was going to have to be on a very restricted diet for the rest of her life.

So I guess the take-home message is this: take chest pains seriously, even if you're young and fit and female.

There are several established treatments for heart attacks. These all relate to the cause of the attack which is stenosis or blockage of a coronary artery. The material of these stenoses are often called plaque.

The first and oldest treatment, is AVG or autogenous vein graft bypass surgery, commonly called, a bypass graft. This is invasive, required up to six months of recovery time and the patient is susceptible to infection. They simply splice a vein from the patients leg around the blockage in the coronary artery.

The second treatment is PTCA or percutaneous transluminal coronary atherectomy, commonly called angioplasty. This involves a balloon inflated with fluid at the end of a catheter deployed into the femoral artery up through the aorta and into the coronary artery and blockage. This is less invasive than bypass surgery and the patient can be discharged in a day or two post operatively.

The third treatment is called a stent which is an internal tubular cage that is deployed on the PTCA balloon inflated and left in the patient's blocked artery to hold it open. These have the advantage of maintaining the viability of the vessel for much longer than the angioplasty however, both angioplasty and stenting have high rates of reblockage or restenosis (upwards of 60%).

The most recent method of treatment is a debulking catheter. This is deployed identically to the angioplasty catheter but instead of a balloon it has a retractable blade and works similarly to a carpenter's wood plane by shaving plaques off, containing them in the catheter and removing them from the patient.

Two words which every man fears.

Maybe its the neatly boxed quizzes in his mom's Reader's Digest which carelessly sum up the fact that both nature and nurture have combined against him. Perhaps its the half-page articles in the 5-parts-pop-culture-1-part-health magazines that show some serious washboard abs next to a bold red font exclaiming their latest sex secrets. It could be the collective unconscious spewing forth years of evolutionary guidance touting the fact that nobody's uncle lives past the age of 40.

Whatever it is that preserves and promotes the constant underlying phobia streaming through a man's veins, the last place he wants to find himself is lying closed casket-style on frigid surgical table with leech like tubes crawling into his chest cavity.

He remembers watching on the Discovery channel the neatly folded blue surgical drapes that dehumanize the fleshly hole that contains the victim's most important muscle on a documentary praising the most serious of heart disease treatments. He can't seem to forget the placidly blank expressions emanating from the narrowed pupils of the manipulators of the latex gloves that moments ago sawed like a butcher through the protective cage surrounding the weakened vessel. These images haunt him at times unexpected, the anxiety pouring over him in those moments before sleep or in the middle of a quick jog where a small gas bubble sent a sharp but lasting pain through his rib cage.

It is in those times that those lost moments of empathy he once felt with his colleague at the office who was suffering the sudden loss of his father begin to return. He thinks about an argument he had with his wife or how he really doesn't have enough life insurance and how that chocolate-covered-double-fudge cheesecake from Applebee's probably was a little over-the-top considering he still hasn't lost that `spare tire' he picked up a couple of years after college. Then, like all good men do, he shrugs it off and files it away as a momentary weakness.

After all, he has tried to stay away from the forbidden cholesterol-ridden foods to only find that the numbers don't change unless your doctor prescribes Lipitor and last time he checked he wasn't a member of AARP. Sure, his blood pressure spikes every now and then but its probably just the 'white coat anxiety' or the 'pointy haired boss' stressing him out. "Modern medicine is a marvel" and someday he'll be able to pop a pill and clean his arteries out.

But just in case, he'll drink some red wine and swallow an aspirin every now and then. He will eat a few turkey subs from Subway each week and even hit the gym a few days a month. But this will only subdue his fear short-term, and he will continue to dread the day where he notices an unusual shortness of breath and a tightness in his chest that mark the beginning of his worst nightmare.

Because for some, it's inevitable.

Women display different symptoms!



