What can 007 teach you about heart attacks?

As an Englishman of a certain age, I grew up with the fictional character 007. Hero or not, Commander James Bond hardly lives a healthy lifestyle—in Ian Fleming’s tomes, he smokes like a chimney and it is only in recent years the screen persona has become smoke free. Britain’s favorite secret agent is almost certainly an alcoholic; his diet is high fat and low fiber; and his driving habits would almost certainly see him banned from the streets. Does he ever actually sleep? How he finds the time to battle evil villains is beyond me.

Given his lifestyle, 007 is more likely to succumb to a heart attack than a bullet. This is the same disease that kills more people than any other disease, and it is a source of endless grief to pilots—either ending their days in the left seat or ending their days.

Simply put, one or more of the arteries supplying blood to the heart becomes occluded by fatty or calcified deposits, which may become inflamed, peel back, and block the vessel. As a result, no blood can get to the area of heart muscle supplied by that artery and the muscle dies. This causes gripping chest pain that may travel up into the neck and down into the arm, nausea, sweating, feeling weak and faint, and difficulty breathing. Or not. Sometimes heart attacks cause the ticker to stop pumping and that, as they say, is that. But sometimes it causes no symptoms at all, and that is a problem.

Hang on a second—if heart attacks sometimes cause no symptoms, how would one know that a heart attack had happened? Well, at a later date there may be a diagnostic heart test such as an electrocardiogram or angiogram that would reveal old damage. Or the poor unsuspecting soul may die another day, and during the autopsy the spectre of evidence is there for the pathologist to see. But that doesn’t help you.

As a doctor, I don’t want to live and let die; I can let you in on a secret because I am not on Her Majesty’s Secret Service. Recently, doctors from Wake Forest studied 9,498 middle-aged men and women and over the course of 10 years, 7.4 percent had a heart attack that was silent in 45 percent of cases. In other words, there were no symptoms in roughly half the cases and that means these patients did not get the benefit of modern medical treatment that can change the course of the disease.

But I can provide a quantum of solace for you: A heart attack need not mean that the sky has fallen, or that you have fallen from your days in the sky; if one presents to the hospital as a heart attack is developing, skilled physicians can navigate a tube into the blocking vessel, extract or expand the gunk that is impeding flow, and re-establish patency with a stent that holds the vessel open. Doctors also can initiate medical therapy to treat high blood pressure, high blood fats, recommend an exercise program, and change people’s diet and other habits. If you don’t tell the medical profession you have a problem, well they can’t help you. To pull a quote from Goldfinger, “Do you expect me to talk?” The response is, “No Mr. Bond, I expect you to die!”

And indeed, the data from this recent study confirm the suspicion: Silent heart attacks have a licence to kill and within 10 years, 58 percent of women are dead and 23 percent of men have succumbed, much higher than patients who get treated early for angina, or fully developed heart attacks. Why are women more than twice as likely to suffer this fate? Several reasons—they have smaller vessels; the disease behaves differently; and doctors have traditionally thought of cardiovascular disease as a man’s ailment, although that is now changing.

The sequels of a heart attack can include heart failure, a rhythm disorder, or other problems that can take away your breath and your ticket to fly. So if you have any concern that the discomfort in your chest is not a pulled muscle, flu, or indigestion, don’t gamble your life at Casino Royale—get checked out because unlike 007, you only live once.

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Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.

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