By Frank Hubbell, DO

Illustrations by T. B. R. Walsh

Unfortunately, heart attacks and premature death due to heart disease are very familiar problems, not only in the USA, but also, around the world.  Very common calls for EMS and for emergency departments in hospitals, they are universal issues. Heart problems occur in all environs, from urban to rural to austere. If you have a heart, you are at risk of heart disease.

US Data from the Center for Disease Control – 2104 Cardiovascular-system-copy

Cardiovascular Disease (CVD):

CVD includes:

coronary artery disease (CAD)

hypertension (HTN),

congestive heart failure (CHF)

heart failure

dysrhythmias (irregular heart beat)

valvular disease

stroke – cerebrovascular disease (CVA)

Since 1900, CVD has been the #1 killer in the US except for 1918 (Spanish flu).

600,000 Americans die per year from heart disease.

380,000 Americans die from an Acute Myocardial Infarction – “heart attack.”

1 in 4 Americans or 25% of all deaths in US are due to CVD.

1 in 4 (80 million) Americans have some form of CVD.

Men have a higher incidence of CVD until age 65, then women have a higher incidence.

An estimated 720,000 Americans will have a heart attack in 2014.

Of that number, 515,000 people will have their first heart attack in 2014, and

205,000 people will have a recurrent heart attack.

Cardiovascular Disease Terminology:

Arteriosclerosis: A disease of the arteries with thickening, hardening, and loss of elasticity in the arterial walls.

Atherosclerosis: The most common form of arteriosclerosis, marked by cholesterol-lipid-calcium deposits in arterial linings.

Coronary Artery Disease (CAD): Narrowing of coronary arteries sufficient to prevent adequate blood supply to the heart muscle.

Angina Pectoris: Pain around the heart caused by deficiency of blood supply to the heart.

Acute Myocardial Infarction (AMI): The condition caused by partial or complete occlusion of one of the coronary arteries. Infarct refers to a blood vessel that has been occluded by a blood clot, emboli, resulting in ischemia (lack of blood flow and oxygen) to the myocardial cells distal to the infarction.

Acute Coronary Syndrome (ACS): A collection of symptoms that can indicate a possible myocardial infarction, but before a definitive diagnosis has been made. This includes angina pectoris and acute myocardial infarction.

Clinical Death: Patient without a pulse.

Biological Death: Occurs within 10 minutes of clinical death due to lack of oxygen to the brain.

Sudden Cardiac Death (SCD):

SCD occurs when the heartbeat stops abruptly and unexpectedly, unassociated with any immediate illness or injury.

Most common underlying cause of SCD is a heart attack that results in ventricular fibrillation (V-fib).

80 % of SCD occurs at home; 60% are witnessed.

Approximately 95% of SCD victims die before reaching the hospital.

Read more

A 40-something fit athlete has a heart attack

Well there it was; blunt news of a friend’s near death. Malcolm Daly (pronounced “daily”), president of the climbing gear company Great Trango Holdings, Inc. and a well-known figure in the US climbing community, had suffered a serious heart attack while ice climbing in Colorado. The email was brief but ended with a typically upbeat assessment by Malcolm:

All I’ve had to do is relax so; I’m getting antsy. Time to think about some exercise…again.

Daly’s story is compelling, scary, and hopeful. It’s compelling because he is like many of us: relatively young (40-something), quite fit, and with no serious family or personal history of heart problems. It’s scary because he is like many of us, and he almost died. It’s hopeful because Malcolm’s recovery is progressing well, and we can all learn from his experience.


July/August 2004   ISSN-1059-6518   Volume 17 Number 4

Read more

Problems with the Pump

September/October 2002   ISSN-1059-6518    Volume 15, Number 5

Disclaimer: The content of the Wilderness Medicine Newsletter is not a substitute for formal training or the recommendation of an expert. The authors, editors, and artists are not responsible for inaccuracies.

Cardiac Risk, Assessment, and Management in the Backcountry

By Brad Boehringer, (W)EMT-B

Every 33 seconds, nearly a million times a year, someone will die as a result of cardiovascular disease (CVD). Cardiovascular disease is the leading cause of death in the United States among men and women of every race. In 1999 it accounted for 1/3 of deaths globally. If you spend time in the wilderness, it’s not far fetched to predict that you may encounter someone having a cardiac event.

As our understanding of CVD has increased, it has become clear that it is well within our capabilities to reduce our risk of suffering from this increasingly common problem. Unfortunately, as care providers it is all too common that we see and deal with CVD in a reactionary instead of prophylactic way. Our role in prevention diminishes. On this premise we must become attuned to recognizing the signs of a possible cardiac event and know what we can do as basic life support providers to help.

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