What's a sign of heart attack? Anything

Former Mayor R.T. Rybak was in obvious good health when he suffered a serious heart attack last weekend. If someone as seemingly fit as Rybak could be vulnerable, who is safe?We asked two Mayo cardiologists for perspective on heart disease.

Some highlights from that conversation:

Dr. Charanjit Rihal on symptoms of a heart attack:
"No, sometimes pain is not associated with the symptoms. The classic thing that we're taught in medical school is sort of the crushing, central chest discomfort. Men who are not diabetic tend to experience that. But heart attacks can present in many, many different ways. They can be a sharp pain, they can be an abdominal pain — you can actually have stomach pain from a heart attack — or shortness of breath, with little else. In brief, any new or unusual symptom could be a heart attack till proven otherwise."

Dr. Sharonne Hayes on risk factors and family history:
"We can check cholesterol, we can talk to people about their lifestyle, we can identify whether they were smokers or not. But even if we take all of those risk factors, we still have a large group, a large percentage of people who develop heart disease, that we don't have a good reason. They don't even have a family reason. So I think we're imperfect in being able to predict. I have a strong family history of heart disease. My father had a heart attack in his early 40s, and his father died in his sleep at 43. I fortunately don't have any signs and symptoms yet, but obviously, I believe in the strong family history aspect. ... Family habits sometimes are inherited too, whether it's smoking or an early diet that was unhealthy. I like to tell patients that your genes aren't your destiny, because you can change many of the things that maybe you got through association rather than your genes."

Rihal on throwing in the towel:
[Lifestyle] really matters tremendously. Our activity level, the blood pressure, the blood sugar, the salt intake, the blood cholesterol — all of these things are within our control. So there's no need to throw in the towel and say, Just because I have a bad family history, I can't do anything. That's not the right approach. And in fact, people who are fit and leading a healthy lifestyle — they're not immune from heart disease, but you know what? Maybe they prevented it for the last 10 or 20 years. Maybe it would have presented 20 years ago, we don't know. I think we would both advocate that all of us do what we can to lead a healthy lifestyle, eat the right foods, and minimize our risk factors.

According to the Centers for Disease Control and Prevention:

• About 600,000 people die of heart disease in the United States every year — that's 1 in every 4 deaths.
• Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease in 2009 were in men.
• Coronary heart disease is the most common type of heart disease, killing more than 385,000 people annually.
• Every year about 715,000 Americans have a heart attack. Of these, 525,000 are a first heart attack and 190,000 happen in people who have already had a heart attack.