We used to think someone had to be old enough to qualify for Medicare to have a heart attack. When noted actor James Gandolfini's heart gave out in June at the age of 51, many people in the prime of life wondered whether they, too, might be vulnerable.

We used to think someone had to be old enough to qualify for Medicare to have a heart attack. When noted actor James Gandolfini's heart gave out in June at the age of 51, many people in the prime of life wondered whether they, too, might be vulnerable.

It's not so much that more people are having heart attacks earlier in life, Dr. Kent Dauterman says, but that people who keep poor health habits are far more likely to have a heart attack. Sometimes their habits catch up with people sooner rather than later, says Dauterman, who practices at Medford's Southern Oregon Cardiology.

"People who eat sausage and biscuits and gravy, who smoke and have diabetes and high blood pressure — it's probably much more likely they're going to have a heart attack," he says.

That said, Dauterman acknowledges he has treated some people who seem unlikely candidates for heart attack, including several women in their 30s and a slender woman in her 50s who ate a vegan diet. Then there was Michael Thomas, an Ashland physician who had no family history of heart attack.

Thomas was pruning roses on a hot day last summer when he began to feel pain between his shoulder blades. He charged it off to 54-year-old muscles that weren't accustomed to so much physical work.

After a while, the pain began to creep around toward his chest. He finished his work for the day, came inside and ate dinner with his wife. The pain persisted, rising and falling in waves. As a physician, he knew the telltale signs of a heart attack, but his symptoms didn't really seem to match — until he started sweating profusely.

"Then I knew what it was," he says. "I told my wife to call 9-1-1."

Emergency medical personnel from Ashland Fire & Rescue rolled up to Thomas's house and connected him to a portable electrocardiograph monitor.

"They came right into my living room and hooked me up," he recalls. "As soon as they saw (the results), they said 'Let's go.' "

Thomas was transported to Medford's Asante Rogue Regional Medical Center, where physicians found a totally blocked right coronary artery. They opened the blockage with a tiny balloon inserted through a blood vessel and placed a fine-mesh stent in the blocked artery to maintain blood flow to the heart muscle.

"Michael had a major heart attack, but he didn't suffer a lot of heart damage," says Dauterman, who treated him that day. Damage to the heart muscle was limited because Thomas called for help as soon as he thought he might be in trouble.

"He did the right thing," Dauterman says. "He promptly called the paramedics."

Dauterman says people who are having a heart attack often put themselves at greater risk because they fail to connect how they feel with what could be a life-threatening condition.

"That's the hard thing to sort out," Dauterman says. "There's not a neon light that goes on that says it's your heart."

Heart disease remains the No. 1 cause of death in the United States, but people who are having a heart attack often fail to seek care because they don't associate how they feel with a potentially fatal problem. Dauterman says only about 50 percent of heart attack patients feel one of the most common symptoms — the feeling of extreme chest pressure that's often described as "an elephant sitting on your chest."

Thomas says he never felt that particular symptom.

Dauterman says about 35 percent of heart attack patients feel what they describe as indigestion, and 10 to 15 percent have no specific symptoms other than a sense of generally feeling bad. The longer people delay seeking help — the longer the heart muscle is deprived of oxygen — the more likely they are to suffer damage to the heart muscle.

"Time is muscle," Dauterman says.

Smoking remains the biggest single factor that determines whether someone will have a heart attack. Dauterman says the vast majority of heart-attack patients he sees who are under the age of 50 are smokers. Thomas says he used to enjoy an occasional cigar, but he's given them up.

For many heart-attack survivors, their discharge from the hospital marks the end of their association with doctors and hospitals. Thomas went one step farther, and enrolled in RRMC's cardiac rehabilitation program, where he learned how to make the most of life after a heart attack.

"I had lots of lessons on diet changes," he says, especially about low-salt and low-fat foods.

He exercised on a treadmill and lifted weights while attached to a heart monitor.

"When we put that heart monitor on him, and he watched every heart beat, it gave him confidence his heart is working well, " says Beth Coker, an exercise physiologist at the cardiac rehab center. "We give (patients) the confidence to do whatever they want to do."

Thomas went to cardiac rehab twice a week for about four months. A year after his heart attack, he says he's lost about 20 pounds. He eats less red meat and more fish, fruits and vegetables. He's also cut down on fatty foods and given up greasy, salty snacks.

"I haven't had one chip," he says.

He exercises regularly, and his endurance has improved dramatically.

"It used to be that 10 or 15 minutes on a flat treadmill was a lot," he says "Now, 30 minutes with elevation is easy."

He knows he was fortunate not to suffer major heart damage.

"I had just come home from a four-day trip to visit family in a rural area," he recalls. "I was two hours away from any cardiac specialty center. My outcome could have been a lot worse."

Bill Kettler is a freelance writer living in Rogue River. Reach him at bdkettler@gmail.com.