HEART ATTACK

What is a heart attack?

A heart attack, or myocardial infarction, occurs when there is a loss of blood supply to the heart. The heart has the ever important job of pumping blood to all the organs of the body. This includes pumping blood to the coronary arteries, the blood vessels that encircle the heart and bring blood to the heart muscle.

All blood vessels, especially the coronary arteries, are prone to developing “plaques”. This is commonly called atherosclerosis. These plaques are build-up of fatty material on the inside of the vessels.

When a piece of the plaque breaks off, a clot can form around the area. If the clot blocks only part of the blood supply to the heart muscle, a person can have heart pain called angina. If enough blood supply is cut off, the heart muscle can be permanently damaged (a heart attack). A heart attack’s severity depends on how much of the heart tissue has been affected and how much time goes by without treatment.

Although not as common, heart attacks can also be caused by spasms in the coronary arteries.

Key points:

1. Build-up on vessels to the heart is known as atherosclerosis.

2. Blood clots can form on top of these plaques resulting in loss of blood flow to parts of the heart muscle.

3. A less common cause of heart attack is coronary spasm.

Symptoms

The classic symptoms of a heart attack are the following:

The pain can often spread up into the neck or jaw, down the left arm or into the back by the shoulder blades. The pain generally can last a couple of minutes to several hours.

Many people do not have these classic symptoms. Women, older adults and people with diabetes often have just one or two of the symptoms with very little pain.

Angina symptoms can be very similar. Often angina pain is brought on in times of exertion or stress and will go away with lying down quietly. You cannot tell the difference between angina and a heart attack by the symptoms.

Key points:

1. Aching or squeezing chest pain, especially with other symptoms, is very worrisome for a heart attack.

2. Some people do not have much pain but more trouble breathing or nausea.

Risk Factors

There are many well known risk factors for having a heart attack. While some can not be changed, many can be with lifestyle modification.

Unchangeable risk factors include the following:

Changeable risk factors include the following:
∑ Uncontrolled diabetes

Key points:

1. Most risk factors for heart attacks can be changed by close attention to following a healthy low fat diet and engaging in a regular exercise program.

2. Above all else – stop smoking!

How is it Diagnosed?

If you think you are having a heart attack – call 911. You must get to a hospital as soon as possible. Upon arrival, blood tests and an electrocardiogram (ECG) may be able to tell the doctor if you are having a heart attack. If this is the case, treatment can be started immediately to prevent any further damage to your heart.

Often the first tests come back normal and the doctor may want you to stay for further testing. This further testing is the only way to be sure the pain you were having is not from your heart. Tests can include catheterization (or angiography), stress echocardiography, or nuclear radiographic studies.

Key points:

1. Time is muscle. The sooner you get to the hospital after you start having symptoms, the better your chance of having minimal or no permanent damage to the heart.

2. Testing includes blood tests, electrocardiograms (ECGs), echocardiograms and cardiac catheterization.


What are the Treatments

Treatment begins with chewing a full strength aspirin. This is often given to the patient by paramedics en route to the hospital.

Upon arrival at the hospital, doctors may elect to use other blood thinners and heart medications to help prevent further damage to the heart. Such medications may include enoxaparin, nitroglycerin, tPA, epti-fi-batide, me-toprolol or other beta blockers, li-sin-opril or other ACE inhibitors, atorvastatin or other cholesterol medicine, and clopidogrel. Keep in mind that your doctor will decide which of these medicines are appropriate for you.

If the lack of blood flow is still occurring when you get to the hospital, a cardiologist may take you for an emergent cardiac catheterization. This allows your doctor to find exactly where the blockage is and shoot clot busting medication right into the blockage. If done quickly enough, permanent damage to the heart can be prevented. During a cardiac catheterization, the physician may also elect to perform a “balloon angioplasty” where a balloon is threaded through to the blockage and inflated to open up the artery. A “stent” (wire mesh tube) positioned within the newly opened artery can also be placed to help keep the artery open.

Sometimes patients may even require a coronary artery bypass grafting (CABG) procedure, a major surgical intervention.

Additional medications are often utilized, either during or after the heart attack, to help the heart recover. These drugs include beta-blockers (e.g. metoprolol, atenolol, carvedilol) and angiotensin converting enzyme inhibitors (ACE inhibitors) (e.g. ramipril, lisinopril, captopril. Some other medications include angiotensin receptor blockers (ARBs) (e.g. valsartan, losartan, candesartan) and lipid lowering medications such as HMG CoA reductase inhibitors (statins) (e.g. atorvastatin, lovastatin, simvastatin).

Your doctor will decide medicines are right for you.
Key points:

1. Aspirin and other medications are standard of care.

2. Emergent cardiac catheterization may be required.

3. Some patients may require CABG surgery.

4. Those recovering from a heart attack often receive additional medications which help the heart heal.


Complications

Once you have suffered a heart attack, you are at higher risk for other heart problems. You are at risk for another heart attack. If enough damage is done, you may develop heart failure, where the heart is not strong enough to pump all the blood , and fluid can collect in the lungs and legs.

You can also be at risk for heart rhythm problems. Many of these can be managed safely with medication but some kinds of rhythm problems can be life threatening. Your cardiologist can tell you more about your risks for rhythm problems based on the amount of damage to your heart.

Key points:

1. All of these complications can be managed with medicine or other devices, so it is essential to take the medicines as prescribed by your doctor.

Tips or patients:

References:

American Academy of Family Physicians
American Heart Association

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