Heart Attack / Myocardial Infarction

Medically termed as Myocardial Infarction, heart attacks are one of the most commonly occurring results of coronary artery disease. Coronary artery disease or coronary heart disease is a condition which involves accumulation of a waxy substance known as plaque building up inside coronary arteries. Eventually, these are the arteries which supply oxygen-rich blood to the muscles of the heart which are essential to function. This build up of plaque inside arteries is medically known as atherosclerosis & gradually occurs over several years. Quite often plaque can break open inside artery & cause formation of a blood clot on the surface. Over time this can become large enough to partly or completely stop blood to flow through the coronary artery. When this blockage is not treated quickly, portion of heart muscle which is fed through this artery begins to die & thereby the healthy heart tissue is replaced by scar tissue. This damage to heart may either be obvious or cause severe long lasting problems.

What is Heart Attack?

Heart attacks generally happen when flow of oxygen-rich blood suddenly stops to a section of the heart muscle. Eventually, this section of the heart begins to die in case blood flow is not quickly restored. Treatments for heart attacks work best only when they are given soon after symptoms begin to occur. It would be the most sensible solution to call a doctor right away even when the situation is unsure.

Causes of Heart Attacks

Most heart attacks are found to occur due to hardening of arteries which over time get clogged with fatty & calcified plaques. Typically, they trigger a heart attack resulting from a blood clot blocking flow of blood through the coronary artery. Doctors now recognize that it is less severe plaques which cause most cases of heart attacks, when these milder blockages rupture & cause formation of blood clots. Heart attacks are also rarely caused by coronary artery spasms temporarily constricting heart arteries. Moreover, inflammation is also found to play a role in causing heart attacks. Sometimes, walls of coronary arteries become inflamed & subsequently increase build up of fatty plaques. Heart attacks can also lead to severe life-threatening health problems like arrhythmias & heart failure. Heart failure is usually a condition where the heart is unable to pump enough blood which is required to meet the demands of the body. Arrhythmias are irregular beats of the heart & ventricular fibrillation is a type of life-threatening arrhythmia which can also cause death if it is not immediately treated.

Risk Factors for Heart Attack

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There are several risk factors which contribute to excessive build up of fatty deposits which narrow the inner passage of arteries all around the body. Improving or eliminating these risk factors can, therefore, reduce chances of a person having heart attacks. Some of these risk factors include the following.

  • Age – Men older than 45 years & women older than 55 years are more likely to have heart attacks than men & women who are younger.
  • High Blood Pressure – This can over a period of time damage arteries which feed the heart by accelerating build-up of plaque. Moreover, high blood pressure which normally occurs with smoking, obesity, diabetes or high cholesterol raises risk even higher.
  • Diabetes – Not producing enough insulin or inability to respond to insulin, like in the case of diabetes will cause blood sugar levels to rise in blood. Therefore, uncontrolled diabetes will invariably raise risk of heart attack.
  • High Blood Cholesterol (Triglyceride Levels) – Higher levels of LDL (low-density lipoprotein) cholesterol will eventually narrow arteries. Higher triglyceride levels, which is blood fat relating to diet, also raise risk of heart attack. However, HDL (high-density lipoprotein) lowers risk of heart attack.
  • Tobacco – Smoking, including long-term exposure to secondhand smoke, generally increase the risk of a person having a heart attack.
  • Family History of Heart Attacks – When parents, grandparents or siblings have had heart attacks before 55 years of age for male relatives & 65 years of age for female relatives, will pose an increased risk of a person have heart attack.
  • Stress – Responding to stress in certain ways can increase risk of a person having heart attack.
  • Obesity – Generally associated with diabetes, high blood pressure, high triglyceride levels & high blood cholesterol levels, losing just 10 percent of the body weight can lower risk of heart attack in obese people.
  • Lack of Physical Activity – Inactive lifestyle eventually contributes to obesity & high blood cholesterol levels. Getting regular aerobic exercise will better cardiovascular fitness & will eventually decrease overall risk of heart attack. Exercise is also a good method for lowering high blood pressure.
  • History of Preeclampsia – This condition generally causes high blood pressure during pregnancy & which subsequently increase the lifetime risk of heart disease & heart attack.
  • History of Autoimmune Conditions Like Lupus or Rheumatoid Arthritis – Both these conditions, as well as other autoimmune disorders, increase the risk of a person having heart attacks.
  • Illegal Drug Use – Certain stimulants like amphetamines & cocaine can trigger spasms within coronary arteries so as to cause a heart attack.

Tests & Diagnosis for Heart Attack

In fact, doctors as a norm should screen patients during a regular physical examination for risk factors leading to heart attack as well. This will identify patients in an emergency setting for symptoms of heart attack. Symptoms of such patients & their pulse, blood pressure & temperature will be checked. They will be connected to a heart monitor & undergo tests to evaluate if they are likely to have a heart attack. These tests are meant to check for signs & symptoms indicating heart attack, chest pain or some other cardiac condition. Moreover, cardiologists would take immediate steps to treat the condition when a heart attack is occurring & may take additional tests in such cases. Some of these tests include the following.

  • Electrocardiogram (ECG) – This is perhaps the first test which is performed for diagnosing a heart attack. It is designed to record the electrical activity of heart with help of electrodes attached to skin. During the procedure, impulses are recorded as waves. Since injured heart muscle will not normally conduct electrical impulses, it is possible that ECG may reveal if heart attack is in progress or has occurred earlier.
  • Blood Tests – There are certain heart enzymes which slowly leak into the patients’ blood when the heart is damaged by heart attack. Cardiologists will, therefore, take samples of the patient’s blood in order to test for the presence of these enzymes.

Additional Tests

  • Chest X-Ray – These images of chest will allow cardiologists to check size of heart & blood vessels, Doctors can also look for fluid within lungs with chest x-rays.
  • Echocardiogram – Sound waves are directed at heart from a transducer held on the patient’s chest. Waves bouncing off the heart are electronically processed to provide video images of heart. Echocardiograms help identify whether any area of heart has been damaged by heart attack & if the heart is at peak capacity & not pumping normally.
  • Angiogram (Coronary Catheterization) – This procedure involves a liquid dye which is injected into arteries of heart through a catheter fed through an artery in groin or leg, all the way to arteries in the heart. This dye is meant to make arteries visible on x-rays while revealing areas of blockage.
  • Exercise Stress Test – Most patients also undergo an exercise stress test in days or weeks following heart attack. These stress tests are meant to measure how heart & blood vessels are able to respond to exertion. Patients are made to walk on a treadmill or pedal stationary bike while they are attached to an ECG machine. Some patients may also receive a drug intravenously so as to stimulate the heart which is quite similar to exercise. Cardiologists sometimes also order a nuclear stress test. This test is similar to exercise stress test, but instead, it uses injected dyes & specialized imaging techniques in order to produce detailed images of the heart during exercise. A nuclear stress test is meant to help determine a long-term treatment plan.
  • Magnetic Resonance Imaging (MRI) or Cardiac Computerized Tomography (CT scan) – Both these tests are commonly used for diagnosing heart problems, including measuring the extent of damage caused by heart attacks. Patients will lie on a table inside a tube-like machine generating a magnetic field during cardiac MRI. Magnetic field aligns atomic particles within some of the patients’ cells while radio waves are broadcast towards aligned particles. These produce varying signals according to the type of tissue as they create images of heart. Heart patients are made to lie on a table within a doughnut-shaped machine in cardiac CT scan. There is an x-ray tube inside the machine which rotates around the patients’ body while collecting images of heart & chest.

Signs & Symptoms of Heart Attack

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Patients should not wait in order to get help while experiencing any of the following signs & symptoms of heart attack. While some heart attacks are found to be intense & occur suddenly, there are several others which start slowly along with discomfort or mild pain.

  • Chest Discomfort – Majority of heart attack cases involve discomfort experienced at the center of the chest. Lasting for more than a few minutes or going away & coming back, patients usually feel uncomfortable fullness, squeezing, pressure or pain.
  • Discomfort in Other Areas of Upper Body – This symptom of heart attack includes discomfort or pain in neck, back, jaw or stomach & in one or both arms.
  • Shortness of Breath – This is commonly felt during heart attack along with or without chest discomfort.
  • Other Signs & Symptoms – Other signs & symptoms of heart attack include lightheadedness, nausea & breaking out in cold sweat.
    However, some symptoms of heart attack typically vary between men & women. Like it is with men, women’s most common symptom of heart attack is also discomfort or chest pain. But then, women are more likely than men to experience other normal symptoms like jaw or back pain, nausea or vomiting & shortness of breath.
  • Angina is Early Warning Sign of Heart Attack
    Several victims of heart attack are in fact warned of impending trouble by episodes of angina. Angina is chest pain which is like in heart attack but provoked by ischemia, but mainly varying in degree. The flow of blood is restored & pain will recede within minutes without causing any permanent damage to heart with angina. However, with heart attack the flow of blood is critically reduced or completely blocked, pain will also last longer & heart muscle will die if prompt treatment is not made available immediately. Almost 25 percent of heart attacks are found to occur without any type of prior warning. This fact is usually associated with a medical phenomenon called ‘silent ischemia’ involving sporadic interruptions in flow of blood to heart. For unknown reasons ‘silent ischemia’ is pain-free even though it may damage heart tissue. Most often it is people with diabetes who are found to have ‘silent ischemia’. In some other cases, heart attacks are also mistaken for reflux disease (heartburn) or flu.

Treatment Options for Heart Attacks

More heart tissue will lose oxygen & deteriorate or die with each passing minute following a heart attack. The only way to prevent further damage to heart is to restore flow of blood as soon as possible.

  • Medication Options
    Medications which are given to patients as a treatment for heart attack include the following.

    • Aspirin – Aspirin is immediately given to a heart attack patient while they are on the way to the hospital. It will help in reducing chances of blood clotting & even help maintain flow of blood to narrowed arteries.
    • Anti-Platelet Agents – These are given by doctors in the emergency room as the patient arrives at the hospital for treatment. Anti-platelet agents help prevent the formation of new clots while restricting existing clots from getting larger. Most common platelet aggregation inhibitors include clopidogrel (Plavix) & others.
    • Thrombolytics – Also known as clot-busters, thrombolytic drugs help in dissolving blood clots which are blocking the flow of blood to heart muscles. The sooner a patient receives thrombolytic drug following the heart attack, greater are the chances that they will survive with lesser damage to the heart.
    • Other Blood Thinning Medicines – The other most common blood thinning medication a heart attack patient will receive is heparin. This will make bloodless ‘sticky’ & therefore less likely to form blood clots. Heparin is administered intravenously or subcutaneously through an injection under skin.
    • Pain Relievers – Heart attack patients receive a pain reliever like morphine in order to ease discomfort.
    • Beta Blockers – These are medicines which help in relaxing the heart muscle by decreasing blood pressure & slowing the heartbeat. Beta blockers are known to limit the amount of damage to heart muscle while preventing the possibility of future heart attacks.
    • Nitroglycerin – This is a medication which is normally used as a treatment for angina (chest pain) & will also help in improving flow of blood to heart muscle by dilating (widening) blood vessels.
    • ACE Inhibitors – These are medications which reduce stress on heart by lowering blood pressure.
  • Surgery & Other Options
    Heart attack patients may undergo any one of the following procedures as treatment for heart attack in addition to the medications mentioned above.

    • Coronary Angioplasty & Stent PlacementDuring this procedure, cardiac surgeons will insert a catheter (long & thin tube) passed through an artery in groin or leg, all the way to the blocked artery in heart. This procedure is most often performed for heart attack patients immediately after cardiac catheterization procedure which is meant to locate blockages. This catheter is equipped with a balloon that is inflated at the blocked site so as to open the coronary artery. A metal mesh stent is also inserted into artery & installed at blocked site in order to keep the artery open in long term & restore flow of blood to heart. Depending upon individual requirement of the case, cardiac surgeons may decide to place stents which are coated with slow-releasing medications which are helpful in keeping the artery open.
    • Coronary Artery Bypass Graft Surgery (CABG) – Cardiac surgeons in some emergency cases may opt for CABG surgery at the time of heart attack. They may suggest that the patient undergo this procedure after about 3 – 7 days of time following recovery from heart attack. CABG surgery involves sewing artery or vein grafts in place beyond narrowed or blocked coronary artery so as to allow flow of blood to heart to bypass the diseased section. The heart attack patient will remain in hospital for several days after flow of blood to heart is restored through CABG surgery & the condition is stable.

Recovery Following Heart Attack

Patients have a better chance of full recovery if they have survived the initial heart attack & remain free of major problems after a few hours of time. However, recovery is a delicate process due to the fact that any heart attack will weaken heart to some extent. Nevertheless, normal life can always be resumed.

Complications Following Heart Attack

Heart attack patients may experience the following complications depending upon the severity of the event.

  • Abnormal Heart Rhythms (Arrhythmias) can develop abnormal heart rhythms & which can also be serious, or even fatal in some cases.
  • Heart Failure (when heart is unable to pump enough blood to fulfill requirements of the body). Heart failure may either be temporary or a chronic condition following extensive & permanent damage to heart.
  • Heart Rupture – Sometimes, some areas of heart are so weakened by heart attack that they can rupture so as to leave a hole in part of heart. This also is fatal most often.
  • Valve Problems – Heart valves can also get damaged during heart attacks & develop severe problems like leakage.
  • Sudden Cardiac Death or Cardiac Arrest (when heart stops beating)
  • Cardiogenic Shock (patient goes into a shock when heart is damaged from heart attack; this may result in damage to other vital organs like liver or kidneys)
  • Death

Preventive Measures for Heart Attacks

It is always welcome to take preventive measures for heart attacks including patients who have already experienced one. Some effective steps to take in this direction include the following.

  • Medications – There are medications which are meant to reduce risk of having another heart attack. Moreover, these medicines also help the damaged heart function better. However, heart attack patients must continue to take medications which doctors have prescribed & enquire with them as to how often they need to be monitored.
  • Changes in Lifestyle – These preventive measures for heart attack include maintaining healthy weight along with a healthy diet. It would also be sensible to quit smoking, exercise regularly & effectively manage stress. When conditions like diabetes, high cholesterol & high blood pressure are not controlled, they can lead a person to heart attack.

Coping & Support for Heart Attack Patients

Heart attack is a scary experience for anyone. There are many questions which come to a patient’s mind following heart attacks. Here are some suggestions which can help heart attack patients cope with physical & emotional demands.

  • Dealing with Emotions – Depression, guilt, anger & fear are all commonly associated with heart attack. Opening out & discussing these with a friend, family member or a doctor can be very helpful. Heart attack patients can also consider talking to a counselor or joining a local or online support group. Moreover, it is very important that a heart attack patient should mention signs & symptoms of depression to doctors. Doctors may suggest cardiac rehabilitation programs which can be extremely effective in prevention or treatment of depression associated with heart attacks.
  • Attending Cardiac Rehabilitation – Several hospitals nowadays offer cardiac rehabilitation programs while they are still at the hospital. Duration however depends upon severity of the heart attack & which may continue for weeks to months even after the patient has returned home. These rehabilitation programs typically focus upon four main aspects which include gradual return to normal activities, emotional issues, lifestyle changes & medications following heart attack.

Sexual Activity Following Heart Attack

Although some heart attack patients worry about indulging in sexual activity following heart attack, most patients safely return to normal following recovery. As to when it is safe for a patient to resume sexual activity normally depends upon psychological preparedness, previous level of sexual activity & present physical comfort of the heart attack patient. However, some medications prescribed for heart attack patients may affect sexual function; therefore, people having sexual dysfunction should talk to doctors about it.

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