Heart Attack Definition
Disturbance in which damage in the area of heart muscle occurs due its insufficient supply of oxygen.
Heart Attack Causes, frequency and risk factors
Causes are clot or spasm in one of the arteries that supply heart muscle with blood (coronary artery). Those and similar conditions block the supply of oxygen to heart area, leading to damage or death of cells in that region. This most often happens in coronary artery which narrows due to changes caused by aterosclerosis. Damaged tissues lose forever the ability to contract that part of heart muscle.
Risk factors include: smoking, hypertension, hypotension, diabetes mellitus, fat rich food, high concentration of blood cholesterol (LDL), obesity, people aged 65 and above as well as hereditary factor. In addition, the disease is more widespread among male population. Risk is further increased by personal or family tendency to coronary artery diseases, cerebrovascular disease, peripheral vessel diseases, angina (especially unstable angina) or weak kidneys requiring hemodialysis. “Trigger” for MI is sometimes, although rarely, can be a strong unexpected stress. In older people risk factor can be straining during defecation.
Acute MI manifests in nearly two out of 1000 people and is the leading cause of sudden death of adults.
Heart Attack Symptoms
The main symptom of MI is chest pain. However, in many cases, the pain is mild or even absent, especially with elderly people and diabetics. Other symptoms, such as weakness, shortness of breath, nausea and vomiting can be dominant.
- chest pain under breast bone
- back pain
- abdominal pain
- shoulder and arm pain (look: shoulder pain)
- neck, teeth and jaw pain (look: toothache, pained face)
- back pain
- pain duration is extended, typically over 20 minutes
- pain is similar to angina, it does not cease by resting or taking nitroglycerin
- every longer lasting pain in chest, back or stomach
Pain is:
- as with indigestion
- intensive, strong, weak, non-existent
- is characterized by sense of gripping or weight, tightening the belt around chest
- as if “an elephant is sitting on the chest”
- shortness of breath
- coughing
- dizziness
- loss of consciousness
- nausea
- vomiting
- perspiration that can be in excess (diaphoresis)
- dryness of mouth
- feeling of “impeding death”
- anxiety
Other symptoms that can indicate the disease are:
- spasms
- fatigue
- temporary cessation of breathing
- difficult breathing, need to lie down
- blood pressure (low, normal, high)
- behavior (unusual and anxious)
Note: Those suffering from heart attack generally deny having it. Symptoms may not manifest (“silent heart attack”).
Signs and examinations
Examination generally reveals bounding pulse. Blood pressure might be normal, high or low. Stethoscope (auscultation) might detect crackle in lungs, heart murmur and other abnormal sounds.
ECG, done once or successively during 2 to 3 days often shows MI.
MI and the scope of heart damage can be diagnosed by the following examinations:
- coronary angiography
- ventriculography
- echocardiography
- ergometry
Byproducts of heart damage and factors that point to MI are detected by laboratory analysis (LDH, LDH isoenzymes, CPK, CPK isoenzymes and others).
Heart Attack Treatment
Acute MI requires urgent intervention by a doctor.
Hospital treatment lasting 1-14 days is usually required. ECG monitoring should immediately be performed because of arrhythmias which can be fatal during the first couple of hours after the acute MI. The goal of treatment is to reduce the heart stress in order to prevent possible complications and to remove the existing ones. Initially physical activities are limited and then gradually increased. During urgent intervention, medication and infusion solutions are infused by intravenous catheter. Depending on overall state, invasive diagnostic methods may be applied. For direct monitoring of bodily fluid status, urinary catheter is inserted. Oxygen is usually given, even if its level in blood is stable, which ensures fast supply to tissues and reduction of heart stress.
Diet limits aren’t mandatory, but if required, the food must not contain a lot of sodium, must be caffeine free and of low fat content.
Medication
- Morphine is analgetic which is usually given to relieve pain.
- Nitrates such as, for example, nitroglycerin, are given to relieve pain and to reduce oxygen usage by heart.
- Beta-blockers (atenolol) reduce heart stress.
- Digitalis improves functioning of heart as a pump.
- Blockers of calcium canals reduce the usage of oxygen in heart muscle. Antiarhytmics and diuretics can also be prescribed.
- Therapy by thrombolytics (anticoagulants) is usually initiated in 6 hours after the initial chest pains. The initial therapy consists of intravenous infusion of anticoagulants (streptokinase or tissue plasminogen activator) and immediately after that intravenous infusion of herapin. Herapin is given for 48-72 hours. Acetylsalicylic acid and warfarin are admitted orally in order to prevent the formation of blood clots. Therapy by thrombolytics is contraindicated in the case of minor surgical procedures, biopsy of organs or major trauma caused 6 weeks prior, recent neurosurgical procedure, trauma to the head one month prior, history of GI (gastrointestinal) bleeding, intracranial tumor, trauma caused 6 months prior or pregnancy.Bleeding and hemorrhage are potential complications by thrombolytics therapy.
- Surgical procedure- With some patients it is required for an urgent surgical procedure.
Prognosis
Result depends on the size and placement of damaged tissue. Damage to system of electric impulse transfer (impulses that control the heartbeat) worsens the prognosis. Third of the cases prove fatal. If the patient survives first two hours after the heart attack, the possibility of his survival is increased, but complications cannot be ruled out. If there are none, complete recovery is possible. MI doesn’t need to cause physical disability, and the patient can gradually return to normal life and everyday activities, including sexual ones.
Complications
Arrhythmias such as ventricular tachycardia, ventricular fibrillation, heart blockage, congestive heart insufficiencies, cardiogenic shock, extension of heart tissue damage, pericarditis, treatment complications (for example, application of thrombolytics increases the risk of hemorrhaging during the treatment).
Call your doctor
In you feel searing pain in chest or some other symptoms of acute MI, go to the doctor on duty or call an ambulance.
Heart Attack Prevention
Whenever you’re able, control risk factors. Control your blood pressure and cholesterol level, reduce or quit smoking, change your diet (increase the intake of high-density lipoprotein and decrease low-density lipoprotein), take a diabetes test if necessary, lose weight if you’re obese. Take up a physical activity to improve your cardiovascular status (consult your doctor beforehand). After MI it is important to be under constant medical surveillance in order to reduce the risk of a new MI. Many recommend a rehabilitation programme that improves the gradual return to normal life. Stay consistent with an exercise programme, diet regimen and/or prescribed medication.