HEART ATTACK

 

What Is a Heart Attack?

A heart attack is when blood vessels that supply blood to the heart are blocked, preventing enough oxygen from getting to the heart. The heart muscle dies or becomes permanently damaged. Your doctor calls this a myocardial infarction

A heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.
Heart attack is a leading killer of both men and women in the world. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 1 hour of the beginning of symptoms. If you think you or someone you’re with is having a heart attack, call emergency help  right away.

Overview

Heart attacks occur most often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty material called plaque (plak) builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.

During a heart attack, if the blockage in the coronary artery isn’t treated quickly, the heart muscle will begin to die and be replaced by scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
Severe problems linked to heart attack can include heart failure and life-threatening arrhythmias (irregular heartbeats). Heart failure is a condition in which the heart can’t pump enough blood throughout the body. Ventricular fibrillation is a serious arrhythmia that can cause death if not treated quickly.

Get Help Quickly!!!!!

Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment is most effective when started within 1 hour of the beginning of symptoms

The most common heart attack signs and symptoms are:

• Chest discomfort or pain—uncomfortable pressure, squeezing, fullness, or pain in the center of the chest that can be mild or strong. This discomfort or pain lasts more than a few minutes or goes away and comes back.
• Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.
• Shortness of breath may occur with or before chest discomfort.
• Other signs include nausea (feeling sick to your stomach), vomiting, lightheadedness or fainting, or breaking out in a cold sweat.

If you think you or someone you know may be having a heart attack:

• Call Emergency within a few minutes—5 at the most—of the start of symptoms.
• If your symptoms stop completely in less than 5 minutes, still call your doctor.
• Only take an ambulance to the hospital. Going in a private car can delay treatment.
• Take a nitroglycerin/ sorbitrate pill if your doctor has prescribed this type of medicine.

Treatment

If you had a heart attack, you will need to stay in the hospital, possibly in the intensive care unit (ICU). You will be hooked up to an ECG machine, so the health care team can look at how your heart is beating.

Life-threatening irregular heartbeats (arrhythmias) are the leading cause of death in the first few hours of a heart attack. These arrythmias may be treated with medications or electrical cardioverson/defibrillation.

The health care team will give you oxygen, even if your blood oxygen levels are normal. This is done so that your body tissues have easy access to oxygen and your heart doesn't have to work as hard.

An intravenous line (IV) will be placed into one of your veins. Medicines and fluids pass through this IV. You may need a tube inserted into your bladder (urinary catheter) so that doctors can see how much fluid your body removes.

ANGIOPLASTY AND STENT PLACEMENT

Angioplasty, also called percutaneous coronary intervention (PCI), is the preferred emergency procedure for opening the arteries for some types of heart attacks. It should preferably be performed within 90 minutes of arriving at the hospital and no later than 12 hours after a heart attack.

Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart.

A coronary artery stent is a small, metal mesh tube that opens up (expands) inside a coronary artery. A stent is often placed after angioplasty. It helps prevent the artery from closing up again. A drug eluting stent has medicine in it that helps prevent the artery from closing.

THROMBOLYTIC THERAPY (CLOT-BUSTING DRUGS)

Depending on the results of the ECG, certain patients may be given drugs to break up the clot. It is best if these drugs are given within 3 hours of when the patient first felt the chest pain. This is called thrombolytic therapy. The medicine is first given through an IV. Blood thinners taken by mouth may be prescribed later to prevent clots from forming.

Thrombolytic therapy is not appropriate for people who have:

• Bleeding inside their head (intracranial hemorrhage)
• Brain abnormalities such as tumors or blood vessel malformations
• Stroke within the past 3 months (or possibly longer)
• Head injury within the past 3 months

Thrombolytic therapy is extremely dangerous in women who are pregnant or in people who have:

• A history of using blood thinners such as coumadin
• Had major surgery or a major injury within the past 3 weeks
• Had internal bleeding within the past 2-4 weeks
• Peptic ulcer disease
• Severe high blood pressure

OTHER MEDICINES FOR HEART ATTACKS

Many different medicines are used to treat and prevent heart attacks. Nitroglycerin helps reduce chest pain. You may also receive strong medicines to relieve pain.

Antiplatelet medicines help prevent clots from forming. Aspirin is an antiplatelet drug. Another one is clopidogrel (Plavix). Ask your doctor which of these drugs you should be taking. Always talk to your doctor before stopping either of these drugs.

• For the first year after a heart attack, you will likely take both aspirin and clopidogrel every day. After that, your doctor may only prescribe aspirin.
• If you had angioplasty and a coronary stent placed after your heart attack, you may need to take clopidogrel with your aspirin for longer than one year.

Other medications you may receive during or after a heart attack include:

• Beta-blockers (such as metoprolol, atenolol, and propranolol) help reduce the strain on the heart and lower blood pressure.
• ACE inhibitors (such as ramipril, lisinopril, enalapril, or captopril) are used to prevent heart failure and lower blood pressure.
• Lipid-lowering medications, especially statins (such as lovastatin, pravastatin, simvastatin, atorvastatin, and rosuvastatin) reduce blood cholesterol levels to prevent plaque from increasing. They may reduce the risk of another heart attack or death.

Always talk to your doctor before stopping any medications, especially these drugs. Stopping or changing the amount of these medicines can be life threatening.

CORONARY ARTERY BYPASS SURGERY

Coronary angiography may reveal severe coronary artery disease in many vessels, or a narrowing of the left main coronary artery (the vessel supplying most of the blood to the heart). In these circumstances, the cardiologist may recommend emergency coronary artery bypass surgery (CABG). This procedure is also called "open heart surgery." The surgeon takes either a vein or artery from another location in your body and uses it to bypass the blocked coronary artery.

Outlook;

Each year, lakhs of people have heart attacks, and almost half of them die. CAD, which often results in a heart attack, is the leading killer of both men and women.
Many more people could recover from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital.

Common reasons for not seeking medical care

• People believe only men have heart attacks.
  • Fact: Heart disease is the most common cause of death in women as well as men. If you have symptoms, call for help.
• You are not sure it is a heart attack.
  • Call anyway--heart attack symptoms can be vague.
• "I can't afford to go to the hospital"
  • Although hospital care is expensive, a heart attack effects your life and future health- this is priceless!
• It feels like heartburn.
  • If you have a history of heart disease, angina, or high blood pressure, the heartburn you feel may actually be a heart attack.
    Call for help immediately.
• You'd feel embarrassed if it turned out you didn't need medical help after all.
  • Never feel embarrassed about calling for help. A little embarrassment might save your life.
• You're hoping that it is not a heart attack.
  • Wishful thinking can be deadly. You can't wish a heart attack away, and getting treatment quickly can save your life.
  • Most people who survive a heart attack can return to their normal life, including work and sexual activity, within 3 months.
• I'm too young to have a heart attack
  • Although much less common in those under 40, heart attacks can strike at any age.
  • If you have any of the risk factors (especially stimulant drug use or family history) seek help for symptoms

PLEASE READ ARTICLES-'EMERGENCY CHEST PAIN' AND 'CARDIAC RESUSCITATION' FOR MORE INFORMATION .