The heart attack is also known as myocardial infarction in medical terms.It occurs when the blood flow to a section of the heart is compromised resulting in the death of the muscles of the heart. The blockage is usually caused by the cholesterol particles lodge in the lumen of blood vessels called the plaques. It is a life-threatening condition and requires immediate medical attention. It is one of the major causes of death going around the world. Damage to the muscles of the heart are irreversible, but immediate treatment helps in limiting further damage to the heart. Delaying treatment for about 10 mins may be fatal.
Symptoms of heart attack or myocardial infarction
Symptoms of myocardial infarction are as follows:
- Central chest pain radiating to jaw, throat and left arm.In some cases, chest pain may be radiated to the epigastric region of the abdomen. Chest pain is not relieved by taking rest but is precipitated by exertion, emotional disturbances, exercise after meals, etc.
- Chest pain may be associated with profuse sweating, nausea, vomiting, palpitation
- Chest discomfort, heaviness or tightness in the chest
- Anxiety and fear of impending death.
- Difficulty in breathing
- Dizziness and weakness.
- Fainting episodes
Cause of heart attack
The most important cause of heart attack is formed of atheromatous plaque which blocks the arteries of the heart, thereby reducing the blood supply to the cardiac muscles.When the arteries are blocked the oxygen supply to the cardiac muscles are compromised and the cardiac muscles begin to die.
Atherosclerosis is caused due to the damage to the endothelium (innermost layer of the artery ). The factors contributing to the damage of endothelium are
- Elevated blood pressure
- Inflammation of the arteries
- Accumulation of the amino acid produced by the body called homocysteine (this is controversial)
Risk factors for heart attack
Risk factors of the heart attack are divided into two groups, namely modifiable risk factors and non-modifiable risk factors.
Modifiable risk factors include:
To control your cholesterol level watch this video.
The effects of modifiable risk factors can be reduced by lifestyle changes such as avoiding smoking, control of the blood pressure and blood sugar levels etc.
Non-modifiable risk factors include
- Age: risk of heart attacks increases with advancing age.
- Race: some ethnic groups such as African Americans have a higher risk of heart attacks
- A family history of heart attacks: lifestyle modifications may help in reducing the incidence of heart attacks in a person having a positive family history of heart attack.
Prompt diagnosis and treatment is lifesaving in heart attack and also limits the damage to the cardiac muscles.
ECG: A 12 lead ECG should be attached to persons suffering from the chest pain to diagnose the underlying cause. It is based on the measurement of electrical activity of the heart. ECG findings are very useful in diagnosing the heart attack.
Blood tests: measurement of cardiac enzymes such as CPK and troponins constitute the blood investigation. Abnormally raised levels of cardiac enzymes confirm the diagnosis of heart attack.
Other tests may include:
- Chest X-ray
- Echocardiogram: It uses the sound waves to take the picture of the activities of the heart.
- Coronary angiogram: It is used to visualize the blocked areas of the coronary artery by injecting a dye through a catheter.
- Stress test: Patient is asked to walk or run on a treadmill and the ECG lead attached to the patient is used to detect the response of the heart muscle to the exercise.
ECG and cardiac enzymes are the baseline investigations which must not be missed in any person presenting with features of the heart attack.
Prevention of heart attack
The risk of heart attacks can be reduced substantially by following the lifestyle modifications such as:
- Cessation of smoking
- Regular physical exercise such as walking, running, cycling for at least half an hour for most days of the week (preferably 5 days in a week)
- Maintenance of body weight as per the height and age of the person.
- Stress-reducing exercises such as meditation, yoga, cardio exercises can help in reducing the cardiovascular risks.
- Consumption of low fat containing and high fibre containing diet.
- Including plenty of vegetables and fruits in the dietary habits
- Restriction of alcohol intake.
- Avoiding intake of table salt.
- Limiting the consumption of red meat and yellow part of the egg.
Heart attacks are the life-threatening medical emergency. Patient suffering from a heart attack should be shifted Cardiac care unit as soon as possible.Treatment includes:
- High flow oxygen should be given. This delivers the oxygen to cardiac muscles whose oxygen demand is not met due to the blockage of the coronary artery.
- Ecg monitoring with the 12 lead ECG
- Intravenous access should be secured
- Aspirin 300mg chewed and Clopidogrel 300mg oral should be given
- Intravenous analgesics should be given to reduce the chest pain. Opioid analgesics such as morphine and pethidine should be given along with the antiemetics
- Patient should be prepared for percutaneous coronary intervention if the facility is available
- Treatment of acute complications of a heart attack like arrhythmia
- Coronary bypass surgery should be done if indicated.
During the discharge of patient
- Aspirin 75 mg daily
- Clopidogrel 75 mg daily
- Lipid-lowering agents such as Atorvastatin
- Drugs for treatment of risk factors such as diabetes and Hypertension should be added.
- Lifestyle modifications should be advised.