Heart Attack

Prof JC Sanasam *

Pain in acute myocardial infarction (front) :: Pix - JHeuser/Wikipedia

There is a very odd irony about the heart. The heart is a bag with four chambers that contain blood for distribution throughout the whole body reaching up to the tips of fingers and toes with its every beat. But there is a situation when it gets starved of blood which, in fact, fills in all of its chambers and the heart can die of it.

This may sound very baffling to many as it did to me when I was a young medical student. The fact is its walls are built with muscles; these muscles need blood to continue to work. Although the muscle-wall is in direct contact to the blood pool itself the blood for its nutrition passes through separate pipes (coronary artery and its branches). When blood-flow through this artery system is obstructed, the muscles get fatigued, and eventually it stops to beat (pump blood), as a result of starvation and death of the muscles. When the heart stops to beat, the brain dies, the whole body dies. Simple thing.

What is Heart Attack

Heart Attack is a situation which occurs when blood flow to a part of your heart is blocked for some duration of time long enough that the affected part of the heart muscle is damaged or dies. In medical term it is called Myocardial Infarction.

Many cardiologists claim that it is the nation's No. 1 killer.

Causes

Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the muscles and other tissues of the heart. If the blood flow is blocked, the heart is starved of oxygen and heart cells die.

Plaque, a hard substance made up of cholesterol and other cells, can build up in the walls of your coronary arteries to make them thickened and prone to produce stasis of blood and eventually clots. A heart attack may occur when blood platelets (ingredients of blood cells that play the chief role in clotting process) stick to tears in the plaque and form a blood clot that blocks blood from flowing to the heart. This is the common cause of heart attacks. A slow buildup of this plaque may almost block one of your coronary arteries.

The cause of heart attacks is not always known. Heart attacks may occur:
o When you are resting or asleep
o After a sudden increase in physical activity
o When you are active outside in cold weather
o After sudden, severe emotional or physical stress, including an illness

In fact many other risk factors may lead to a heart attack.

Symptoms

* Caution: A heart attack is a medical emergency. Call the easiest or nearest available help.

o DO NOT TRY TO DRIVE yourself to the hospital
o DO NOT WAIT. You are at greatest risk of sudden death in the early hours of a heart attack
Chest pain is the most common symptom of a heart attack. You may feel the pain in only the left side of your chest, or it may move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or back. The pain may be severe or mild. It can feel like:
o A tightening band around your chest
o Bad indigestion
o Something heavy sitting on your chest
o Squeezing or heavy pressure

The pain usually lasts longer than 20 minutes. Rest or pain killers or medicine for angina-pain like nitroglycerine may not completely relieve the pain of a heart attack. Symptoms may go away and come back again. Other associated symptoms of heart attack can be: anxiety, cough, fainting, dizziness or light-headedness, nausea or vomiting, palpitations (feeling like your heart is beating too fast or irregularly), shortness of breath, sweating which may be profuse.

Some people (more specifically the elderly, people with diabetes, and women) may have little or no chest pain. Or, they may have unusual symptoms like shortness of breath, fatigue, and weakness. Sometimes heart attacks occur without symptoms and they are called 'Silent Heart Attacks'.

Investigation and laboratory tests

In addition to the physician's detailed clinical or physical examination you may certainly go for: ECG or EKG, a troponin blood test that can show if you have heart tissue damage or heart attack; coronary angiography (X-ray picture of the heart blood vessels using contrast colours of dyes), echocardiography, exercise stress test, nuclear stress test and other tests of levels of biochemicals (bio-marker tests).

Treatment

You will be connected to a heart monitor, oxygen, and an intravenous (IV) line; may be given medication to relieve the pain originating from the heart, anticoagulants (drugs that prevent blood clotting). Dangerous abnormal heartbeats (arrhythmias) may be treated with medication or electric shocks.

Emergency Treatment

Immediate angioplasty is often the first choice of treatment if facilities are available. It is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. A stent, a metal mesh tube is often inserted and placed at the narrowed part after angioplasty to prevent further or future re-narrowing. Surgical intervention called bypass surgery, more popularly known as 'open heart surgery' is very often adopted in the modern heart-attack management.

AFTER YOUR HEART ATTACK

Follow-up treatment in the line of regular medication and observation by a health-care provider is a must, may be for life. A heart-healthy diet, safe active exercise advised by your physician may be very helpful. Advice on quitting smoking, avoiding alcohol, control of diabetes, kidney disease, if any, and avoidance of others that may harm your heart and blood vessels, and what you should do if you have chest pain again so on and so forth should be taken seriously. After a heart attack, you may feel sad. You may feel anxious and worry about being careful about everything you do. All these feelings are normal. They go away for most people after 2 or 3 weeks. You may also feel tired when you leave hospital to go home. It is best to take things lightly, hope for the best and prepare for the worst.