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Heart Attack
Also known as Acute MI, Myocardial Infraction
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Heart attacks affect more than one million Americans every year. Also known as an acute MI or myocardial infarction, a heart attack causes permanent and irreversible damage to the heart muscle. Normally, the heart has numerous coronary arteries that supply blood to the heart muscle. Unfortunately, unlike other body areas, the heart doesn't have an extra blood supply to take over when a coronary artery becomes blocked. A blocked coronary artery means there will be death of the muscle supplied by the artery. The amount of heart muscle death depends on the location of the blockage of the coronary artery.
Coronary arteries can be blocked with fatty matter such as cholesterol and triglycerides and can be blocked with calcium, which leads to a hard plaque. When the plaque ruptures, platelets come in to help seal the area and blood clots form, blocking the artery to a degree that it cuts off the circulation to the heart muscle. If there is heart muscle death, this represents a heart attack. In addition, spasm of the heart artery can cause a heart attack. A person with this condition doesn't even have to have diseased coronary arteries. Spasm of the coronary arteries is less common than blockage due to cholesterol and calcium plaques.
Heart attack symptoms include having pressure, heaviness or discomfort in the chest, an arm or beneath the breast bone. It can include radiation of the pain to the jaw, throat, arm or back. It can feel much like heartburn, with indigestion symptoms. You can feel nausea, vomiting, dizziness or sweating. Some people feel anxious and weak with shortness of breath and irregular heartbeats. The symptoms often last at least 30 minutes or longer and, if you take nitroglycerin, it tends not to change the symptoms. Rest alone doesn't change the symptoms. In diabetics and some other individuals, the symptoms of a heart attack are absent, which complicates the diagnosis.
At the first sign of a heart attack, you should call 911 so that doctors can open up the blockage of the coronary artery sooner rather than later. This can save heart muscle and can save your life. The best time for treatment of an acute MI is about one to two hours after the first symptoms appear.
There are several tests used to assess the degree and presence of a heart attack. The first is an EKG or ECG. This is an electrocardiogram that can look at stress, strain or damage to the electrical activity of the heart. It can be done repeatedly to look for changes in the heart muscle. Blood tests monitor enzymes released when the heart is damaged. One of them is the CPK level and the other is the LDH level. These enzymes are also checked serially to look for changes in the size of the heart damage. An echocardiogram can look at the movement of the heart to see if there are areas of the heart that just aren't moving much, indicating damage to the heart. A cardiac catheterization can look directly at blockages in the heart to see which arteries are involved. Blockages can be broken up during a cardiac catheterization as well.
Doctors treat a heart attack as soon as one is diagnosed. It can even be treated in the ambulance on the way to the hospital. Clot busters, such as TPA are used to break up the clot. Aspirin has been found to diminish the risk of death due to heart attack. Plavix is a drug used to prevent blood clotting. It is an antiplatelet drug. All three of the above drugs can be used at once in the first hours of having a heart attack.
Next, you will likely visit the cardiac catheterization lab. This directly assesses the degree of damage to the heart and tells the doctor where the blockages are. An angioplasty with stent placement can be done to open the blockage. An emergency bypass surgery might be done in the first few days after a heart attack to take care of all areas of blockage in the heart.
Future heart attacks are prevented by lowering cholesterol, keeping blood pressure in check and preventing clot formation. Some blood pressure medications reduce the load of work on the heart. This allows your heart to perform more efficiently. If there are irregular heartbeats, these are managed with medications called anti-arrhythmics.