A heart attack happens when something blocks the blood flow to your heart so it can’t get the oxygen it needs. It’s a medical emergency. Call 911 right away at the first sign of any symptoms. Don’t wait to see if the symptoms pass.
Heart attacks are also called myocardial infarctions (MIs). "Myo" means muscle, "cardinal" refers to the heart, and "infarction" means the death of tissue because of a lack of blood supply. This tissue death can cause lasting damage to your heart muscle...
Symptoms of HEART ATTACK:
1. Discomfort, pressure, heaviness, tightness, squeezing, or pain in your chest or arm or below your breastbone
2. Discomfort that goes into your back, jaw, throat, or arm.
3. Fullness, indigestion, or a choking feeling (it may feel like heartburn)
4. Sweating, upset stomach, vomiting, or dizziness
5. Severe weakness, anxiety, fatigue, or shortness of breath.
6. Fast or uneven heartbeat.
Symptoms can be different from person to person or from one heart attack to another. Women are more likely to have these heart attack symptoms:
1. Unusual fatigue
2. Shortness of breath
3. Nausea or vomiting
4. Dizziness or lightheadedness
5. Discomfort in your gut. It may feel like indigestion.
6. Discomfort in the neck, shoulder, or upper back
With some heart attacks, you won’t notice any symptoms (a "silent" myocardial infarction). This is more common in people who have diabetes.
DIAGNOSIS:
An electrocardiogram (ECG) is an important test in suspected heart attacks. It should be done within 10 minutes of being admitted to the hospital.
An ECG measures the electrical activity of your heart. Every time your heart beats, it produces tiny electrical impulses. An ECG machine records these signals onto paper, allowing your doctor to see how well your heart is functioning.
An ECG is painless and takes about 5 minutes to do. During the test, flat metal discs (electrodes) are attached to your arms, legs, and chest. Wires from the electrodes are connected to the ECG machine, which records the electrical impulses.
An ECG is important because: It helps confirm the diagnosis of a heart attack it helps determine what type of heart attack you have had, which will help determine the most effective treatment
Types of heart attack:
Heart attacks can be classified by measurement from an ECG known as the ST segment. This corresponds to the area of damage inflicted on the heart.
1. Acute coronary syndrome:
A heart attack is a form of the acute coronary syndrome (ACS), where there is a significant blockage in the coronary arteries.
The 3 main types of ACS include:
A. ST-segment elevation myocardial infarction (STEMI)
B. Non-ST segment elevation myocardial infarction
(NSTEMI)
C. unstable angina
A. ST-segment elevation myocardial infarction (STEMI):
A STEMI is the most serious type of heart attack where there is a long interruption to the blood supply. This is caused by a total blockage of the coronary artery, which can cause extensive damage to a large area of the heart. A STEMI is what most people think of when they hear the term "heart attack".
B. Non-ST segment elevation myocardial infarction (NSTEMI):
An NSTEMI can be less serious than a STEMI because the supply of blood to the heart may be only partially, rather than completely, blocked. As a result, a smaller section of the heart may be damaged. However, an NSTEMI is still regarded as a serious medical emergency. Without treatment, it can progress to serious heart damage or STEMI.
C. Unstable angina:
Unstable angina is the least serious type of ACS. However, like NSTEMI, it is still a medical emergency as it can also progress to serious heart damage or STEMI. In unstable angina, the blood supply to the heart is still seriously restricted, but there is no permanent damage, so the heart muscle is preserved.
Other tests:
Other tests can be used to assess the state of your heart and check for related complications. However, because heart attacks are medical emergencies, some of these tests are usually done after your initial treatment has begun and your condition has been stabilized.
Blood tests:
Damage to your heart from a heart attack causes certain proteins to slowly leak into your blood. Enzymes are special proteins that help regulate chemical reactions that happen in your body.
If doctors suspect you have had a suspected heart attack, a sample of your blood will be taken so it can be tested for these heart proteins (known as cardiac markers).
The most common protein measurement is called cardiac troponin. Your troponin level will be measured through a series of blood tests done over the course of a few days.
This will allow damage to your heart to be assessed, and also help determine how well you are responding to treatment.
Chest X-ray:
A chest X-ray can be useful if the diagnosis of a heart attack is uncertain and there are other possible causes of your symptoms, such as a pocket of air trapped between the layers of your lungs (pneumothorax).
A chest X-ray can also be used to check whether complications have happened because of the heart attack, such as a build-up of fluid inside your lungs (pulmonary oedema).
Echocardiogram:
An echocardiogram is a type of scan that uses sound waves to build a picture of the inside of your heart.
This can be useful to identify exactly which areas of the heart have been damaged and how this damage has affected your heart's function.
Coronary angiography:
Coronary angiography can help determine whether there is a blockage or narrowing in the coronary arteries and, if so, locate the exact place of the blockage or narrowing.
The test involves inserting a thin tube (catheter), into one of the blood vessels in your groin or arm. The catheter is guided into your coronary arteries using X-rays.
A special fluid, called a contrast agent, is pumped through the catheter. This fluid can be seen on X-rays and studying how it flows around and through your heart can help locate the site of any blockage or narrowing. This helps a doctor who specializes in heart conditions (cardiologist) decide the best treatment for you.
TREATMENT:
The treatment options for a heart attack depend on whether you've had an ST-segment elevation myocardial infarction (STEMI), or another type of heart attack.
An ST-segment elevation myocardial infarction (STEMI) is the most serious form of heart attack and requires emergency assessment and treatment. It's important you're treated quickly, to minimize damage to your heart after a STEMI.
If you have symptoms of a heart attack and an electrocardiogram (ECG) shows you have a STEMI, you'll be assessed for treatment to unblock your coronary arteries.
The treatment used will depend on when your symptoms started and how soon you can access treatment.
If your symptoms started within the past 12 hours – you'll usually be offered primary percutaneous coronary intervention (PCI).
If your symptoms started within the past 12 hours but you cannot access PCI quickly – you'll be offered medicine to break down blood clots.
If your symptoms started more than 12 hours ago – you may be offered a different procedure, especially if your symptoms have improved. The best course of treatment will be decided after an angiogram and may include medicine, PCI, or bypass surgery.
If a PCI isn’t suitable for you – you may be offered a combination of medicines to prevent blood clots, called antiplatelet medicines.
Primary percutaneous coronary intervention (PCI):
Primary percutaneous coronary intervention (PCI) is the term for emergency treatment of a STEMI. It's a procedure to widen the coronary artery (coronary angioplasty).
Coronary angiography is done first, to assess your suitability for PCI.
You may also be given blood-thinning medicines to prevent further clots from forming, such as low-dose aspirin.
You may need to continue taking medicines for some time after PCI.
Coronary angioplasty:
It is a potentially complex procedure that requires specialist staff and equipment, and not all hospitals have the facilities.
This means you'll need to be taken urgently, by ambulance, to one of the specialist centers (Heart Attack Centres) that now serve most of the UK's regions.
During coronary angioplasty, a tiny tube with a sausage-shaped balloon at the end (a balloon catheter) is put into a large artery in your groin or arm. The catheter is passed through your blood vessels and up to your heart, over a fine guidewire, using X-rays to guide it.
Once the catheter is in the narrowed section of your coronary artery, the balloon is inflated to
open it. Flexible metal mesh (a stent) is usually inserted into the artery to help keep it open afterward.
Medicines to break down and prevent blood clots:
A. Medicines to prevent blood clots:
There are two types of medicines to prevent blood clots. These are called antiplatelets and anticoagulants and are usually taken as a tablet. They make blood flow through your veins more easily. This means your blood will be less likely to form a clot.
B. Medicines to break down blood clots:
Medicines used to break down blood clots, known as thrombolytics or fibrinolytic, are usually given by injection.
Thrombolytics, or fibrinolytic, target and destroy a substance called fibrin. Fibrin is a tough protein that makes up blood clots by acting like a sort of fiber mesh that hardens around the blood.
You may also be given a medicine called a glycoprotein IIb/IIIa inhibitor if you have an increased risk of experiencing another heart attack in the future.
Glycoprotein IIb/IIIa inhibitors do not break up blood clots, but they prevent blood clots from getting bigger. They're an effective method of stopping your symptoms from getting worse.
Coronary artery bypass graft:
A coronary angioplasty may not be technically possible if the anatomy of your arteries is different from normal. This may be the case if there are too many narrow sections in your arteries or if there are lots of branches coming off your arteries that are also blocked.
In such circumstances, an alternative operation, known as a coronary artery bypass graft (CABG), may be considered.
A CABG involves taking a blood vessel from another part of your body (usually your chest, leg or arm) and attaching it to your coronary artery above and below the narrowed area or blockage. This new blood vessel is known as a graft.
The graft diverts blood around narrowed or clogged parts of your major arteries to improve blood flow and oxygen supply to your heart.
Treating non-ST segment elevation myocardial infarction (NSTEMI) and unstable angina:
If an ECG shows you have an NSTEMI or unstable angina (the "less serious" types of heart attack), blood-thinning medicine, including aspirin and other medicines, is usually recommended.
In some cases, further treatment with coronary angioplasty or coronary artery bypass graft (CABG) may be recommended in cases of NSTEMI or unstable angina, after initial treatment with these medicines.
RECOVERY:
Making lifestyle changes is the most effective way to prevent having a heart attack (or having another heart attack).
There are 3 main steps you can take to help prevent a heart attack (as well as a stroke):
1. Eat a healthy, balanced diet
2. Do not smoke
3. Try to keep your blood pressure at a healthy level
- Written by B Manogna Reddy
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MEDICAL