Cardiovascular Diseases
Heart Attack (Myocardial Infarction)
If you or someone you know is experiencing signs of a
heart attack, call 911 immediately.
The following are the most common symptoms of a heart attack. However, each individual may experience symptoms differently. Symptoms may include:
- indigestion
- severe pressure, fullness, squeezing, pain and/or discomfort in the center
of the chest that lasts for more than a few minutes
- pain or discomfort that spreads to the shoulders, neck, arms, or jaw
- chest pain that increases in intensity
- chest pain that is not relieved by rest or by taking nitroglycerin
- chest pain that occurs with any/all of the following (additional) symptoms:
- sweating, cool, clammy skin, and/or paleness
- shortness of breath
- nausea or vomiting
- dizziness or fainting
- unexplained weakness or fatigue
- rapid or irregular pulse
Although chest pain is the key warning sign of a heart attack, it may be confused with indigestion, pleurisy, pneumonia, or other disorders.
A heart attack, or myocardial infarction, occurs when one of more regions of the heart muscle experience a severe or prolonged lack of oxygen caused by blocked blood flow to the heart muscle.
The blockage is often a result of atherosclerosis - a buildup of plaque, known as cholesterol, other fatty substances, and a blood clot. Plaque inhibits and obstructs the flow of blood and oxygen to the heart, thus reducing the flow to the rest of the body. The cause of a heart attack is a blood clot that forms within the plaque-obstructed area.
If the blood and oxygen supply is cut off severely or for a long period of time, muscle cells of the heart suffer damage and die. The result is dysfunction of the muscle of the heart in the area affected by the lack of oxygen.
There are two types of risk factors for heart attack, including:
| Inherited (or genetic): |
Acquired: |
| Inherited or genetic risk factors are risk factors you are born with that cannot be changed, but can be improved with medical management and lifestyle changes. |
Acquired risk factors are caused by activities that we choose to include in our lives that can be managed through lifestyle changes and clinical care. |
- persons with inherited hypertension (high blood pressure)
- persons with inherited low levels of HDL (high-density lipoproteins), or high levels of LDL (low-density lipoprotein) blood cholesterol or high levels of triglycerides
- persons with a family history of heart disease (especially with onset before age 55)
- aging men and women
- persons with type 1 diabetes
- women, after the onset of menopause (generally, men are at risk at an earlier age than women, but after the onset of menopause, women are equally at risk)
- persons with acquired hypertension (high blood pressure)
- persons with acquired low levels of HDL (high-density lipoproteins), high levels of LDL (low-density lipoprotein) blood cholesterol or high levels of triglycerides
- cigarette smokers
- people who are under a lot of stress
- people who drink too much alcohol
- individuals who lead a sedentary lifestyle
- persons overweight by 30 percent or more
- persons who eat a diet high in saturated fat
- persons with Type II diabetes
A heart attack can happen to anyone - it is only when we take the time to learn which of the risk factors apply to us, specifically, can we then take steps to eliminate or reduce them.
Managing your risks for a heart attack begins with:
- examining which of the risk factors apply to you, and then taking steps to eliminate or reduce them.
- becoming aware of conditions like hypertension or abnormal cholesterol levels, which may be "silent killers."
- modifying risk factors that are acquired, not inherited, through lifestyle changes. See your physician as the first step in starting right away to make these changes.
- consulting your physician soon to determine if you have risk factors that are genetic or inherited and cannot be changed, but can be managed medically and through lifestyle changes.
The goal of treatment for a heart attack is to relieve pain, preserve the heart muscle function, and prevent death.
Treatment in the emergency department may include:
- intravenous therapy - nitroglycerin, morphine
- continuous monitoring of the heart and vital signs
- oxygen therapy - to improve oxygenation to the damaged heart muscle
- pain medication - by decreasing pain, the workload of the heart decreases, thus, the oxygen demand of the heart decreases
- cardiac medication - such as beta-blockers or calcium channel blockers to promote blood flow to the heart, prevent blood clotting, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure
- fibrinolytic therapy - intravenous infusion of a medication which dissolves the blockage, thus, restoring blood flow
- antithrombin/antiplatelet therapy - used to prevent further blood clotting
- antihyperlipidemics - medications used to lower lipids (fats) in the blood, particularly Low Density Lipid (LDL) cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor®), atorvastatin (Lipitor®), and pravastatin (Pravachol®), among others. Bile acid sequestrants - colesevelam, cholestyramine and colestipol - and nicotinic acid (niacin) are two other types of medications that may be used to reduce cholesterol levels.
Once the condition has been diagnosed and the patient stabilized, additional procedures to restore coronary blood flow may be utilized. Those procedures include:
-
coronary angioplasty - with this procedure, a catheter is used to create a bigger opening in the vessel to increase blood flow. Although angioplasty is performed in other blood vessels, Percutaneous Transluminal Coronary Angioplasty (PTCA) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. There are several types of PTCA procedures, including:
- balloon angioplasty - a small balloon is inflated inside the blocked artery to open the blocked area.
- atherectomy - the blocked area inside the artery is cut away by a tiny device on the end of a catheter.
- laser angioplasty - a laser used to "vaporize" the blockage in the artery.
- coronary artery stent - a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
-
coronary artery bypass - Most commonly referred to as simply "bypass surgery," this surgery is often performed in people who have angina (chest pain) and coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest may also be used to create a bypass graft.
An American Heart Association study surveying
365 U.S. hospitals on procedures to get patients angioplasty quickly indicates
St. John's average is 80 minutes – 10 minutes faster than the
90-minute window suggested by the heart association. Studies show that reopening
clogged arteries by inflating a tiny balloon at the site of the blockage is the
best way to treat a severe heart attack. The procedure, balloon angioplasty, can
cut a patient's risk of dying by 40 percent, but only if it is done within 90
minutes of the patient's arrival at the hospital.
St. John's has been tracking heart attack
time-to-treatment for 10 years and aggressively working on ways to decrease it.
"If you think about a patient arriving in the
emergency room, you don't know they have a heart attack when they arrive, you
make the diagnosis, call the team in, get them to the lab and you do the
angiogram and then get across the total occluded vessel and open it up and you
do that in less than 90 minutes, that takes a team effort a lot people to make
happen," says cardiologist Kelvin Van Osdol, M.D.
Click here to view the
Online Resources of Cardiovascular Disease
|