Heart Attack

Definition

A heart attack is when an area of the heart does not get enough blood flow. The area becomes damaged or dies within a short time after blood flow is stopped. If a large or vital area is affected the heart may stop. A heart attack may be:

• STEMI—A major artery is fully blocked. This is a more serious type of heart attack
• NSTEMI—Partial block of an artery. The block may also allow periods of some blood flow.

There are two main coronary arteries. They split off into smaller branches that spread out over the heart. A blockage on larger artery will affect more of the heart. It can cause a severe heart attack. Blockages in the smaller arteries will have a smaller effect.

Blockages may only last a short time and then allow some blood flow. Others may last longer and cause more harm.

Heart Attack.

Copyright © 2002 Nucleus Communications, Inc. All rights reserved.

http://services.epnet.com/getimage.aspx?imageiid=24852485si1452.jpgHeart AttackNULLjpgHeart AttackNULL\\filer01\Intellect\images\si1452.jpgCopyright © 2002 Nucleus Communications, Inc. All rights reserved.21NULL2002-10-012553912485_11814Copyright © Nucleus Medical Media, Inc.

Causes

The coronary arteries bring blood and oxygen to the heart muscle. A heart attack happens when one or more of these arteries is blocked due to:

• Narrowing of the coronary arteries due to one or more of following:
  • Thickening of the artery walls (common aging process)
  • A buildup of fatty plaques inside the arteries
  • A spasm of the coronary arteries
  • A blood clot that develops in the arteries
• An embolism—a blood clot that travels to the heart from other areas of the body

Risk Factors

The risk of heart attack is greater in males and older adults. The risk is also higher in those with blood vessel disease or damage. Things that may increase risk of blood vessel disease and heart attacks are:

• Certain health problems, such as:
  • Obesity
  • High blood pressure
  • High blood cholesterol—high LDL cholesterol and low HDL cholesterol
  • Diabetes
  • High blood triglycerides
• Lifestyle habits, such as:
  • Smoking and vaping
  • Not getting enough daily activity
  • Cocaine use
  • Poor sleep
• The use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• Stress
• Family members with heart disease
• Using testosterone therapy

Symptoms

Symptoms can differ from person to person. Common ones are:

• Squeezing, heavy chest pain behind breastbone—usually comes on quickly especially with:
  • Exercise or exertion
  • Emotional stress
  • Cold weather
  • A large meal
• Pain in the left shoulder, left arm, or jaw
• Shortness of breath
• Sweating, clammy skin
• Nausea
• Weakness
• Loss of consciousness
• Anxiety or a sense of doom or panic without a reason

Unusual symptoms of heart attack (more common in women):

• Stomach pain
• Back and shoulder pain
• Confusion
• Fainting

Diagnosis

A heart attack is an emergency. Tests to confirm a heart attack and look for changes in the heart include:

• ECG—shows the electrical activity of the heart. It can show if a heart attack has happened or may be happening. ECG can show if the heart attack is STEMI or NSTEMI.
• Blood tests—can show markers in the blood. These markers appear when a heart attack occurs. They can also show how much damage was done to the heart muscle.
• Echocardiogram—shows the size, shape, and motion of the heart.
• Coronary angiography—Can help find blockages or damage to the arteries.

Other tests will be based on a person's specific needs. They may include:

• Stress test—records the heart's electrical activity under physical stress. This may be done days or weeks after the heart attack.
• Electron-beam computed tomography (EBCT)—takes pictures of the heart, coronary arteries, and surrounding area.

Treatment

The first goal of treatment is to improve blood flow and get oxygen to the heart as fast as possible. Treatment includes:

• Aspirin and other antiplatelet agents—to break up clots in the blood and improve blood flow. It works best when given within the first 6 hours after symptoms appear.
• Oxygen therapy—to increase oxygen to the heart
• Nitrate medicines—to quickly open blood vessels and improve blood flow to heart muscle
• Medicine to ease pain
• Beta-blockers and angiotensin-converting enzyme (ACE) inhibitors—to decrease the workload on the heart
• Anti anxiety medicine

Prevention

Healthy heart habits can lower the risk of a heart attack. These are:

• Reaching and maintaining a healthy weight
• Regular physical activity
• Not smoking or vaping
• Eating plenty of whole grains, fruits, and vegetables and choosing healthy fats like those found in fish, nuts, and seeds
• Managing chronic health problems, such as high blood pressure, diabetes, and high cholesterol
• Getting enough sleep
• Practicing relaxation methods to manage stress

Small daily doses of aspirin may help some people lower their risk. This should only be done with a doctor’s approval. Aspirin can have side effects like bleeding in the stomach. Aspirin may also cause problems with other medicine.