Heart Attack

Heart attack is a lay-term for myocardial infarction. Myocardial infarction is, in simple terms, death of cardiac cells/ tissues. Myocardial cell death occurs when the cells do not receive adequate nutrition and oxygen to perform their regular function.

The most common cause of reduced oxygen supply is a sudden compromise in blood supply due to atherosclerosis of the coronary arteries. This leads to severe left-sided chest pain that radiates to the left arm, characteristic of a heart attack.

Since it’s a lay-term, a heart attack is also used to refer to angina. Angina is basically a compromise in blood supply to the heart but not severe or long enough to cause myocardial cell death. The pain goes away with rest or nitroglycerin treatment, and the damage is not permanent. However, angina is a warning of compromised cardiovascular function.

Compromised blood supply is often limited to a specific region of the heart supplied by a branch of the main coronary artery. The major branches of the coronary arteries include the Left Coronary Artery and the Right Coronary Artery.

Signs and Symptoms

The severity of the symptoms of a heart attack depends on the extent of myocardial damage.

  • The most characteristic symptom of a heart attack is the sudden left sided chest pain that radiates to the left arm.
  • Sweating, weakness are other non-specific symptoms of a heart attack

After the patient recovers from the critical condition, he/she usually presents with the following symptoms.

1. Fatigue

2. Obesity, weight gain

3.  Irregular and low appetite

4. Chronic cough, wheezing with mucous, there can also be coughing with blood

5. Fluctuating heart rate

6. Tachycardia and palpitations on slight activity

7.  Swelling of the abdomen in some cases

8. Breathing problems such as shortness of breath

9. Venous blood pooling in legs and foot

10.  Engorgement of neck veins

Risk Factors

1: Coronary Artery Diseases and History of Heart Attack

Coronary artery disease is a common condition that occurs due to atherosclerosis of the coronary vessels. Atherosclerosis is when cholesterol deposits itself in the walls of blood vessels and, most notably, in the coronary arteries that supply the heart. Compromised blood supply leads to myocardial cell death and damage to cardiac muscles. The affected cells and tissues get fibrosed and can lead to complications later on.

2: High Blood Pressure

High blood pressure has been shown to increase the risk of heart attack significantly. The heart needs to pump with a greater force against higher systemic blood pressure. The workload of the heart drastically increases, leading to an increased energy requirement.

3: Myocarditis and Valvular Disease

Inflammation of the heart muscles, also known as myocardial infarction, is a significant risk factor. Valvular diseases such as rheumatic heart disease also compromise the health of myocardial cells.

4: Certain Chronic Disease  

Diabetes increases the risk of atherosclerosis and subsequent heart attack in the long term. Similarly, hypothyroidism and hyperthyroidism interfere with heart activity.

5: Certain lifestyle Factors

Smoking and alcohol cause long-term damages to myocardial tissues. Similarly, an unhealthy diet increases the risk of atherosclerosis and heart attack.

Complications

Congestive heart failure

Heart attack is a life-threatening condition. If a heart attack is not treated on time, it can lead to a congestive type of heart failure. The heart will not pump blood effectively, leading to pooling in placing such as the veins of legs, liver, and lungs.

Brain Damage

Brain cells are more susceptible to necrotic damage in short-term hypoxia. An untreated heart attack will invariably lead to brain cell injury.

Death

If the blood supply to the heart is not established immediately, myocardial infarction sets in, severely compromising heart function. The heart supplies blood to the rest of the organs. A malfunctioning heart compromises blood supply to the rest of the body leading to multi-organ failure and death.

Diagnosis

The diagnosis of heart attack will be in three steps.

1: History Taking

In history taking, the doctor will ask you about your symptoms, focusing on the symptoms’ intensity, duration, frequency, and activity association.

2: Physical Examination

Your doctor will check your cardiovascular parameters, including blood pressure, heart rate, and heart sounds. He will also check for venous engorgement in the neck and legs.

3: ECG

An ECG is the most appropriate way to diagnose a heart attack. The ECG will give you the electrical activity of the different chambers of your heart. By looking at your ECG, your doctor can find the area of the heart that is affected. It could also differentiate the different types of heart attacks.

4: Laboratory Tests And Cardiac Markers

The most important lab tests include cardiac markers such as Troponins and Creatine Kinase. Elevated cardiac markers are seen in myocardial infarction.

Treatment

The treatment route of a heart attack will depend on the severity of your disease. The treatment options include medications, surgery, and the implantation of devices.

1. Medications

The usual medications used in heart attack include anticoagulants, beta-blockers, angiotensin antagonizing drugs, calcium channel blockers, anti hyperlipidemia drugs, and vasodilators such as nitrates.

The above-described drugs improve the symptoms of a heart attack in different ways. These ways include improving the heart’s pumping capacity, reducing the arterial pressure against which the heart has to pump, reducing blot clots, and improving the heart’s blood supply.

2. Surgical Treatment

The surgical treatment options for heart attack in the case of angina include bypass surgery and angioplasty.

In bypass surgery, the surgeon creates an additional path for the blood to reach your heart. A healthy piece of the blood vessel is taken and is attached in pre and post part of the vessel obstruction.

In angioplasty, a catheter is passed into your vessel. The catheter has a balloon at its end. As the end of the catheter reaches the blacked part of the vessel, the balloon is inflated. This inflation opens the atherosclerotic block.

3. Implantation of devices

Artificial Pacemaker: The heart will beat according to the set frequency of the pacemaker.

Implantable Cardioverter Defibrillator: It detects arrhythmias and readjusts them by giving a shock to your heart.

Prevention

Though, a heart attack is not always predictable. You can adopt the following lifestyle changes to prevent heart attack.

1. Stop smoking and drink in moderation.

2. Regular exercise to prevent diabetes and other chronic diseases.

3. A healthy diet keeps your cholesterol, glucose, and weight in control. This control reduces the risk of a heart attack.

4. Stress is also a contributing factor in the progression of a heart attack. Managing your stress and making a good sleep pattern reduces the risk of a heart attack.

If you have any symptoms of cardiovascular problems, consult your doctor regularly. It is essential to follow the instructions of your doctor to prevent adverse outcomes.

References

1: Quah, J. L., Yap, S., Cheah, S. O., Ng, Y. Y., Goh, E. S., Doctor, N., Leong, B. S., Tiah, L., Chia, M. Y., & Ong, M. E. (2014). Knowledge of signs and symptoms of heart attack and stroke among Singapore residents. BioMed research international2014, 572425. https://doi.org/10.1155/2014/572425

2: Phillips, A. N., Shaper, A. G., Pocock, S. J., Walker, M., & Macfarlane, P. W. (1988). The role of risk factors in heart attacks occurring in men with pre-existing ischaemic heart disease. British heart journal60(5), 404–410. https://doi.org/10.1136/hrt.60.5.404

3: Fang, J., Luncheon, C., Ayala, C., Odom, E., & Loustalot, F. (2019). Awareness of Heart Attack Symptoms and Response Among Adults – United States, 2008, 2014, and 2017. MMWR. Morbidity and mortality weekly report68(5), 101–106. https://doi.org/10.15585/mmwr.mm6805a2

4: Greenlund, K. J., Keenan, N. L., Giles, W. H., Zheng, Z. J., Neff, L. J., Croft, J. B., & Mensah, G. A. (2004). Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin Islands, 2001. American heart journal147(6), 1010–1016. https://doi.org/10.1016/j.ahj.2003.12.036

5: Ornato, J. P., & Hand, M. M. (2001). Warning signs of a heart attack. Circulation104(11), 1212–1213. https://doi.org/10.1161/hc2501.093258

7: Schwartz, B. G., Mayeda, G. S., Burstein, S., Economides, C., & Kloner, R. A. (2010). When and why do heart attacks occur? Cardiovascular triggers and their potential role. Hospital practice (1995)38(3), 144–152. https://doi.org/10.3810/hp.2010.06.308

The content shared on the Health Literacy Hub website is provided for informational purposes only and it is not intended to replace advice, diagnosis, or treatment offered by qualified medical professionals in your State or Country. Readers are encouraged to confirm the information provided with other sources and to seek the advice of a qualified medical practitioner with any question they may have regarding their health. The Health Literacy Hub is not liable for any direct or indirect consequence arising from the application of the material provided.

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