Signs and symptoms
Each person's symptoms may differ but the common ones are:
- Chest pain is accompanied by a feeling of pressure, tightness, or a squeezing sensation in the centre of your chest. People often mistake this pain for heartburn or indigestion.
- The pain may radiate to the neck, jaw, left shoulder, back, or stomach.
- A feeling of dizziness or fainting
- Shortness of breath
- Racing heart rate
- Feeling nauseous or vomiting
Figure: Chest Pain During Heart Attack
Heart attacks are caused by the sudden interruption of the blood supply to the heart. This can occur due to the development of blockage in the arteries supplying blood to the heart. Coronary artery disease (CAD) is one of the leading causes of this. In CAD patients, there is an accumulation of cholesterol and other substances, known as plaques, on the heart's arteries. This plaque can sometimes break and form a clot within the artery, restricting blood flow to your heart which triggers a heart attack.
Less common causes of heart attack are:
- Illicit drugs such as cocaine can narrow coronary arteries, limiting blood flow and causing a heart attack.
- Lack of oxygen in the blood hence the heart doesn't receive enough oxygenated blood, which damages the heart muscles and results in a heart attack.
- A severe spasm of the coronary artery can cause constriction of the arteries of the heart, resulting in interrupted blood supply to the heart.
- Heart attacks can also be caused by factors that increase oxygen demand, such as strenuous exercise, fever, or hyperthyroidism.
- Aneurysms of the coronary arteries, as well as other coronary abnormalities, can lead to heart attacks.
- Cholesterol, air, or sepsis-related emboli cause coronary artery emboli, which can lead to heart attacks.
- Trauma, vasculitis, and aortic dissection can also cause heart attacks.
When to Seek Advice?
A heart attack requires immediate medical attention as this is a medical emergency. Call the ambulance if you have a severe heart attack warning signals such as chest pain that radiates to the hand and jaw or pain that get worse quickly or last longer than 5 minutes.
Risks and Complications of Heart Attack
Risk Factors include:
- Family history of heart diseases
- Medical conditions such as diabetes mellitus and high blood pressure
- Sedentary lifestyle, cigarette smoking, and alcohol consumption
- Advanced age
Complications of heart attack
Heart attack can result in the following complications:
- Heart failure - The heart's blood pumping capacity is compromised following a heart attack. This occurs as a result of the damage caused to the heart's muscles.
- Arrhythmias - A heart attack can disrupt the electrical signals of the heart. This disruption can result in irregular heartbeats, also known as arrhythmia.
- Cardiogenic Shock - Cardiogenic shock occurs when your heart abruptly stops pumping enough oxygen-rich blood to your body, putting your life in jeopardy. This is a life-threatening condition that is frequently brought on by a heart attack.
- Heart Rupture - This is one of the rare but life-threatening complications of a heart attack. Heart rupture occurs due to the rupture of the heart's muscles, valves, or walls.
Taking the following steps can prevent the occurrence of heart attack:
- Stop smoking if you are a smoker
- Maintain a healthy weight
- Remain physically active and exercise regularly
- Reduce alcohol consumption
- Consuming a nutritious diet
- Attempt to maintain healthy blood pressure and cholesterol level
Once you reach the hospital, your doctor will carry out several tests to confirm if you have had a heart attack.
Blood tests: After a heart attack, certain cardiac proteins progressively leak into your bloodstream. These proteins, or enzymes, will be tested in your blood by emergency room doctors.
Electrocardiogram (ECG): This is one of the first tests done to diagnose a heart attack. The electrical activity of your heart is measured by attaching electrical leads attached to your arms, chest, and legs.
Other non-invasive tests that are carried out include:
- Chest X-ray
- Cardiac CT scan or MRI
Figure: ECG Depicting Heart Attack Figure: Echocardiogram
Invasive Diagnostic Tests:
Coronary Angiography: Angiography helps to detect a blocked or narrowed coronary artery. During this process, a small tube or catheter will be inserted into your coronary artery through a blood vessel in the groin. The coronary artery is then pumped with a contrast agent, which helps to visualize the narrowing or blockages of the arteries
Treatment of Heart Attack
Emergency Treatment At Home
Heart attack treatment requires immediate action. Take the following steps if you or your loved ones are having a heart attack to help save one's life:
- Chew and swallow an aspirin tablet (preferably 300mg) unless you are allergic to it. This will help to thin your blood and improve blood supply to the heart.
- If you have already been using nitroglycerine for any known heart condition, then take it now. This expands the coronary arteries to enhance oxygen delivery to the heart muscle.
Call an ambulance or your friends and family to drive you home.
Emergency Treatment At The Hospital
Depending on the severity of the heart attack, it can be treated with medications to dissolve blood clots or require surgical intervention.
Medications: Thrombolytic Medications are used to dissolve blood clots restricting blood flow during a heart attack. These drugs must be given as quickly as possible to lower the amount of damage to the heart muscle. Other drugs may be administered to lower the chance of a second heart attack. These include the following: aspirin, anti-platelets, and anti-coagulants.
Enrol in a cardiac rehabilitation program after your heart attack. Cardiac rehab is a medically supervised program that is designed to help you improve your cardiovascular health. This program involves a combination of exercises, counselling, and educational sessions.
Suffering from a heart attack requires making lifestyle changes in future. These include:
- After a heart attack, physical activity (as directed by a cardiologist) will be important for maintaining long-term heart health.
- If you still haven't stopped smoking, this is the time to do it.
- Eat a diet that is good for your heart. Low-cholesterol and low-saturated-fat foods should be included in your diet. Increase your intake of fruits and vegetables. Reducing your intake of red meat instead may increase your intake of white meat and fish.
- Have control of your cholesterol and blood pressure levels.
- Reduce your stress levels.
What to Ask and Tell Your Doctors?
When the patient is brought into an emergency, the doctor may enquire about any previous cardiovascular problems of the patient.
Two types of interventional procedures can be carried out to help restore the heart's blood flow during a heart attack
- During this surgical procedure, your cardiologist will use a special balloon to open the blocked coronary artery.
- A specific metal tube (stent) may then be left inside your artery to keep it open.
- Angioplasty is not possible if there are too many blocks in the coronary arteries. In such cases, an alternative surgery, known as coronary artery bypass graft surgery, is carried out.
- After being discharged home, most patients recover and return to work within a week.
Figure: Cardiac Stent
Coronary artery bypass graft surgery (CABG):
- During CABG, blood vessels from either your arms, legs, or chest are attached above and below the blocked coronary artery. This new blood vessel is termed a graft.
- It enables the increase of oxygen supply and blood flow to the heart by creating diversions around congested or blocked areas of the major arteries.
- You'll probably feel a little groggy and uncomfortable following the treatment, but you'll be given medicines to help you feel better.
- After CABG, you'll generally need to stay in the hospital for about a week.
- It takes time to recover following a CABG procedure, and everyone recovers at a different pace. The majority of people recover completely within 12 weeks of surgery.
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