Heart Attack – Know the Facts – If you have coronary artery disease, those arteries become narrow and blood cannot flow as well as they should.
What is A Heart Attack (Myocardial Infarction)?
The heart muscle requires a constant supply of oxygen rich blood to nourish it. The coronary arteries provide the heart with this critical blood supply. If you have coronary artery disease, those arteries become narrow and blood cannot flow as well as they should. Fatty matter, calcium, proteins, and inflammatory cells build up within the arteries to form plaques of different sizes. The plaque deposits are hard on the outside and soft and mushy on the inside.
A heart attack occurs when the flow of blood to the heart is blocked, most often by a build-up of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The interrupted blood flow can damage or destroy part of the heart muscle.
When the plaque is hard, the outer shell cracks (plaque rupture), platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. If a blood clot totally blocks the artery, the heart muscle becomes “starved” for oxygen. Within a short time, death of heart muscle cells occurs, causing permanent damage. This is a heart attack.
While it is unusual, a heart attack can also be caused by a spasm of a coronary artery. During a coronary spasm, the coronary arteries restrict or spasm on and off, reducing blood supply to the heart muscle (ischemia). It may occur at rest, and can even occur in people without significant coronary artery disease.
What are the Symptoms?
- Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back.
- Fullness, indigestion, or choking feeling (may feel like heartburn)
- Shortness of breath.
- Cold sweat.
- Lightheadedness or sudden dizziness.
- Rapid or irregular heartbeats.
During a heart attack, symptoms last 30 minutes or longer and are not relieved by rest or nitroglycerin under the tongue.
Some people have a heart attack without having any symptoms (a “silent” myocardial infarction). A silent MI can occur in anyone, but it is more common among people with diabetes.
Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms, while for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you’re having a heart attack.
Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning may be recurrent chest pain (angina) that’s triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart.
A heart attack differs from a condition in which your heart suddenly stops (sudden cardiac arrest, which occurs when an electrical disturbance disrupts your heart’s pumping action and causes blood to stop flowing to the rest of your body). A heart attack can cause cardiac arrest, but it’s not the only cause.
What are the Causes?
A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks.
During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can completely block the flow of blood through the coronary artery.
Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Use of tobacco and of illicit drugs, such as cocaine, can cause a life-threatening spasm. A heart attack can also occur due to a tear in the heart artery (spontaneous coronary artery dissection).
What are the Risk Factors?
Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or subsequent heart attack.
Heart attack risk factors include:
Age – Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women.
Tobacco – Smoking and long-term exposure to secondhand smoke increase the risk of a heart attack.
High blood pressure – Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure that occurs with obesity, smoking, high cholesterol or diabetes increases your risk even more.
High blood cholesterol or triglyceride levels – A high level of low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the “good” cholesterol) lowers your risk of heart attack.
Diabetes – Insulin, a hormone secreted by your pancreas, allows your body to use glucose, a form of sugar. Having diabetes — not producing enough insulin or not responding to insulin properly — causes your body’s blood sugar levels to rise. Diabetes, especially uncontrolled, increases your risk of a heart attack.
Family history of heart attack – If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you may be at increased risk.
Lack of physical activity – An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure.
Obesity – Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however.
Stress – You may respond to stress in ways that can increase your risk of a heart attack.
Illegal drug use – Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack.
A history of preeclampsia – This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease.
A history of an autoimmune condition, such as rheumatoid arthritis or lupus – Conditions such as rheumatoid arthritis, lupus and other autoimmune conditions can increase your risk of having a heart attack.
What are the Complications?
Heart attack complications are often related to the damage done to your heart during a heart attack. This damage can lead to the following conditions:
- Abnormal heart rhythms (arrhythmias) – If your heart muscle is damaged from a heart attack, electrical “short circuits” can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal.
- Heart failure – The amount of damaged tissue in your heart may be so great that the remaining heart muscle can’t do an adequate job of pumping blood out of your heart. Heart failure may be a temporary problem that goes away after your heart, which has been stunned by a heart attack, recovers. However, it can also be a chronic condition resulting from extensive and permanent damage to your heart following your heart attack.
- Heart rupture – Areas of heart muscle weakened by a heart attack can rupture, leaving a hole in part of the heart. This rupture is often fatal.
- Valve problems – Heart valves damaged during a heart attack may develop severe, life-threatening leakage problems.
Note : A heart attack usually is diagnosed in an emergency setting. However, if you’re concerned about your risk of heart attack, see your doctor to check your risk factors and talk about prevention. If your risk is high, you may be referred to a heart specialist (cardiologist).
Important : Remember, heart attack won’t subside resting, it needs immediate medical treatment. With each passing minute after a heart attack, more heart tissue loses oxygen and deteriorates or dies. The main way to prevent heart damage is to restore blood flow quickly.
What are the Drugs Available?
Aspirin – Take Aspirin immediately (with medical advice). Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery.
Thrombolytics – These drugs, also called clotbusters, help dissolve a blood clot that’s blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you’ll survive and with less heart damage.
Antiplatelet agents – Emergency room doctors may give you other drugs to help prevent new clots and keep existing clots from getting larger. These include medications, such as clopidogrel (Plavix) and others, called platelet aggregation inhibitors.
Other blood-thinning medications – You’ll likely be given other medications, such as heparin, to make your blood less “sticky” and less likely to form clots. Heparin is given intravenously or by an injection under your skin.
Nitroglycerin – This medication, used to treat chest pain (angina), can help improve blood flow to the heart by widening (dilating) the blood vessels.
Beta blockers – These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart’s job easier. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks.
ACE inhibitors – These drugs lower blood pressure and reduce stress on the heart.
In addition to medications, you may undergo one of the following procedures to treat your heart attack:
- Coronary angioplasty and stenting
- Coronary artery bypass surgery.
How you can prevent/recover from a Heart Attack?
Avoid smoke – The most important thing you can do to improve your heart’s health is to not smoke. Also, avoid being around secondhand smoke.
Control your blood pressure and cholesterol levels – If one or both of these is high, your doctor can prescribe changes to your diet and medications. Ask your doctor how often you need to have your blood pressure and cholesterol levels monitored.
Get regular medical checkups – Some of the major risk factors for heart attack – high blood cholesterol, high blood pressure and diabetes – cause no symptoms early on. Your doctor can perform tests to check for these conditions and help you manage them, if necessary.
Exercise regularly – Regular exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack by helping you to control your weight, diabetes, cholesterol and blood pressure. Exercise needn’t be vigorous. Walking 30 minutes a day, five days a week can improve your health.
Maintain a healthy weight – Excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes.
Eat a heart healthy diet – Saturated fat, trans fats and cholesterol in your diet can narrow arteries to your heart, and too much salt can raise blood pressure. Eat a heart healthy diet that includes lean proteins, such as fish and beans, plenty of fruits and vegetables and whole grains.
Manage diabetes – High blood sugar is damaging to your heart. Regular exercise, eating well and losing weight all help to keep blood sugar levels at more-desirable levels. Many people also need medication to manage their diabetes.
Control stress – Reduce stress in your day to day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life.
If you drink alcohol, do so in moderation – Nothing more to say.
PREVENT Death – It’s never too late to take steps to prevent a heart attack – even if you’ve already had one. Here are ways to prevent a heart attack:
Medications – Taking medications can reduce your risk of a subsequent heart attack and help your damaged heart function better. Continue to take what your doctor prescribes, and ask your doctor how often you need to be monitored.
Lifestyle factors – You know the drill: Maintain a healthy weight with a heart-healthy diet, don’t smoke, exercise regularly, manage stress and control conditions that can lead to heart attack, such as high blood pressure, high cholesterol and diabetes.
Sex after a heart attack
Some people worry about having sex after a heart attack, but most people can safely return to sexual activity after recovering from a heart attack. When you can resume sexual activity will depend on your physical comfort, psychological readiness and previous sexual activity. Ask your doctor when it’s safe to resume sexual activity.
Some heart medications may affect sexual function. If you’re having problems with sexual dysfunction, talk to your doctor.
Remember – There is no cure for coronary artery disease. In order to prevent the progression of heart disease and another heart attack, you must follow your doctor’s advice and make necessary lifestyle changes – quitting smoking, lowering your blood cholesterol, controlling your diabetes and high blood pressure, following an exercise plan, maintaining an ideal body weight, and controlling stress.
How Are Future Heart Attacks Prevented?
The goal after your heart attack is to keep your heart healthy and reduce your risks of having another heart attack. Your best bet to ward off future attacks are to take your medications, change your lifestyle, and see you doctor for regular heart checkups.