Heart attack is also known as Myocardial Infarction. When a part of heart muscle loses its blood supply, it starts to suffer injury. Heart is supplied blood by two arteries, which ultimately become three vessels. When blood flow through these vessels becomes obstructed, it leads to a heart attack.
The magnitude of damage depends on the size of area that is supplied by the blocked artery as well as the lapse in time between injury and treatment. After several weeks the heart muscle heals by forming scar tissue and becomes weaker and will not pump as much blood as it used to.
There are two mechanisms of obstruction
1) Atherosclerosis-deposition of fat rich particles inside the lumen leading to gradual narrowing and ultimately complete obstruction.
2) Spasm – a sudden and transient narrowing of blood vessel despite patent lumen. Former is the most common process.
Symptoms
Most common symptom is chest pain, which may radiate to jaw, neck, and hand (more commonly left side). Some triggering factors are physical exertion (during but not after exertion), cold exposure, heavy meal, intense emotion. Changing position, resting or lying down does not alleviate the pain. A heart attack may also occur without causing chest pain; these are more common in elderly persons and in diabetics.
Other common symptoms are nausea, vomiting, dizziness, breathing discomfort, restlessness, clammy and sweaty with a feeling of terror that life is coming to end, face seems gray.
Risk factors
There are many risk factors, mentioned below and their effects are multiplicative rather than additive.
Age: largest risk factor. More precisely men over 45 years and women over 55 years are at particular risk. Scientists from the University of Copenhagen found fat deposits near eyelid and baldness, ear crease are associated with increased risk.
Positive family history: It is said to be present when first degree relatives had this problem at relatively early ages.
Hypertension High cholesterol levels in blood Diabetes mellitusPhysical inactivity: it roughly doubles the risk.
Obesity AlcoholDiet: Diet deficient in fresh fruit, vegetables, and polyunsaturated fat are associated with increased risk. Mediterranean style diet reduces the chance.
Other than these work stress, social deprivation, certain blood disorder and personality traits are contributing factors.
Diagnostic tools
ECG: It is a device which records electrical signal of heart, usually able to say whether someone has had heart attack or not.
Cardiac Enzyme test: Dying heart muscle release some enzymes such as Troponin, CK-MB etc into blood, which help to confirm the diagnosis.
Treatment
The faster the heart attack patient can be treated, the more successful the treatment will be. So it is of particular importance to remember that the patients survival largely depends on how quickly he can be taken to a hospital.
Treatments during a heart attack:
If patient stops breathing, they do not move or respond, CPR should be started straight away. CPR includes 30 chest compressions and mouth to mouth breathing. Defibrillation is also an option here.
Aspirin 300mg is given to heart attack patients which helps to stop the clot (obstruction). Thrombolytics: These agents dissolve blood clots but must be advised after considering the contraindications. Pain killers such as Morphine is also used.Treatments after heart attack
Most patients will require further treatment to prevent the further episodes. These medications include Aspirin and other anti platelets, Beta blocker, ACE inhibitors, Statins.
Surgery after heart attack
Depending on specific situation some patients get benefit from this modality of treatment.
Angioplasty: It opens up the coronary arteries. In this procedure, a small wire loop is introduced through arm or groin and pushed till it reaches the clot then the narrowed area is dilated by mechanical means.
CABG: Obstructed blood vessel is by-passed with grafts taken from blood vessels elsewhere in the body.
Recovery
It is a slow and gradual process. The patient’s recovery will generally start in hospital and then continue at home.
Physical activity is vital in a patient with heart attack. They should remain active, as it strengthens the heart. It is advised to refrain from driving for at least four weaks. One-fifth of patients suffer from depression after the attack, which should be shared with the doctor immediately.
