A heart attack is also called Myocardial Infarction (MI), occurs when blood flow reduces or stops to a part of the heart and it leading to partial or complete damage of the heart muscles. MI is a major global health disorder which is causing about one in every five deaths. It affects both genders but predominantly with midlife (35 to 54 years) women and becomes more common with age. Though it can occur at younger ages too particularly in people who lead unhealthy lifestyles.
The function of the heart is to pump the blood throughout the body to nourish the cells by providing oxygen and nutrition. This heart muscle itself requires a blood supply which is managed by the coronaries. The formation of atheromatous plaques inside the coronary blood vessels over many years reducing the blood flow and its supply of oxygen to the heart muscle, this results in pain or discomfort around the chest region, it is also called angina.
A heart attack happens when atheromatous plaques rupture and blocking the blood supply completely and leading to damage to the heart muscle, this damage can also lead to many cardiovascular problems such as hypertension, heart failure, cardiac arrest, etc.
How a heart attack is diagnosed?
Once it is suspected, a doctor will ask more about your history of symptoms and assess your risk factors for heart disease including your family history. After this, a range of tests might be used to confirm the diagnosis including blood tests and ECG, or EKG which traces the electrical pattern of the heartbeat, exercise stress tests, and an echocardiogram which is an ultrasound scan of the heart. Finally, a procedure called an angiogram is done where a contrast dye is injected into the blood during x-ray imaging this is used to find out precisely which blood vessels around the heart are affected.
What Causes a heart attack?
Coronary arteries supplies blood to the heart muscles, a significant blockage in any of the coronary arteries can cause a heart attack. Coronary artery disease is a common cause of a heart attack. This is when deposits of fat and other substances build up in the inner lining of an artery. This build-up is called atheroma or plaque. If one of the plaques ruptures, a blood clot will form which can block the artery and cause a Myocardial Infarction/heart attack.
You might have a complete or partial blockage of the coronary artery.
- A complete blockage means you've had an ST-elevation myocardial infarction (STEMI).
- A partial blockage means you've had a non-ST elevation myocardial infarction (NSTEMI).
Diagnosis and treatment might be different depending on which type you've had.
Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Using tobacco and illicit drugs, such as cocaine, can cause a life-threatening spasm.
There is a lot we don’t understand about what contributes to causing a heart attack, but people who have a family history of heart attack or heart disease are more likely to have a heart attack themselves.
If you are aged under 50 when you have your heart attack, your immediate relatives are at greater risk of developing heart disease.
Symptoms of a heart attack
There are clear symptoms of a heart attack that require immediate medical attention.
A feeling of pressure, tightness, pain, squeezing or aching in the chest or arms that spread to the neck, jaw, or back can be a sign that a person is having a heart attack.
The following are other possible signs and symptoms of a heart attack occurring:
- Crushing chest pain
- Shortness of breath called dyspnea
- Face seeming gray
- A feeling of terror that life is ending
- Feeling awful, generally,
- Feeling clammy and sweaty
- Shortness of breath
Changing the position does not alleviate the pain of a heart attack. The pain a person feels is normally constant, although it may sometimes intermittent. It is possible to have a 'silent' heart attack, where you do not experience pain or where the only warning sign may be an indigestion type of discomfort. This is most common in women or people with diabetes. It is medically referred to as silent ischemia (lack of oxygen) to the heart muscle.
Heart attack symptoms in women:
Women may have different heart attack symptoms than men. This is possible because women are more likely to have blockages, not only in their main coronary arteries but also in the tiny coronary artery blood vessels that branch off from the main ones. This is called microvascular coronary disease. Heart attack symptoms can be subtle in women, which is why it's important to know what to look out for.
Heart attack symptoms vary:
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. For others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the chance 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 might be recurrent chest pain or pressure (angina) that's triggered by activity and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart.
Cardiac arrest or Heart attack?
A heart attack is not the same as a cardiac arrest. They are two different types of a cardiac event. A heart attack occurs when a coronary artery becomes blocked, preventing blood flow to part of the heart muscle. During a heart attack, a person remains conscious and keeps breathing. A cardiac arrest occurs when the heart stops pumping blood around the body. Normal breathing stops and consciousness is lost.
Sometimes a heart attack can cause a cardiac arrest. This is because a person who is having a heart attack may develop a dangerous heart rhythm, which causes a cardiac arrest. A heart attack and cardiac arrest are both emergencies.
Risk factors for Heart attack:
There are many risk factors for heart disease and some can be controlled but not others. Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body.
Heart attack risk factors include:
- Menage 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women.
- This includes active and passive smoking and consuming tobacco products.
- High blood pressure.Over time, high blood pressure can damage arteries that lead to high blood pressure that occurs with other conditions, such as obesity, high cholesterol, or diabetes, increases your risk even more.
- High blood cholesterol or triglyceride levels.A high level of low-density lipoprotein (LDL) cholesterol ("bad" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also increases your risk of a heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol ("good" cholesterol) may lower your risk.
- Obesity is linked to high blood cholesterol levels, high triglyceride levels, high blood pressure, and diabetes. Losing just 10% of your body weight can lower this risk.
- Not producing enough of a hormone secreted by your pancreas (insulin) or not responding to insulin properly causes your body's blood sugar levels to rise, increasing your risk of a heart attack.
- Metabolic syndrome.This syndrome occurs when you have obesity, high blood pressure, and high blood sugar. Having metabolic syndrome makes you twice as likely to develop heart disease than if you don't have it.
- Family history of heart attacks.If your siblings, parents, or grandparents have had early heart attacks (by age 55 for males and by age 65 for females), you might be at increased risk.
- Lack of physical activity.Being inactive contributes to high blood cholesterol levels and obesity. People who exercise regularly have better heart health, including lower blood pressure.
- You might respond to stress in ways that can increase your risk of a heart attack.
- Illicit 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.
- An autoimmune condition.Having a condition such as rheumatoid arthritis or lupus can increase your risk of a heart attack.
Heart Attack – Complications
There are two types of complications that can happen following a heart attack. The first occurs pretty much straight away and the second happens later on.
- Arrhythmias: the heart beats irregularly, either too fast or too slowly.
- Cardiogenic shock: a person’s blood pressure drops suddenly and the heart cannot supply enough blood for the body to work adequately.
- Hypoxemia: levels of oxygen in the blood become too low.
- Pulmonary edema: fluid accumulates in and around the lungs.
- DVT or deep vein thrombosis: the deep veins of the legs and pelvis develop blood clots that either block or interrupt the flow of blood in the vein.
- Myocardial rupture: the heart attack damages the wall of the heart, meaning an increased risk of a heart wall rupture.
- Ventricular aneurysm: a heart chamber, known as a ventricle, forms a bulge.
Complications that can occur later
- Aneurysm: scar tissue builds up on the damaged heart wall, leading to blood clots, low blood pressure, and abnormal heart rhythms.
- Angina: not enough oxygen reaches the heart, causing chest pain.
- Congestive heart failure: the heart can only beat very weakly, leaving a person feeling exhausted and breathless.
- Edema: fluid accumulates in the ankles and legs, causing them to swell.
- Loss of erectile function: erectile dysfunction is generally caused by a vascular problem. However, it can also be the result of depression.
- Loss of libido: a loss of sexual drive can happen, especially in the case of men.
- Pericarditis: the lining of the heart becomes inflamed, causing serious chest pain.
A doctor must monitor a person for several months after they have had a heart attack to check for any of these complications that may occur.
Treatment for Heart Attack
The quicker someone is treated when having a heart attack, the greater the chances of success. These days, most heart attacks can be dealt with effectively. However, it is crucial to remember that a person’s survival depends largely on how quickly they reach the hospital. If a person has a history of heart attacks, they should speak to a doctor about treatment plans.
Treatments during a heart attack
Sometimes, a person who is having a heart attack will stop breathing. In this case, cardio-pulmonary resuscitation, or CPR, should be started immediately. This process involves:
- manual chest compressions
- a defibrillator
Treatments following a heart attack:
Most people will need several kinds of medications or treatments after a heart attack. These measures aim to prevent future heart attacks. They may include:
- aspirin and other antiplatelets
- ACE (angiotensin-converting enzyme) inhibitors
- CABG or coronary artery bypass graft
Heart Attack Prevention
The best way of preventing a heart attack is to have a healthy lifestyle. Measures for healthy living include the following:
- not smoking
- eating a balanced, healthful diet
- getting plenty of exercises
- getting plenty of good quality sleep
- keeping diabetes under control
- keeping alcohol intake down
- maintaining blood cholesterol at optimum levels
- keeping blood pressure at a safe level
- maintaining a healthy body weight
- avoiding stress where possible
- learning how to manage stress
Recovery from Heart Attack
Recovering from a heart attack can be a gradual process. It depends on the severity of the heart attack and other factors, such as a person’s age.
A person’s recovery may involve:
- Resuming physical activity: a recovering heart attack patient must stay active. However, a specialist should design any exercise program for them.
- Returning to work: the appropriate time for someone to go back to work depends on various factors, including the severity of the heart attack and the type of job they do. It is vital not to rush back to work.
- A period of depression: many people who have had a heart attack experience depression not long afterward. Those who feel depressed or anxious should tell their doctors.
- Driving again: experts advise that a person refrains from driving for at least 4 weeks after a heart attack.
- Erectile dysfunction: approximately one-third of men have problems getting or sustaining an erection after a heart attack.
Men with erectile dysfunction must talk to their doctors, as medication can restore function in most cases.