what you need to know about Heart Attacks

A heart attack, also known as a myocardial infarction, is a common medical emergency in which one of the coronary arteries becomes blocked and the heart loses its supply of oxygen-rich blood. If blood flow is not restored the heart muscle will start to die within 20-40 minutes. Thus, it is imperative that heart attacks be detected and treated as quickly as possible.

When it comes to heart attacks the phrase “time is tissue” is known to medical providers, this is because the quicker the heart attack is treated, the better the chance the patient will survive and the medical team will be able to save as much of the heart tissue as possible.

How common are heart attacks?

According to the Center for Disease Control and Prevention (CDC), a heart attack occurs every 40 seconds in the United States. Each year nearly 735,000 Americans have a heart attack, with 525,000 of those experiencing their first heart attack and 210,000 experiencing another heart attack after their first. Nearly 1 in 5 heart attacks are silent, meaning that the person is not even aware they have had a heart attack because it occurs with no symptoms.

What is a Heart Attack?

A heart attack is a serious medical condition that results from a blockage of blood supply to a part of the heart. Generally, the blockage is caused from the buildup of fat, cholesterol, or other substances called plaques in the arteries. When oxygen-rich blood is unable to reach a section of tissue in the heart, this is known as ischemia. When the deprivation of oxygen and nutrients results in damage or death to the heart muscle, this is called a myocardial infarction or “heart attack.” The longer the heart tissue goes without oxygen, the worse off the patient will be.

There are several risk factors that increase the likelihood of developing a heart attack. Lifestyle factors include a western diet, lack of exercise, smoking, and alcohol, all of which can greatly increase your risk of suffering a heart attack during your life. Heart attacks are often fatal, however, the earlier it is identified and treated the better the outcome will be.

After a heart attack occurs the heart can take several weeks to heal and recovery time depends on the severity of the heart muscle damage. Generally, the heart is not permanently damaged from a heart attack and will, at least in-part, heal. Often though, the healing process never returns the heart to its pre-attack state and the heart is weaker, making it unable to pump as much blood as it did before the attack. With the proper treatment plan, as well as lifestyle changes, the heart will heal faster and remain stronger over time.

Symptoms

The signs and symptoms of a heart attack can vary, but the most common heart attack symptoms include:

  • Pressure, tightness, pain, or squeezing sensation in the chest or arms that may spread to the neck, jaw, or back
  • Nausea, heartburn, indigestion, or abdominal pain; may feel like you’re choking
  • Shortness of breath
  • Fatigue
  • Cold Sweats
  • Sudden dizziness or lightheadedness
  • Rapid or irregular heartbeats

Every person is different and not everyone has the same symptoms or severity of symptoms. In fact, some people may experience a sudden heart attack without any warning signs or symptoms. This is called a “silent” myocardial infarction. Most people, however, will have several of these signs or symptoms for hours, days, or even weeks before the heart attack occurs. Generally, the earliest warning signaling is chest pain that is triggered by exertion and relieved by rest.

Women may experience different heart attack symptoms than men. For example, women may have a heart attack without any chest pressure. Instead, women often feel short of breath combined with upper back pressure and dizziness, which can sometimes be misdiagnosed as acid reflux, the flu, or just normal aging. Therefore, if you are experiencing any of these symptoms it is important to always confer with a medical professional to ensure that it is not a more serious condition.

Risk Factors

Heart attacks are the result of unwanted buildup of plaques within the heart’s arteries or spasm of the arteries. There are certain risk factors that can make unwanted buildup or spasms more likely to occur. These factors include:

  • Age: Men ages 45+ and women ages 55+ are more likely to have a heart attack than younger men and women.
  • Gender: Overall, men have a greater risk of heart attack than women and often have heart attacks earlier in life than women. However, women are more likely to die from a heart attack than men.
  • Tobacco usage: Long term exposure to smoke, whether through smoking yourself or secondhand smoke increases the risk of a heart attack.
  • High blood pressure: Blood pressure refers to the amount of pressure the blood puts on the body’s circulatory system. High blood pressure means that the pressure in the veins and arteries of the circulatory system is higher than normal. This elevated pressure can damage the circulatory system and make it more difficult for the heart to pump blood throughout the body. It also can increase the risk of buildup of fat in the circulatory system. High blood pressure in combination with other risk factors such as smoking, high cholesterol, and diabetes increases the risk of a heart attack even more than just high blood pressure by itself.
  • High blood cholesterol or triglyceride levels: Cholesterol is a type of fat that is important for proper heart function. There is “good” cholesterol and “bad” cholesterol. Too much bad cholesterol can narrow the arteries and lead to an increased risk of a heart attack. Triglycerides are another type of fat and too much triglycerides also increases the risk of a heart attack. Both cholesterol and triglycerides are obtained through food and therefore a diet high in cholesterol and triglycerides can especially increase your risk of a heart attack. 
  • Diabetes: A disease that arises because the body can no longer properly break down the sugar eaten from food. The protein responsible for breaking down sugar is insulin. In diabetes, the body does not produce enough insulin and therefore too much sugar remains in the blood. Diabetes increases the risk of a heart attack due to the overwhelming inflammatory effect and stress that too much sugar puts on the body.
  • Family History: If someone in your family has had a heart attack in the past, then this can increase your risk of having a heart attack too. Family history especially increases your risk if a sibling, parent, or grandparent had a heart attack before the age of 55 for males, and 65 for females.
  • Race: African-Americans have a greater risk of heart attacks than Caucasians.
  • Lack of physical activity: Exercise and an active lifestyle keep the heart healthy. An inactive lifestyle often can cause high blood cholesterol and obesity, which increases the risk of a heart attack. Regular exercise is one of the best ways to decrease the risk of a heart attack.
  • Stress: Stress can increase the risk of a heart attack due to the inflammatory effect and extra stress it puts on the heart. 
  • Illegal drug use: The use of stimulant drugs, especially cocaine or amphetamines can trigger the arteries to spasm and cause a heart attack.
  • Alcohol: Drinking too much alcohol can increase blood pressure, cause higher triglycerides, produce irregular heartbeats, and contribute to obesity. All of these factors can result in an increased risk of a heart attack.
  • Preeclampsia: Preeclampsia is a condition that results from high blood pressure during pregnancy. If you had preeclampsia while pregnant this increases your risk of having a heart attack.
  • Obesity: Obesity is associated with many of the above risk factors, including high blood cholesterol, high triglyceride levels, high blood pressure, and diabetes. If you are obese, losing 10% of your body weight can significantly lower the risk of a heart attack.
  • Autoimmune Conditions: Autoimmune disorders occur when the body’s immune system starts attacking itself and can cause serious harm to the body. Certain autoimmune conditions, including rheumatoid arthritis and lupus can harm to the heart and its arteries, increasing your risk of having a heart attack.

Diagnosis

Generally, a primary care doctor will screen your risk factors and regularly schedule physical exams to monitor your heart health. In an emergency situation or if you are presenting with symptoms, doctors will perform a variety of tests to identify and confirm if you are having a heart attack. These tests include:

  • Electrocardiogram (ECG): This test is often the first test performed to diagnose a heart attack. It is performed by measuring the electrical activity of your heart via electrodes attached to the skin. If you have had a heart attack, your heart will not beat properly and therefore will not conduct electrical impulses properly, which the ECG can detect. 
  • Blood tests: In the case of a heart attack, certain heart proteins begin to leak into the blood. These proteins can be detected via a simple blood test and can suggest whether you may have or are having a heart attack.
  • Chest X-ray: A chest X-ray is an image the doctor uses to examine the size of your heart and blood vessels. It can also be used to check for fluid in the lungs. During a heart attack, the size of your heart and blood vessels will appear abnormal and fluid can collect in the lungs.
  • Echocardiogram: An echocardiogram is performed by directing sound waves to the heart through a wand-like device called a transducer. The transducer is held on the chest and the sound waves can bounce off the heart and provide the doctors with an electronic image of your heart. An echocardiogram can identify if a particular area of the heart is damaged and if it is not pumping properly.
  • Coronary catheterization (angiogram): An angiogram is performed by injecting a liquid dye into the heart’s arteries. The dye is injected using a long, thin tube, called a catheter, into the leg or groin, which carries the dye to the heart. This dye allows for the arteries to be visible on an X-ray and can reveal where a blockage has occurred
  • CT Scan or MRI: A CT scan and MRI both work by visualizing the heart and its arteries, which allow the doctors to obtain an image of your heart. This image allows doctors to identify where the damage or blockage has occurred.
  • Exercise stress test: An exercise stress test is performed by having the patient walk on a treadmill or pedal a stationary bike while attached to an ECG. This test will not be performed during an emergency, but instead performed days or weeks after the heart attack. This test can measure how well your heart is healing from an attack.

Your medical provider may perform any combination of the above-mentioned tests. Once these tests are performed, your provider will be able to characterize how severe the heart attack was. The severity of heart attacks is divided into two categories: a complete blockage and a partial blockage.

A complete blockage means that the heart attack was caused by a blockage that completely blocked the use of one or more arteries. This type of heart attack is sometimes called a STEMI heart attack, which stands for ST-Elevation Myocardial Infarction.

A partial blockage means that one or more arteries were only partially blocked. This type of heart attack is sometimes called a NSTEMI, which stands for a Non-ST-Elevation Myocardial Infarction.


Treatment

The treatment required will vary from person to person, but can be divided into two categories; medication or procedural.

Medication given to treat a heart attack includes

  • Aspirin: Aspirin is an over-the-counter medication that works by reducing blood clotting and helping to main blood flow through a clogged artery. An emergency medical professional, including a 911 operator, may suggest that you take a baby aspirin if you are experiencing symptoms of a heart attack.
  • Thrombolytics: Thrombolytics are drugs used to help dissolve a blood clot that is preventing proper blood flow through your artery and to your heart. This is often a first defense medication and the sooner a thrombolytic is used after a heart attack the better it is for your heart.
  • Antiplatelet agents: These drugs are given to prevent new clots or by keeping older clots from growing larger.
  • Blood thinners: Prescribed blood thinners so what their name suggests, they thin the blood and slow clotting times to allow easier blood flow through clogged arteries. An example of a common blood thinner given to heart attack patients is heparin. As you can imagine those on blood thinners are at increased risk of bleeding. 
  • Pain relievers: Heart attacks are painful events that can cause severe discomfort. Therefore, doctors will sometimes prescribe pain killers to improve your comfort level and decrease pain.
  • Vasodilators: Vasodilators are prescribed for the treatment of chest pain. They work by widening the blood vessels to improve blood flow to the heart. One commonly used vasodilator is nitroglycerin.
  • Beta Blockers: Beta blockers work by relaxing the heart, slowing the heartbeat, and decreasing blood pressure. These activities make the heart’s job easier and can help prevent damage to the heart muscle. These medications can also be used to prevent future heart attacks.
  • ACE Inhibitors: ACE inhibitors lower blood pressure, which helps the heart pump blood throughout the body.
  • Diuretic: Diuretics relieve the body of excess fluids through frequent urination. This decreases the amount of work the heart must do and limits the buildup of fluid in the lungs.

Procedures performed to treat a heart attack include:

  • Coronary angioplasty and stenting: This procedure is performed by inserting a catheter into an artery to locate the blocked artery. On one end of the catheter is a special balloon. Once the blockage has been identified the balloon can be inflated to open a blocked artery and restore blood flow to the heart. If the blockage is especially severe, a stent may be placed in the area to keep the artery open.
  • Coronary artery bypass surgery: In some heart attack cases a coronary artery bypass surgery is performed. This procedure involves routing around the blockage with surgically placed veins and arteries. These replacement veins and arteries are sewn into place by the surgeons and this allows for the blood to be routed around the damaged artery. This restores blood flow to the heart.
  • Artificial heart valve surgery: This procedure is like the coronary artery bypass surgery, however, instead of routing around the blockage with surgically placed veins and arteries, an artificial heart valve surgery replaces a damaged heart valve with an artificial one.
  • Heart transplants: In rare, extremely severe heart attack cases, the heart cannot be repaired with medical or traditional procedural methods. In these cases, a heart transplant may be possible to replace the damaged heart.

*Reminder: If you have any typical or atypical symptoms of heart attack make sure you see your medical provider right away or call  911, its better to be safe than sorry when it comes to heart attacks. 

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