Heart attack is the prevention of the supply of blood flow (in turn oxygen) to a part of the heart muscle as a result there is damage of the part of the heart muscle to where the blood supply is interrupted.
The coronary arteries carry blood to the heart muscles. If there is a blockage in the coronary artery the heart muscle cells do not get sufficient oxygen for their activities and they tend to die. The major cause of heart attack is the blockage of one of the coronary arteries due to blood clot in the blood.
If the coronary artery has a blockage due to plaque, it becomes narrow. The plaque may break and generate clot in the blood. Sometimes too much stress can also cause heart attack.
An uncommon cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Drugs, such as cocaine, can cause such a life-threatening spasm.
Obesity, diabetes, age above 65, high blood pressure, fat rich diet, high LDL (bad cholesterol) cholesterol levels, family history of coronary artery disease and smoking including long term exposure to passive smoking also leads to heart attack.
Chest pain is the most common symptom of heart attack. The pain may be mild or severe. The pain may be like indigestion, or like that of a heavy object placed on the chest, or like a compressor / heavy pressure on the chest or tightening of the chest. The pain may be only in chest or it may be radiating to neck, shoulder, arms, belly area, back or jaw.
Pain lasts normally for 20 minutes and is not relieved by rest or medications. Other symptoms are nausea, vomiting, sweating, palpitation, breathlessness, light headedness, dizziness, coughing, fainting or anxiety.
Many a times there may not be any symptoms of heart attack and it is referred to as “silent heart attack”.
Heart attack is diagnosed based on physical examination, stethoscopic sounds, pulse and blood pressure.
Other tests used which can see the condition of heart are electrocardiogram, echocardiography, coronary angiography, CT scan, MRI and nuclear ventriculography. Blood test may be done for heart enzymes that are specific for reacting during a heart attack.
Hospitalization is required in case of heart attack. Continuous ECG monitoring is done in an intensive care unit with oxygen supply. Medicines and other fluids are given intravenously and urine is collected (to check the amount of urine output).
Blood thinning medications are given intravenously initially and later on they are prescribed as oral tablets. The use of blood thinners is contraindicated in patients with stroke or head injury in last three months, bleeding inside the head, brain abnormalities like tumor or blood vessel malformation, pregnant women, peptic ulcer disease, severe high blood pressure, internal bleeding or major injury in last one month, major surgery in last one month or history of past blood thinner like coumadin.
Other medicines given in heart attack are antianginals (nitroglycerine, isosorbide mono/di-nitrates) antiplatelets (aspirin, clopidogrel) , anticoagulants (heparin, LMWH), antithrombotics (TPA, urokinase, streptokinase), beta blockers, ACE inhibitors and Lipid lowering medications.
Interventional procedures either angioplasty (opening of the blocked artery) with stenting or coronary artery bypass surgery (open heart surgery) are the some types of other treatment modalities available for treatment of heart attack.
The outcome depends upon the site of damage. Approximately in one third patients heart attack is fatal. If the patient survives for two hours after heart attack then he can recover. In some cases there may be complications. In patients if there are no complications the patient recovers completely and can gradually start daily activities.
Complications of heart attack may be blood clot in lungs, congestive heart failure, irregular heart beats, cardiogenic shock, heart valve damage, damage to the wall between the two heart sides, inflammation of the lining of the heart and side effects of drug treatment.
After first heart attack there is always a risk of future heart attack.
Control over blood sugar, blood pressure and cholesterol level; low fat, low animal fat and high fruit and vegetable diet; baked or grilled fish twice a week, avoiding smoking and control over alcohol; recommended exercise and weight reduction (if overweight) can prevent heart attack.
