Heart Attack
Heart Attack
(Myocardial Infarction)
by Rosalyn Carson-DeWitt, MD
Definition
A heart attack occurs when blood flow to the heart muscle is interrupted. This deprives the heart muscle of oxygen, causing tissue damage or tissue death.
Heart Attack
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Copyright © 2005 Nucleus Communications, Inc. All rights reserved.
Causes
A heart attack may be caused by:
• Thickening of the walls of the arteries feeding the heart muscle (coronary arteries)
• Accumulation of fatty plaques in the coronary arteries
• Narrowing of the coronary arteries
• Spasm of the coronary arteries
• Development of a blood clot in the coronary arteries
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Sex: Male
• Increased age
• Obesity
• Smoking
• High blood pressure
• Sedentary lifestyle
• High blood cholesterol (specifically, high LDL cholesterol, and low HDL cholesterol)
• High blood triglycerides
• Diabetes
• Stress
• Family members with heart disease
Symptoms
Symptoms include:
• Squeezing, heavy chest pain, especially with:
o Exercise or exertion
o Emotional stress
o Cold weather
o A large meal
• Pain in the left shoulder, left arm, or jaw
• Shortness of breath
• Sweating, clammy skin
• Nausea
• Weakness
• Loss of consciousness
Unusual symptoms of heart attack (may occur more frequently in women):
• Stomach pain
• Back pain
• Confusion
• Fainting
Diagnosis
If you think you are having a heart attack, call 911 immediately. You need emergency medical care.
Tests may include:
Blood Tests – to look for certain substances found in the blood within hours or days after a heart attack. Blood tests will be repeated every 6-8 hours to track the progressive elevation of certain enzymes that indicate heart muscle damage.
Urine Tests – to look for certain substances found in the urine within hours or days after a heart attack
Electrocardiogram (EKG) – records the heart's activity by measuring electrical currents through the heart muscle. Certain abnormalities in the EKG occur when there is significant blockage of the coronary arteries and/or damage to the heart muscle. The EKG will be repeated to track the progression of these changes.
Echocardiogram – uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
Stress Test – records the heart's electrical activity under increased physical demand
Thallium Stress Test – thallium is used to scan the myocardium, the middle layer of the heart
Nuclear Scanning – radioactive material is injected into a vein and observed as it is absorbed by the heart muscle
Electron-beam CT scan – a type of x-ray that uses a computer to make pictures of the heart and surrounding structures
Coronary Angiography – x-rays taken after a dye is injected into the arteries; to look for abnormalities in the arteries
Treatment
Treatment may include:
• Oxygen
• Pain-killing medications (such as morphine)
• Nitrate medications
• Atropine
• Beta-blocking and/or ACE inhibitor medications
• Anti-anxiety medications
• Clot-busting agents: within the first six hours after a heart attack, you may be given medications to break up blood clots in the coronary arteries. These include:
o Tissue plasminogen activator (tPA)
o Streptokinase
o APSAC
Surgery
Surgeries for people with severe blockages in their coronary arteries may include:
• Coronary bypass graft
• Atherectomy
• Balloon angioplasty with or without stenting
Physical or Rehabilitative Therapy
During recovery from a heart attack, you may need physical or rehabilitative therapy to help you regain your strength.
Psychotherapy or Antidepressant Medication
Some people have depression after suffering a heart attack. If you do, psychotherapy and/or antidepressant medications may help relieve depression.
Prevention
Preventing or treating coronary artery disease may help prevent a heart attack.
• Maintain a healthy weight.
• Begin a safe exercise program with the advice of your doctor.
• If you smoke, quit.
• Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
• Appropriately treat high blood pressure and/or diabetes.
• Ask your doctor about taking a small, daily dose of aspirin. It has been shown to decrease the risk of heart attack.
• Ask your doctor about taking cholesterol-lowering medications.
• Ask your doctor about taking nitrate medications if you have angina due to coronary artery disease.
• Ask your doctor about taking medication to improve heart function or prevent future ehart attacks, such as:
o Beta-blockers
o ACE-inhibitors
o Platelet inhibiting drugs
o Digitalis-type drugs
RESOURCES:
American Academy of Family Physicians
American Heart Association
American Medical Association
References:
American Medical Association website. Available at: . Accessed October 7, 2005.
Meier MA, Al-Badr WH, Cooper JV, et al. The new definition of myocardial infarction: diagnostic and prognostic implications in patients with acute coronary syndromes. Arch Intern Med. 2002 Jul 22;162(14):1585-9.
Rakel RE and Bope ET. Conn's Current Therapy 2001, 53rd ed. Philadelphia, PA: W.B. Saunders Company; 2001.
What is a Heart Attack? American Heart Association website. Available at: . Accessed October 7, 2005.
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