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Heart Attack (Myocardial Infarction) (more information)

Overview

Heart attack is the No. 1 heart disease and killer of Americans. Men suffer heart attacks over 10 years earlier than women (6/23/03, http://www.body1.com/news/index.cfm/5/95, Body 1, main page).

A heart attack, or myocardial infarction (MI), is permanent damage to the heart muscle. "Myo" means muscle, "cardial" refers to the heart and "infarction" means death of tissue due to lack of blood supply.

Take this test first. How much do you know about heart attack? http://www.nhlbi.nih.gov/actintime/taha/quiz.htm

What happens during a heart attack?

Your heart needs a continuous supply of oxygen and sugar to be able to function. Day in and day out oxygen-rich blood is delivered to the heart through the coronary arteries. Fatty material, called plaque, can narrow the blood vessels of the heart. If the blood vessels that carry oxygen to the heart become clogged, coronary artery disease (CAD) develops.

It is possible for the coronary arteries to become completely blocked by plaque or by a thrombus. Thrombosis stops blood flow to a part of the heart. Without blood, the cells of the affected heart muscle will become permanently damaged; this is what happens during a heart attack.

See heart attack in progress www.nhlbi.nih.gov/actintime/aha/what.htm, 6/30/2003

Risk factors

Similar to other heart diseases, your chances of having a heart attack are affected by uncontrollable and controllable factors. Uncontrollable factors are: pre-existing coronary heart diseases, including previous heart attacks, a prior angioplasty or bypass surgery, or angina. If you are a man, your risk for heart attack increases after the age of 45. Your family history of early heart disease-a father or brother diagnosed before age 55; or a mother or sister diagnosed before age 65-increases your chance of having a heart attack.

Are You at an Increased Risk for Heart Attack? Find out. www.nhlbi.nih.gov/actintime/haws/quiz.htm

Prevention and Planning Ahead

If you have any of the risk factors for heart attack, try to control them. See your doctor regularly to check your blood pressure, cholesterol, and blood sugar levels. If you are a smoker, consider quitting. Thirty-percent of all deaths from heart disease are directly related to cigarette smoking. If you are overweight or obese, please consult your doctor about losing weight and starting a healthy diet. Try to get enough sleep at night and manage stress in your life. If you are experiencing or have experienced any of the signs of heart attack, see your physician immediately.

If a heart attack happened to you or a friend, what would you do? Make a plan. Doing so will save time and could help save your life or the life of a friend or loved one. Check out this website to make your plan. See Plan Ahead. www.nhlbi.nih.gov/actintime/saha/plan.htm. 6/24/03 "Plan Ahead".

For more on prevention of heart attack see: Understanding Heart Attack-Treatment

www.my.webmd.com/content/article54/61488.htm

Warning Signs & Symptoms

The warning signs for a heart attack are similar to those of other coronary heart diseases: chest pain, arm pain, jaw pain, upper abdominal pain, nausea, feeling like there is too much acid in your stomach, shortness of breath, breaking out in a cold sweat, nausea, cold clammy skin, gray pallor, a severe appearance of illness, light-headedness or fainting (rare).

Most people expect a heart attack to be sudden intense pain, but often heart attacks start slowly as mild pain. The pain may not feel severe or "stabbing." Most heart attack patients feel discomfort in the center of the chest that last for more than a few minutes, or goes away and comes back. The discomfort may feel like pressure, squeezing, fullness, or pain. Discomfort in other areas of the body can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach. Men who are over the age of 75 or individuals who have diabetes may not experience any chest pain during a heart attack (see silent ischemia).

Most patients whose symptoms did not match their expectation of what a heart attack should feel like, delayed longer before seeking treatment. Delay cost lives. Within 6 hours of a heart attack damage to the heart is extensive. If you are experiencing or have experienced any of the preceding symptoms, see your physician immediately. It is okay to be wrong. Running the risk of being embarrassed is better than dying or having a permanently damaged heart.

Diagnosis

If you think you're having a heart attack, get help at once. Don't wait to be sure.

Call 9-1-1 right away. Delay can be deadly.

Once you get help, you will take tests to see if you've actually had a heart attack. Some tests are done at the hospital and others are done by the emergency medical personnel who come in the ambulance.

Some key tests are: electrocardiogram (ECG or EKG), blood tests, exercise stress test, coronary angiography (or arteriography), and nuclear scan (called a stress thallium scan).

Complications of disease: What about silent heart attacks?

"The nation's longest-running heart study suggests that about one heart attack in four produces no symptoms- or at least none that the victim associates with a heart problem", state Healthinfo's website (par. 1). Silent heart attacks are only the most extreme case of a more common condition called "silent ischemia"- a chronic shortage of oxygen and nutrient bearing blood to a portion of the heart. See silent ischemia.

Recent research indicates that Asian Americans are at heightened risk for a painless heart condition that can progress without warning to a potentially fatal heart attack. See Asian American risk (link to article).

More complications include stroke, persistent heart arrhythmias, congestive heart failure, and formation of blood clots, an aneurysm or bulging in a weakened heart chamber.

Complications of disease: Cardiac Arrest

Sometimes during a heart attack a person may go into cardiac arrest. Cardiac arrest occurs when the heart stops pumping or becomes ineffective in pumping blood to organs of the body. Ten seconds into cardiac arrest a person losses consciousness. If you shake or shout at the person, he or she will not respond.

As the heart stops or loses its synchronized beating pattern (fibrillation), breathing may stop completely. When this happens the person is having cardiopulmonary arrest. With cardiopulmonary resuscitation, or CPR, the person will die. Many facilities, like the gym or airport, have automated external defibrillators (AEDs). These devices can save a person's life by shocking the heart to resume a functional beating pattern.

Other complications include: stroke, persistent heart arrhythmias, congestive heart failure, formation of blood clots in the legs or heart, an aneurysm or bulging in a weakened heart chamber.

Interventions/Treatments

Fast action is your best defense against a heart attack. Clot busting drugs and other artery-opening treatments can stop a heart attack while it is occurring. These drugs can limit and prevent further damage to your heart and increase your chances of survival and recovery. The sooner treatments are received the more effective they will be. Treatment should be given within 1 hour of the start of the heart attack symptoms. Surgery may also be used to treat a heart attack.

Long-term treatments include: lifestyle changes and medication. Try to exercise at least 30 minutes a day. You can walk, run, jog, or play a team sport. If you already have a heart condition, schedule a stress test before beginning an exercise program in order to determine how much exertion is safe. It is recommended for heart attack survivors to exercise with other people rather than alone during the first months of recovery. Many community health and recreation centers offer doctor-supervised cardiovascular rehabilitation programs.

In addition to exercise, quit smoking and maintain healthy blood pressure, cholesterol, and blood sugar levels by changing your diet. Decrease your fat and cholesterol intake and increase your fruit, vegatable, and fiber intake. Eating magnesium-rich foods such as nuts, beans, bran, fish, and dark-green vegetables may help prevent heart attack. Magnesium protects the heart by stabilizing heart rate, reducing coronary artery spasm, and combating such conditions as atherosclerosis and high blood pressure.

It has been shown that unstable chemical compounds known as free radicals make the body more vulnerable to heart attack by promoting atherosclerosis in the coronary arteries. Free radicals can be neutralized by antioxidants such as vitamins A, C, and E. Fruits, vegetables, and grains supply many of the antioxidant vitamins.

Medication may consists of antiplatelet agents, such as aspirin, and anticoagulants to reduce the risk of blood clots. For more information on treatments see the following websites:

Alternative Medicine

Doctors and alternative medicine practitioners agree alternative medicine cannot compete with standard drug and surgical therapy during emergency and follow-up phases of heart attack. However, alternative medicine can make valuable contributions to prevention and recovery. You may want to consult the following website for alternative treatments for heart attacks:

Frequently Asked Questions

Q: What exactly happens during a heart attack?

A: During a heart attack the coronary arteries become blocked by plaque or a thrombus. A thrombus, or thrombosis, is when blood clots in an artery and totally blocks it. Thrombosis stops blood flow to a part of the heart. Without blood, the cells of the heart muscle will become permanently damaged; this is what happens during a heart attack.

Q: What does a heart attack feel like?

A: Most people expect a heart attack to be a sudden intense pain, but often heart attacks start slowly as mild pain. Most heart attack patients feel discomfort in the center of the chest that last for more that a few minutes, or goes away and comes back. The discomfort may feel like pressure, squeezing, fullness or pain. Discomfort in other areas of the body may be present (arms, back, jaw or stomach). Some patients experienced no pain at all.

Q: How does smoking increase my chances of having a heart attack?

A: Thirty percent of deaths from heart disease are directly related to cigarette smoking. That's because smoking is a major cause of coronary artery disease. The nicotine present in smoke causes decreased oxygen to the heart, increased blood pressure and heart rate, increase in blood clotting, and damage to cells that line coronary arteries and other blood vessels.

Q: Can using drugs cause a heart attack?

A: Cocaine use has been closely related to strokes, heart attacks, and a host of other cardiovascular problems. Some of them have been fatal even in first-time cocaine users.

For an interactive tool on heart attack see http://www.nlm.nih.gov/medlineplus/tutorials/congestiveheartfailure.html, 6/30/2003)

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