Heart Attack

A heart attack happens when the heart doesn't get enough blood. This is usually caused by a narrowing or blockage in the arteries that supply blood to the heart (coronary arteries). This narrowing is often due to a buildup of fatty substances like cholesterol and other materials. These fatty deposits are called plaque. The process of plaque buildup is called atherosclerosis.

Imagine the arteries as pipes. If plaque builds up inside these pipes, it makes them narrower, just like a clog in a drain. Sometimes, a piece of plaque can break open (rupture). This can trigger the formation of a blood clot. This clot can completely block the blood flow to part of the heart muscle. Without blood, the heart muscle can be damaged or die.

Heart attack symptoms can be different for everyone. Some people experience mild discomfort, others have intense pain, and some have no symptoms at all. It's important to be aware of the possible signs.

Common heart attack symptoms include:

• Chest pain: This can feel like pressure, squeezing, tightness, aching, or pain.
• Pain spreading: The discomfort might travel to your shoulder, arm, back, neck, jaw, teeth, or even your upper stomach.
• Sweating: A sudden cold sweat can be a symptom.
• Feeling tired: Fatigue, or extreme tiredness, is another possible sign.
• Digestive issues: Heartburn, indigestion, or nausea might occur.
• Lightheadedness/dizziness: A sudden feeling of lightheadedness or dizziness could be a warning sign.
• Shortness of breath: Difficulty breathing is another possible symptom.

Women sometimes experience different or less obvious symptoms. For example, they might have brief, sharp pains in their neck, arm, or back. In some cases, a sudden cardiac arrest is the first noticeable symptom of a heart attack.

Not all heart attacks happen suddenly. Many people experience warning signs beforehand, sometimes hours, days, or even weeks before the actual heart attack. A key early warning sign is recurring chest pain or pressure (called angina) that doesn't go away when you rest. Angina happens because blood flow to the heart temporarily decreases. This reduced blood flow causes the pain. If you notice recurring chest pain or pressure, it's crucial to seek medical attention immediately.

If you think you're having a heart attack, get help immediately. Here's what to do:

1. Call Emergency Services: This is the most important step. Immediately call 911 or your local emergency number. If you can't call, have someone else drive you to the nearest hospital. Only drive yourself if absolutely necessary and there's no other way to get help. Time is critical during a heart attack.

2. Take Nitroglycerin (if prescribed): If a doctor has prescribed nitroglycerin, take it as directed. Follow the instructions carefully. This medicine can help ease chest pain during a heart attack.

3. Take Aspirin (if recommended): A doctor or emergency medical professionals may recommend taking aspirin. Aspirin can sometimes help prevent blood clots, which can reduce the damage to your heart during a heart attack. However, it's crucial to understand that aspirin can interact with other medications. Never take aspirin unless a doctor or emergency medical personnel tells you to. Don't delay calling 911 to take an aspirin. Calling emergency services is always the first priority.

Important Note: If you have any questions or concerns about taking aspirin, or if you are on any other medications, talk to your doctor or the emergency medical personnel. They can give you specific advice based on your health condition.

Most heart attacks are caused by coronary artery disease. This happens when one or more of the blood vessels that supply the heart (coronary arteries) get blocked. This blockage is often due to fatty deposits called plaques building up inside the arteries. These plaques narrow the arteries, making it harder for blood to reach the heart.

If a plaque breaks open, it can trigger a blood clot to form in the artery. This clot can completely or partially block blood flow to the heart, causing a heart attack.

Doctors often use an electrocardiogram (ECG or EKG) to help diagnose heart attacks. An ECG shows the electrical activity of the heart. Some heart attacks show specific changes on the ECG, like an elevated ST segment. These are called ST-elevation myocardial infarctions (STEMIs). These heart attacks need immediate, invasive treatment.

Other heart attacks don't show these specific ECG changes. These are called non-ST-elevation myocardial infarctions (NSTEMIs). Sometimes, an NSTEMI means a partial blockage, but not always. Sometimes a person with an NSTEMI actually has a full blockage, but the ECG doesn't show the specific changes.

Heart attacks aren't always caused by blocked arteries. Other things can cause them:

• Coronary artery spasm: Sometimes, a coronary artery squeezes tightly, even without a blockage. This squeezing can be a result of existing plaque buildup, early hardening of the arteries (due to things like smoking), or other risk factors. This is sometimes called Prinzmetal's angina, vasospastic angina, or variant angina.

• Certain infections: Viruses, like COVID-19, can sometimes damage the heart muscle and lead to a heart attack.

• Spontaneous coronary artery dissection (SCAD): In this rare but serious condition, a tear forms inside a coronary artery. This can cause a life-threatening heart attack.

Heart attacks can happen to anyone, but some things make you more likely to have one. Here are some key risk factors:

Age: As you get older, your chances of a heart attack increase. For men, this risk rises after age 45, and for women, after 55. This is because the heart and blood vessels naturally change over time.

Smoking and Secondhand Smoke: Smoking, or long-term exposure to smoke from others, significantly raises your heart attack risk. If you smoke, quitting is one of the best things you can do for your heart health.

High Blood Pressure: High blood pressure puts extra strain on your blood vessels, potentially damaging them over time. This damage can lead to a heart attack. Having high blood pressure along with other problems like obesity, high cholesterol, or diabetes makes the risk even greater.

High Cholesterol and Triglycerides: Cholesterol is a fatty substance in your blood. High levels of LDL ("bad") cholesterol can narrow your arteries. High levels of triglycerides, another type of fat in the blood, also increase your risk. Having enough HDL ("good") cholesterol can help lower your risk.

Obesity: Being significantly overweight or obese can lead to high blood pressure, high levels of bad cholesterol and triglycerides, and low levels of good cholesterol, all of which increase heart attack risk.

Diabetes: Diabetes happens when your body doesn't properly use a hormone called insulin, leading to high blood sugar. High blood sugar damages blood vessels and increases your risk of a heart attack.

Metabolic Syndrome: This condition occurs when you have at least three of these problems: a large waistline (excess belly fat), high blood pressure, low good cholesterol, high triglycerides, and high blood sugar. Metabolic syndrome significantly raises your risk of heart disease.

Family History: If close family members had heart attacks at a young age (before age 55 for men and 65 for women), you might have a higher risk yourself. This could be due to shared genes or lifestyle habits.

Lack of Exercise: A sedentary lifestyle (not getting enough physical activity) is a significant risk factor. Regular exercise strengthens your heart and improves overall health.

Unhealthy Diet: Eating a lot of sugary foods, unhealthy fats (like those in processed foods and animal products), and too much salt can raise your risk of a heart attack. Focus on fruits, vegetables, fiber, and healthy fats.

Stress: Feeling stressed, especially extreme anger or frustration, can increase your chances of a heart attack.

Illegal Drug Use: Stimulants like cocaine and amphetamines can cause spasms in the arteries that supply blood to the heart, leading to a heart attack.

Preeclampsia: High blood pressure during pregnancy can increase your risk of heart disease later in life.

Autoimmune Conditions: Conditions like rheumatoid arthritis or lupus can increase your risk of heart problems.

Understanding these risk factors is the first step towards taking control of your heart health. Talk to your doctor about your specific risk and how to manage it.

Heart attacks can cause serious problems beyond the initial event. Damage to the heart muscle is often the culprit. Here are some possible outcomes:

• Heart rhythm problems (arrhythmias): A heart attack can disrupt the electrical signals that control your heartbeat. This can lead to abnormal rhythms, some of which are very dangerous and can be fatal. Imagine your heart's electrical system getting scrambled. This can cause your heart to beat too fast, too slow, or irregularly.

• Cardiogenic shock: In this rare but severe situation, the heart suddenly struggles to pump blood effectively. It's like the heart's pump is failing very quickly. This can happen because of the damage from the heart attack.

• Heart failure: Extensive heart muscle damage can weaken the heart's ability to pump blood throughout the body. This can be a temporary problem or a long-term, chronic condition. The heart might not be able to keep up with the body's needs.

• Inflammation around the heart (pericarditis): Sometimes, a heart attack triggers an unusual response from the body's immune system. This leads to inflammation of the sac around the heart, which can be painful. This condition is sometimes called Dressler syndrome, post-myocardial infarction syndrome, or post-cardiac injury syndrome.

• Cardiac arrest: In a frightening scenario, the heart can suddenly stop beating. A change in the heart's electrical signals can cause this sudden cardiac arrest. A heart attack increases the risk of this life-threatening condition. Without immediate medical help, cardiac arrest can lead to death.

Preventing a heart attack, even after one, is possible. Here's how:

Live a healthy lifestyle. Quitting smoking is a crucial first step. A heart-healthy diet, focused on foods like fruits, vegetables, and lean proteins, can help you maintain a healthy weight. Regular physical activity, like brisk walking, swimming, or cycling, is essential. And, managing stress through techniques like yoga, meditation, or spending time in nature can make a big difference.

Control underlying health issues. Conditions like high blood pressure and diabetes can significantly raise your risk of a heart attack. Regular checkups with your doctor are vital to monitor these conditions and adjust treatment plans as needed. Talk to your doctor about how often you should be getting checked, as it depends on your individual health situation.

Take your medications as prescribed. Your doctor might prescribe medications to help protect your heart and improve its function. These medications are often crucial for managing conditions that increase heart attack risk. Be sure to follow your doctor's instructions carefully about dosage and timing.

Learn life-saving skills. Knowing CPR (Cardiopulmonary Resuscitation) can be life-saving in a heart attack emergency. Taking a certified first-aid course, covering CPR and the use of Automated External Defibrillators (AEDs), is a valuable skill to learn. This training will teach you how to respond effectively and potentially save a life.

Doctors should check for heart attack risk factors during regular medical checkups.

Heart attacks are often diagnosed in emergency rooms. If you're having a heart attack, doctors will quickly start treatment. They'll ask questions about your symptoms and health history, if you're able to answer.

To diagnose a heart attack, doctors check things like your blood pressure, pulse, and temperature. They also do tests to see how well your heart is working and how healthy it is overall.

Here are some common tests used to diagnose a heart attack:

• Electrocardiogram (ECG or EKG): This is often the first test. Tiny sticky pads (electrodes) are placed on your chest, arms, and legs. The test records the electrical activity of your heart, showing it on a screen or printed paper. An ECG can show if you're having a heart attack or if one has recently happened.

• Blood tests: After a heart attack, some proteins from the damaged heart leak into your blood. Doctors can check your blood for these proteins (called cardiac markers) to see if you've had a heart attack.

• Chest X-ray: A chest X-ray shows the size and condition of your heart and lungs. It can help doctors see if there are any other problems.

• Echocardiogram: This test uses sound waves (ultrasound) to create a moving picture of your heart. It shows how blood flows through the heart and how the heart valves are working. This can help spot areas of heart damage.

• Coronary catheterization (angiogram): A thin, flexible tube (catheter) is inserted into an artery, usually in the leg, and guided to your heart. A special dye is used to make the arteries show up more clearly on images. This allows doctors to see if there are blockages in the arteries that supply blood to the heart.

• Cardiac CT or MRI: These tests create detailed images of your heart and chest. A CT scan uses X-rays, and an MRI uses a magnetic field and radio waves. You'll lie on a table that moves inside a long tube-like machine. Both tests can help diagnose heart problems and show how severe the damage is.

These tests help doctors understand the problem and create a treatment plan.

Heart attack treatment is crucial because heart tissue dies with each passing minute without blood flow. Quick treatment is vital to restore blood flow and oxygen to the heart. Oxygen is given immediately.

The best treatment for a heart attack depends on how blocked the artery is (partially or completely). Several medications and procedures are used:

Medications:

• Aspirin: Aspirin helps prevent blood clots, keeping blood flowing through narrowed arteries. If you're having a heart attack, you might chew aspirin, as it's often given by emergency responders right away.
• Clot Busters (Thrombolytics): These powerful drugs break up blood clots blocking blood flow to the heart. Getting these drugs as soon as possible after a heart attack is key to limiting damage and improving survival chances.
• Other Blood Thinners: A medicine like heparin is often given through a vein (IV). Heparin helps prevent blood from clotting too easily.
• Nitroglycerin: This medicine widens blood vessels, improving blood flow to the heart. It's used to treat chest pain (angina) and is often given under the tongue, as a pill, or through an injection.
• Morphine: This pain reliever is given if chest pain doesn't go away with nitroglycerin.
• Beta Blockers: These slow the heartbeat and lower blood pressure, which helps limit heart muscle damage and reduces the risk of future heart attacks. These are often given to people having a heart attack.
• ACE Inhibitors: These blood pressure medications reduce the strain on the heart.
• Statins: Statins help lower unhealthy cholesterol levels, a factor in artery blockages. High levels of "bad" cholesterol (LDL) can clog arteries.

Procedures:

• Coronary Angioplasty and Stenting (PCI): This procedure is used to open blocked heart arteries. A thin, flexible tube (catheter) is guided to the blocked area. A tiny balloon is inflated to widen the artery, and a small wire mesh tube (stent) is often placed inside to keep the artery open. Sometimes, this is done during a procedure to identify blockages (cardiac catheterization), especially after a heart attack. Some stents are coated with medicine to help prevent the artery from narrowing again.
• Coronary Artery Bypass Grafting (CABG): This is a more extensive surgery where a surgeon uses a healthy blood vessel from another part of the body to create a new path for blood around the blocked or narrowed coronary artery. This bypasses the blockage. It can be done as an emergency procedure during a heart attack or a few days later, after the heart has somewhat recovered.

Cardiac Rehabilitation:

Cardiac rehab is a personalized program that helps people improve their heart health after a heart attack or surgery. It combines exercise, a heart-healthy diet, stress management techniques, and a gradual return to daily activities. Most hospitals offer this program, starting during the hospital stay and continuing for a few weeks or months after discharge. Participating in cardiac rehab is strongly linked to better long-term outcomes, including a lower risk of future heart attacks and complications. If the program isn't recommended during your hospital stay, ask your doctor about it.