Myocardial infarction (MI), or heart attack

2021-07-27 04:20 PM

A heart attack usually occurs when a blood clot forms in the flow of blood through the coronary artery, a blood vessel that supplies part of the heart muscle.

Define

A heart attack usually occurs when a blood clot in the coronary artery, which supplies blood to part of the heart muscle, disrupts blood flow to the heart, which can damage or destroy part of the heart muscle.

A heart attack also called a myocardial infarction, is usually fatal. Thanks to better awareness of heart attack signs and symptoms and improved treatment, most people who have had a heart attack now survive.
 
Overall lifestyle - what you eat, how often you exercise, and how to deal with stress play a role in recovering from a heart attack. Additionally, a healthy lifestyle can help prevent a heart attack by controlling risk factors that contribute to the narrowing of the coronary arteries that supply blood to the heart.

Symptoms

Common symptoms of a heart attack include:

Pressure, feeling of fullness or squeezing pain in the center of the chest that lasts more than a few minutes.

Chest pain radiates to the shoulders, arms, back, or even to the teeth and jawbone.

Chest pain increases in severity.

Persistent pain in the upper abdomen.

Shortness of breath.

Perspire.

Feeling of imminent death.

Fainting.

Nausea and vomiting.

Symptoms of pain in women with a heart attack may include

Abdominal pain or heartburn.

Moist skin.

Dizziness or dizziness.

Unusual or unexplained fatigue.

Different symptoms of heart attack

Not all people who experience a heart attack experience the same symptoms and to the same extent. Some people have no symptoms at all. However, the more signs and symptoms you have, the greater the likelihood of a possible heart attack.

A heart attack can happen at any time - at work or play, while at rest, or in motion. Some heart attacks strike suddenly, but many people who experience a heart attack already have warning signs and symptoms hours, days, or weeks in advance. The earliest warning of a possible recurrent heart attack is chest pain (angina) triggered by mild exertion or rest. Angina is caused by a temporary decrease in blood flow to the heart.
 
Many people confuse a heart attack with a condition where the heart suddenly stops (sudden cardiac arrest). A heart attack differs from sudden cardiac arrest, which occurs when electrical disturbances occur in the heart.

During a heart attack, act immediately. Some people wait too long because they don't recognize important signs and symptoms. Do the following steps:

Call for emergency medical help. If you suspect you're having a heart attack, don't hesitate. Immediately call the local emergency number. If emergency medical services cannot be called, have a driver take you to the nearest hospital. Driving yourself is only the last option if there is absolutely no other option. Driving yourself puts you at risk if your condition suddenly worsens.

Use nitroglycerin, if indicated. If your doctor prescribes nitroglycerin, follow the instructions while waiting for the arrival of paramedics.

Take aspirin, if recommended. If you're concerned about your heart attack risk, ask your doctor to chew an aspirin if you have heart attack symptoms. Taking aspirin during a heart attack can reduce damage to the heart by making it less likely to form blood clots. Aspirin can interact with other medications, however, so do not take aspirin unless directed by your doctor or emergency medical personnel.

What to do if you see someone having a heart attack?

If you encounter an unconscious person believed to be from a heart attack, call for emergency medical help. If trained in emergency procedures, begin cardiopulmonary resuscitation (CPR). This will help deliver oxygen to the body and brain.

In 2010, the American Heart Association changed its guidelines for CPR. Regardless of training, CPR should be initiated with chest compressions. The sternum descends about 5 cm above the chest at a rate of about 100 minutes at a time. If CPR trained, check airway and assist breathing every 30 cycles of compressions. Without training, keep doing - just squeeze.

In the early minutes, a heart attack can also cause ventricular fibrillation. If not treated immediately, ventricular fibrillation leads to sudden death. Prompt use of an external defibrillator (AED) can help return the heart to a normal rhythm before reaching the hospital.

Causes

A heart attack occurs when one or more of the arteries that supply oxygen-rich blood (coronary arteries) to the heart muscle become blocked. Over time, coronary arteries can become narrow from a buildup of cholesterol. This buildup - collectively known as plaque - in arteries throughout the body is called atherosclerosis.

During a heart attack, one of the plaques can rupture, and a blood clot forms at the ruptured plaque. If the clot is large enough, it can block blood flow through the coronary artery. When the coronary arteries have narrowed due to atherosclerosis, the condition is called coronary artery disease. Coronary artery disease is the main cause of cardiovascular disease.

A common cause of a heart attack is a coronary artery spasm that cuts off blood flow to part of the heart muscle. Drugs, such as cocaine, can cause life-threatening spasms.

A heart attack is the end of a process that usually progresses over hours. With each passing minute, more heart tissue is stripped of blood and damaged or dead. However, if blood flow is restored within the given time, damage to the heart can be limited or prevented.

Risk factors

Several factors contribute to unwanted fat accumulation (atherosclerosis) that narrows the arteries in the body, including the arteries of the heart. Many of the risk factors that reduce the risk of heart attack can be improved or eliminated.

Risk factors for a heart attack include:

Age. Men 45 or older and women 55 or older are more likely to have a heart attack than younger men and women.

Cigarette. Smoking and long-term exposure to secondhand smoke damage the inner walls of your arteries - including your heart's arteries - allowing cholesterol and other substances to build up and slowing blood flow. Smoking also increases your risk of forming a deadly blood clot and causing a heart attack.

Diabetes. Diabetes is the inability of the body to produce enough or the right quality of insulin. Insulin, the hormone secreted by the pancreas that allows the body to use glucose, the form of sugar from food. Diabetes can occur in childhood, but it appears more often in middle age and among people who are overweight. Diabetes increases the risk of a heart attack.

Hypertension. Over time, high blood pressure can damage the arteries that feed the heart by promoting atherosclerosis. The risk of blood pressure increases with age, but the main culprits for most people are eating a diet too high in salt and being overweight. High blood pressure can also be a genetic problem.

High cholesterol or triglycerides in the blood. Cholesterol is a component that can narrow the arteries in the body, including those that supply blood to the heart. High levels of bad cholesterol in the blood increase the risk of a heart attack. Low-density lipoprotein (LDL) cholesterol - the "bad" cholesterol that is most likely to narrow the arteries. High LDL is not good and is often the result of a diet high in saturated fat and cholesterol. High levels of triglycerides, a type of dietary fat in the blood, are also undesirable. However, high levels of high-density lipoprotein (HDL) cholesterol are good for the body, are desirable, and reduce the risk of a heart attack.

Family history of heart disease. If a parent, sibling, or grandparent has had a heart attack, there may be an increased risk. Families may have a genetic condition that increases the level of unwanted cholesterol in the blood. Hypertension can also run in families.

Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who exercise regularly have better cardiovascular health, which reduces the overall risk of a heart attack. Exercise is also beneficial in reducing high blood pressure.

Obesity. Obese people have a high percentage of body fat (body mass index 30 or higher). Obesity increases the risk of heart disease because it is associated with high blood cholesterol levels, high blood pressure, and diabetes.

Stress. The body responds to stress in ways that can increase the risk of a heart attack. If you're under stress, you may overeat or smoke. Excessive stress, such as anger, can also raise blood pressure.

Using illegal drugs. Using stimulants, such as drugs or stimulants, can cause heart muscle contractions that cause a heart attack.

Complications

Cardiac complications are often related to damage to the heart during a heart attack. This damage can lead to the following problems:

Abnormal heart rhythm (arrhythmia). If the heart muscle is damaged from a heart attack, abnormal heart rhythms can develop, some of which can be serious, even fatal.

Heart failure. The amount of damaged tissue can be so great that the remaining heart muscle cannot pump blood adequately. This reduces blood flow to tissues and organs in the body and can cause fatigue, shortness of breath, and swelling in the ankles and feet. Heart failure can be a temporary problem followed by a heart attack, recovering in a few days to weeks. However, it can also be a chronic condition caused by extensive and long-term damage to the heart muscle following a heart attack.

Broken heart. Areas of heart muscle weakened by a heart attack can rupture, leaving holes in part of the heart. Heart failure is often fatal.

Heart valve problems. Heart valves damaged during a heart attack can develop into a serious, life-threatening condition.

Tests and diagnostics

Ideally, your doctor checks you regularly for risk factors that can lead to a heart attack.

If a heart attack is being had or is suspected to be, the diagnosis occurs in an emergency setting. You will be asked to describe your symptoms, measure your blood pressure, heart rate, and check your temperature. You'll be hooked up to a heart monitor that monitors your heart almost immediately to see if you're actually having a heart attack.

Listen to the heart and lungs and ask about your health and family history of heart disease. Tests will help check for signs and symptoms, such as chest pain, which may signal a heart attack or other illness. These tests include:

Electrocardiogram (ECG). This was the first test performed to diagnose a heart attack. It is usually done while asking questions about the symptoms. This test records the electrical activity of the heart through electrodes attached to the skin. The pulse is recorded as a "wave" displayed on a screen or printed on paper. Because the heart muscle does not conduct electrical impulses normally, the electrocardiogram can show that a heart attack has occurred or is in progress.

Blood tests. Certain enzymes from the heart leak into the bloodstream if the heart is damaged by a heart attack. Urgently, your doctor will take a blood sample to check for the presence of these enzymes.

Additional tests

If a heart attack has already occurred or is happening, doctors will take immediate steps to treat it. You may also undergo additional tests:

X-ray. Chest X-ray images allow your doctor to check the size and shape of your heart and its blood vessels.

Echocardiography. This test uses sound waves to create images of the heart. In an echocardiogram, sound waves are directed at the heart from a transducer, a wand-like device that is pressed against the chest. Sound waves exit the heart and are reflected back through the chest wall and electronic processing provides a video image of the heart. An echocardiogram can help determine the area of ​​the heart that has been damaged by a heart attack and the heart's ability to pump blood.

Nuclear radiation. This test helps identify blood flow problems to the heart. A small amount of radioactive material is injected into a blood vessel. Special cameras can detect radioactive material as it flows through the heart and lungs.

Coronary catheterization (angiography). This test can show whether a coronary artery is narrowed or blocked. Liquid dye is injected into the arteries of the heart through a catheter, a tube that passes an artery, usually in the leg, to an artery in the heart. With arterial staining, the arteries become visible on radiographs, revealing areas of obstruction. Alternatively, once the catheter is in place, the doctor can treat the blockage by balloon angioplasty. In most cases, a mesh tube (stent) is also placed inside the artery to keep it wide open and prevent future re-stenosis.

Stress test. In the days or weeks after a heart attack, you may also undergo a stress test. Check how the heart and blood vessels respond to exercise. It is possible to walk on a treadmill or ride a bicycle while attached to the ECG machine. Or maybe given intravenous drugs, stimulating the heart similar to exercise.

Stress testing helps doctors decide the best long-term treatment. If your doctor wants to see an image of your heart while you're exercising, nuclear stress testing can be done.

Cardiac computed tomography (CT) or magnetic resonance imaging (MRI). These tests can be used to diagnose heart problems, including damage from a heart attack.

Treatments and drugs

What to do if you see someone having a heart attack?

If you encounter an unconscious person believed to be from a heart attack, call for emergency medical help. If trained in emergency procedures, begin cardiopulmonary resuscitation (CPR). This will help deliver oxygen to the body and brain.

In 2010, the American Heart Association changed its guidelines for CPR. Regardless of training, CPR should be initiated with chest compressions. Descend about 5 cm above the chest at a rate of about 100 times a minute. If CPR trained, check the airway and give rescue breaths every 30 compressions. Without training, continue to do just pressing.

Heart attack treated in hospital

If there is a heart attack, hospital treatment for a heart attack varies depending on the situation. It may be treated with medication, undergo an invasive procedure, or both - depending on the severity of the condition and the amount of damage to the heart.

Medicine

With every minute that passes after a heart attack, heart tissue loses more oxygen and damages or dies. The main way to prevent heart damage is to restore blood flow quickly.

Medications for heart attack include:

Aspirin. Aspirin can be given as soon as medical staff arrives or as soon as you get to the hospital. Aspirin reduces blood clotting, which in turn helps maintain blood flow through narrowed arteries.

Thrombolysis. These drugs, also known as thrombolytics, help dissolve blood clots that block blood flow to the heart. Taking a thrombolytic drug after a heart attack, there is a better chance it will survive and lessen the damage to the heart.

Superaspirins. Doctors in the emergency room may give other medications similar to aspirin to prevent new blood clots from forming. These include drugs such as clopidogrel (Plavix) and others called platelet IIb/IIIa inhibitors.

Blood thinners. You may be given another medicine, such as heparin, to make the blood less "sticky" and less likely to form dangerous blood clots. Heparin is given intravenously or subcutaneously and is usually used for the first few days after a heart attack.

Analgesic. If chest pain or pain is involved, pain medication, such as morphine, may be given to reduce discomfort.

Nitroglycerin. This medication is used to treat chest pain (angina), temporarily open up arterial blood vessels, and improve blood flow to and from the heart.

Beta-blockers. These medications help relax the heart muscle, slow the heart rate, and lower blood pressure making the heart's job easier. Beta-blockers can limit the amount of heart muscle damage and prevent future heart attacks.

Drugs that lower cholesterol. Examples include statins, niacin, fibrates, and acid sequestrants. These drugs lower unwanted cholesterol in the blood and may be helpful if taken soon after a heart attack to improve survival.

Surgery and other procedures

In addition to medication, you may undergo one of the following procedures to treat a heart attack:

Angioplasty and stenting. Emergency angioplasty opens the coronary artery, allowing blood to flow more freely to the heart. Doctors pass a long thin tube through an artery, usually in the leg, to a blocked artery in the heart. This catheter is equipped with a special balloon tip. Once in position, the balloon tip briefly increases pressure to open the blocked coronary artery. At the same time, a metal stent can be inserted into the artery to keep it open long-term, restoring blood flow to the heart. Depending on the condition, your doctor may choose to place a stent coated with slow-release medication to keep the artery open.

Angioplasty is done at the same time as angiography, the procedure that doctors do first to locate the narrowing of the heart's arteries. When angioplasty is done to treat a heart attack, do it as soon as possible to limit damage to the heart.

Coronary artery bypass surgery. In rare cases, a doctor may perform emergency surgery at the time of a heart attack. Usually, the doctor may recommend surgery after the heart has had time to recover from a heart attack.

Once blood flow to the heart is restored and the condition is stable after a heart attack, you may be hospitalized for observation. Visits are usually limited to family members and close friends.

Lifestyle and Remedies

Live a heart-healthy life. Taking the following steps can help not only prevent but also recover from a heart attack:

No smoking. If you smoke, the only thing you can do to improve your heart health is to stop smoking. Quitting smoking can be difficult, so ask your doctor for a treatment plan to help kick the habit.

Avoid secondhand smoke. Ambient smoke can potentially cause a heart attack, as many of the chemicals in tobacco can damage arteries.

Check cholesterol. Has your blood cholesterol checked regularly, through a blood test in your doctor's office? If your bad cholesterol levels are high, your doctor may prescribe dietary changes and medications to help lower the number and protect heart health. Regularly check high cholesterol levels depends on cholesterol level. People with high cholesterol may need more frequent tests.

Get regular medical check-ups. Some of the main risk factors for heart attack - high blood cholesterol, high blood pressure, and diabetes - cause no symptoms in the early stages. Your doctor may perform tests to check. If a problem exists, your doctor can manage it early to prevent complications that can lead to a heart attack.

Control blood pressure. Check your blood pressure every two years. Your doctor may recommend more frequent measurements if you have high blood pressure or a history of coronary artery disease.

Exercise regularly. Years ago, doctors encouraged exercise after a heart attack for fear it would cause other problems. But regular exercise improves heart muscle function after a heart attack. Exercise is now an important part of a cardiac rehabilitation program. Exercise helps prevent heart attacks by helping to achieve and maintain a healthy weight and control diabetes, high cholesterol, and high blood pressure. Exercise is not vigorous. For example, walking 30 minutes a day, five days a week can improve health.

Maintain a healthy weight. Excess weight can contribute to high cholesterol, high blood pressure, and diabetes. Losing weight can reduce your risk of heart disease.

Eat a heart-healthy diet. Too much-saturated fat and cholesterol in the diet can narrow the arteries of the heart. If you've had a heart attack, limit fat, cholesterol, and salt. A diet high in salt can raise blood pressure. Follow your dietitian's advice and eat a heart-healthy diet. Prepare heart-healthy meals with the family. Fish is part of a heart-healthy diet. It contains omega-3 fatty acids, which help improve blood cholesterol levels and prevent blood clots. Eat lots of fruits and vegetables. Fruits and vegetables contain antioxidants - nutrients that help prevent daily fat deposition and coronary artery damage.

Stress management. To reduce your risk of a heart attack, reduce the stress of daily activities. Rethink your workaholic habits and find healthy ways to minimize or cope with stressful life events.

Drink alcohol in moderation. Moderate drinking will help raise levels of HDL cholesterol - "good" - and may have a protective effect against heart attack. Men should have no more than two drinks a day, and women should have no more than one drink. Drinking too much can raise blood pressure and triglyceride levels, increasing the risk of a heart attack. Drinking more than 1-2 alcoholic drinks a day raises blood pressure, so cut back if necessary. One glass of drink is equivalent to 355 ml of beer, 118 ml of wine, or 44 ml of spirits.

Prevention

It's never too late to take steps to prevent a heart attack - even if you already have one. Taking medication can reduce the risk of a second heart attack and help the damaged heart function better. Lifestyle factors also play an important role in heart disease prevention and recovery.

Medicine

Doctors often prescribe medication for people who have had a heart attack or who are at high risk. Medications that can help your heart function more efficiently and reduce your risk of a heart attack may include:

Blood thinners. Aspirin makes the blood less "sticky" and less likely to form blood clots. Doctors recommend daily aspirin for most people who have had a heart attack.

Doctors may prescribe aspirin and anticoagulants, such as clopidogrel (Plavix), for people undergoing angioplasty or stenting to open up narrowed coronary arteries, both before and after the procedure.

If you're taking aspirin to prevent a heart attack, keep in mind that taking the pain reliever ibuprofen (Advil, Motrin, etc.) at the same time can increase your risk of digestive problems and may interfere with the heart benefits of aspirin. . If a pain reliever is needed for certain conditions, such as arthritis, discussing it with your doctor is best.

Beta-blockers. These drugs lower heart rate and blood pressure, reduce the heart's need for oxygen and help prevent heart attacks. Many people will need to take beta-blockers for the rest of their lives after a heart attack.

ACE inhibitors. Doctors prescribe ACE inhibitors for most people after a heart attack, especially for people who have had a moderate to a severe heart attack that has reduced the heart's pumping capacity. These drugs allow blood to flow more easily from the heart, preventing some of the complications of a heart attack and making a second heart attack less likely.

Drugs that lower cholesterol. There are many medications, including statins, niacin, fibrates, and acid sequestrants, that can help lower unwanted cholesterol levels in the blood. Most people who have had a heart attack take cholesterol-lowering drugs, which reduce the risk of a second heart attack. These medications can help prevent future heart attacks even if cholesterol was not very high at the time of the heart attack.

Lifestyle change

In addition to medication, lifestyle changes that can help recover from a heart attack can also help prevent future heart attacks. These include:

No smoking.

Control certain conditions, such as high blood pressure, high cholesterol, and diabetes.

Maintain physical activity.

Eat healthy food.

Maintain weight.

Reduce and manage stress.

Coping and supporting

Having a heart attack is a terrifying experience. Even if the doctor says it's OK, it can still be scary. Will this affect life? Is it possible to get back to work or resume activities? Even more terrifying - will it happen again?

Fear is just one of the emotions so many people and families have to deal with. Emotions that can be especially difficult to cope with after a heart attack may include:

Angered. You may get angry and wonder, "Why did I have a heart attack, and why now?" It is feeling discontent after a heart attack.

Guilty. Family members may feel scared at first and then be convicted of a heart attack. Some may even feel responsible for heart attacks.

Depression. Depression is common after a heart attack. May feel that can no longer do things to do.

These feelings are common, and openly discussing them with your doctor, a family member, or a friend can help you cope better. It is important to take care of yourself mentally as well as physically after a heart attack. Exercising and participating in cardiac rehabilitation with others who are recovering from a heart attack can help better through this exposure.

Cardiac rehabilitation

The goal of emergency treatment of a heart attack is to restore blood flow to heart tissue. The aim of further treatment is to promote heart healing and prevent a heart attack.

Many hospitals offer cardiac rehabilitation programs that can begin while in the hospital, depending on the severity of the heart attack, continuing weeks to months after returning home. . Cardiac rehabilitation programs typically focus on three main areas - medications, lifestyle changes, and emotional issues.

Sex after a heart attack

Many people fear having sex after a heart attack will be too hard on the heart. However, most people can safely return to sexual activity after recovering from a heart attack. Each person has a different time, depending on their physical comfort, psychological readiness, and prior sexual activity.

Requests to have sex when the heart is working are like taking a brisk walk, cleaning the floor, or climbing a flight or two of stairs. Sexual activity is the same as with any other exertion - heart rate, breathing rate, and blood pressure levels increase. Ask your doctor when it's safe to resume sexual activity. With time, it will be possible to resume normal sexual activity.

Some heart medications, such as beta-blockers, can affect sexual function. However, sexual dysfunction after a heart attack is more often due to depression or anxiety than medication. If you have problems with sexual dysfunction, talk to your doctor. He or she can help identify the problem and seek appropriate treatment.

Make a question. There can be a lot of questions and concerns after a heart attack. If so, it can be helpful to talk to people who are experiencing some of the same things. Many cardiac rehabilitation programs offer counseling and support groups for heart attack victims.