Heart Attack: Causes, Symptoms, Diagnosis, Treatment, Complications & Preventions
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| Heart Attack (Acute Myocardial Infarction) |
Heart Attack
A heart attack is a serious condition in which blood cannot reach the heart muscle. The cardiac muscles that are supplied by the coronary artery die as a result of prolonged ischemia, which is caused by the occlusion of the artery. It might be reversible or not. Acute myocardial infarction is another name for a heart attack.
If the ischemia lasts for about 5 minutes or less, then the acute myocardial infarction is reversible. But if the ischemia is severe and lasts for about 20 to 40 minutes, then it causes irreversible heart damage and microvascular thrombosis. It is also known as a heart attack.
If the ischemia lasts for about 5 minutes or less, then the acute myocardial infarction is reversible. But if the ischemia is severe and lasts for about 20 to 40 minutes, then it causes irreversible heart damage and microvascular thrombosis. It is also known as a heart attack.
The risk of heart attack is 8 times greater in individuals older than 45 years of age. The risk of acute myocardial infarction also increases in people with high blood pressure and high blood cholesterol levels.
Obesity, stress, and cigarette smoking also put you at a higher risk of developing a heart attack. If a heart attack is left untreated, it can result in abnormal heart rhythms, heart failure, and cardiac arrest.
Causes Of Heart Attack
In your cardiovascular system, which also includes various types of blood vessels, your heart is the main organ. The arteries are some of the most important vessels. They deliver oxygen-rich blood to every organ in your body.
Your heart muscle receives oxygen-rich blood directly from the coronary arteries. The accumulation of plaque can cause these arteries to become blocked or narrowed, which can result in a significant or complete reduction in blood flow to your heart. Heart attacks may result from this.
Atherosclerosis is the major risk factor for the development of myocardial infarction or heart attack. Atherosclerosis is a serious condition in which fatty substances or cholesterol buildup in the form of plaques inside the arteries of your heart. Almost 90% of cases of myocardial infarction or heart attack are caused by atherosclerosis.
Although uncommon, a heart attack can also occur without a blockage. It is responsible for nearly 10% of heart attacks. Some of the possible causes of this kind of heart attack are as follows:
- Spasm of the coronary artery
- Trauma
- Coronary artery tears or ruptures.
- An embolism is a blood clot or air bubble that gets stuck in a coronary artery.
- An imbalance of electrolytes.
- Problems with eating.
- Stress cardiomyopathy
1. NSTEMI: (Non-ST-Segment Elevation Myocardial Infarction)
- ST-segment depressions
- T wave changes
- No Q wave development
- Mild enzyme elevations ST-segment depression and T-wave inversion are associated with subendocardial infarction.
2. STEMI: (ST-Segment Elevation Myocardial Infarction)
- ST-segment elevations
- T wave changes
- Q wave development
- Enzyme elevations ST-segment elevation, followed by T wave inversion and Q waves, are associated with transmural infarction.
Risk Factors For Heart Attack
Risk factors for heart attacks include:- Age. Heart attacks are more common in men and women over the age of 55 and 45 than in younger people.
- Family history of a heart attack.
- Use of tobacco
- High blood pressure. It can cause damage to the heart's arteries over time. In combination with other conditions like diabetes, high cholesterol, or obesity, high blood pressure raises the risk even more.
- A high triglyceride level or cholesterol. The "bad" cholesterol, low-density lipoprotein (LDL), is most likely to cause arteries to narrow. Triglycerides, specific blood fats, also raise the risk of having a heart attack. If your "good" cholesterol, high-density lipoprotein (HDL), levels are within the normal range, you may have a lower risk of having a heart attack.
- Obesity
- Diabetes. When insulin isn't used correctly or the body doesn't make it, blood sugar rises. Heart attack risk is increased by high blood sugar.
- A metabolic disorder
- Insufficient exercise.
- A sedentary lifestyle, a lack of physical activity.
- Ill-fitting diet
- Stress
- Use of illegal drugs.
- An auto-immune disease.
Symptoms Of Heart Attack
The blood flow to a particular area of the heart drops far below normal or stops during a heart attack. This results in damage to that area of your heart muscle or even death. When a portion of your heart is unable to pump because it is dying from lack of blood flow, this can disrupt the order in which your heart pumps. That slows down or even stops blood flow to other parts of your body, which can be fatal if not treated immediately.
Chest pain is relieved by taking rest in angina but there is no improvement by taking rest, position change, or nitrate administration in a heart attack. The pain may radiate toward the lower jaw, neck, right arm, back, upper abdomen, and left arm.
Approximately 20-30% of patients don’t have chest pain. Elderly people with diabetes mellitus and hypertension are at higher risk for developing chest pain.
Other symptoms such as dyspnea, excessive sweating, palpitations, loss of consciousness, nausea, vomiting, and light-headedness are also reported in heart attacks. The severity of chest pain is identified with the help of the PQRST assessment.
- P- Precipitating events
- Q- Quality of pain
- R- Radiation of pain
- S- Severity of pain
- T- Timing
Diagnosis Of Heart Attack
Diagnosing a heart attack involves a combination of medical history assessment, physical examination, and diagnostic tests. Here is an overview of the diagnostic process:
Medical History Assessment
The healthcare provider will begin by taking a detailed medical history, which may include:
- Asking about the patient's symptoms, including the nature, duration, and intensity of chest pain or discomfort.
- Inquiring about risk factors for heart disease, such as family history, smoking, high blood pressure, diabetes, and high cholesterol.
- Gathering information about the patient's medical history, including any prior heart conditions or procedures.
Vital indicators, such as blood pressure, heart rate, and respiratory rate, will be evaluated during a physical examination. To hear any unusual noises, the healthcare professional may also listen to the patient's heart and lungs.
Electrocardiogram (ECG or EKG)
An electrocardiogram (ECG or EKG) is a crucial diagnostic tool for heart attack detection. To gauge the electrical activity of the heart, electrodes are applied to the skin. The ECG pattern may alter if there has been heart muscle injury.
Blood Tests
Blood Tests
Blood samples are collected to assess certain cardiac markers like troponin and creatine kinase (CK-MB). Increased blood levels of these markers may indicate cardiac muscle injury, which is common during a heart attack.
Chest X-Ray
A chest X-ray may be carried out to evaluate the health of the heart and lungs to identify the underlying causes.
Echocardiogram (Echo)
An echocardiogram (Echo) utilizes ultrasound waves to provide pictures of the function and structure of the heart. It can assist in locating places where the heart muscle has suffered injury or restricted blood supply.
Coronary Angiography
In certain cases, a coronary angiography may be carried out to identify blockages or narrowed blood vessels in the coronary arteries and visualize them. Interventional procedures including angioplasty and the implantation of stents are frequently guided by this technique.
Cardiac Computed Tomography (CT) or Magnetic Resonance Imaging (MRI)
These imaging tests may be used to assess the heart's structure and blood flow, providing detailed information about the heart's condition.
Treatment Of Heart Attack
The effective treatment plan for heart attack or myocardial infarction may consist of,
- Analgesics – Opiates
- Antithrombotic drugs (Antiplatelet medicines & Anti-coagulants)
- Anti-anginal drugs (Nitrates & Beta Blockers)
- Antiemetics
- Non-dihydropyridine CCBs
- Thrombolytics
Analgesics – Opiates: Sublingual nitroglycerin should be given immediately for the reduction of chest pain. If there is no improvement in pain reduction after taking two or three tablets of nitroglycerin, then intravenous opioids are recommended.
Opioids produce rapid and effective analgesia and decrease pulmonary congestion. Commonly used opioid drugs are morphine sulfate or meperidine.
Antithrombotic agent: Antithrombotic agents act by reducing the formation of blood clots. There are two types of antithrombotic drugs: anticoagulants and antiplatelet drugs.
Heparin is an anticoagulant agent and acts by causing the inactivation of blood clotting factors. It also blocks the conversion of fibrinogen into fibrin & prothrombin to thrombin. The dose of heparin for the treatment of heart attack is 60 units/kg via IV bolus followed by 12 units/kg/h. Warfarin and pentasaccharide are also commonly used, anticoagulant agents.
Aspirin is an antiplatelet agent. It acts by causing irreversible inactivation of cox-I. The dose of aspirin is 162 mg or 325 mg at once. Clopidogrel is prescribed for those patients who are allergic to aspirin. The dose of Clopidogrel is 600 mg rather than 75mg. Clopidogrel can also be given in combination therapy with aspirin.
Another effective class of drugs used for the treatment of heart attack is glycoprotein 2b and 3a receptor antagonists. Abciximab & tirofiban are commonly used glycoprotein 2b and 3a receptor antagonists and they act by causing the inactivation of fibrinogen into fibrin and thus resulting in inhibiting clot formation.
Nitrates are first-line anti-anginal drugs used for the treatment of chest pain. Sublingual or oral nitroglycerin is usually effective.
Beta-blockers are effective in decreasing the rates of recurrent heart attacks and cardiovascular mortality. Atenolol & metoprolol are commonly used beta 1 blockers for the treatment of heart attack because these receptors are present specifically in the heart.
Metoclopramide is an effective and common antiemetic used in a heart attack. It acts by blocking the effects of dopamine & serotonin receptors in CTZ.
Non-dihydropyridine CCBs are third-line agents for the treatment of heart attacks. Diltiazem or verapamil are commonly used L-type non-dihydropyridine CCB because these receptors are specifically present in the heart.
Thrombolytic agents: Streptokinase, alteplase (t-PA), reteplase (r-PA), and tenecteplase (TNK) are the commonly used thrombolytic agents for the treatment of myocardial infarction.
Opioids produce rapid and effective analgesia and decrease pulmonary congestion. Commonly used opioid drugs are morphine sulfate or meperidine.
Antithrombotic agent: Antithrombotic agents act by reducing the formation of blood clots. There are two types of antithrombotic drugs: anticoagulants and antiplatelet drugs.
Heparin is an anticoagulant agent and acts by causing the inactivation of blood clotting factors. It also blocks the conversion of fibrinogen into fibrin & prothrombin to thrombin. The dose of heparin for the treatment of heart attack is 60 units/kg via IV bolus followed by 12 units/kg/h. Warfarin and pentasaccharide are also commonly used, anticoagulant agents.
Aspirin is an antiplatelet agent. It acts by causing irreversible inactivation of cox-I. The dose of aspirin is 162 mg or 325 mg at once. Clopidogrel is prescribed for those patients who are allergic to aspirin. The dose of Clopidogrel is 600 mg rather than 75mg. Clopidogrel can also be given in combination therapy with aspirin.
Another effective class of drugs used for the treatment of heart attack is glycoprotein 2b and 3a receptor antagonists. Abciximab & tirofiban are commonly used glycoprotein 2b and 3a receptor antagonists and they act by causing the inactivation of fibrinogen into fibrin and thus resulting in inhibiting clot formation.
Nitrates are first-line anti-anginal drugs used for the treatment of chest pain. Sublingual or oral nitroglycerin is usually effective.
Beta-blockers are effective in decreasing the rates of recurrent heart attacks and cardiovascular mortality. Atenolol & metoprolol are commonly used beta 1 blockers for the treatment of heart attack because these receptors are present specifically in the heart.
Metoclopramide is an effective and common antiemetic used in a heart attack. It acts by blocking the effects of dopamine & serotonin receptors in CTZ.
Non-dihydropyridine CCBs are third-line agents for the treatment of heart attacks. Diltiazem or verapamil are commonly used L-type non-dihydropyridine CCB because these receptors are specifically present in the heart.
Thrombolytic agents: Streptokinase, alteplase (t-PA), reteplase (r-PA), and tenecteplase (TNK) are the commonly used thrombolytic agents for the treatment of myocardial infarction.
Complications Of Heart Attack
Heart attack complications can be extremely dangerous and even fatal. To reduce these risks, prompt medical attention is essential. Here are a few such complications:- Heart Failure: A heart attack can weaken the heart muscle, making it less capable of efficiently pumping blood. Heart failure is a disorder that can cause symptoms including tiredness, fluid retention, and shortness of breath.
- Arrhythmias: Heart attacks can disrupt the heart's electrical system, leading to irregular heart rhythms or arrhythmias. Ventricular fibrillation, a rapid and chaotic rhythm, is a life-threatening arrhythmia that can result from a heart attack.
- Cardiogenic Shock: In severe cases, a heart attack can cause the heart to pump so poorly that it cannot maintain adequate blood pressure and oxygen delivery to vital organs. This condition, called cardiogenic shock, is a medical emergency.
- Heart Rupture: In rare cases, a heart attack can cause a rupture of the heart muscle or the wall between the heart chambers, leading to internal bleeding and cardiac tamponade.
- Pericarditis: After a heart attack, the pericardium, the sac that surrounds the heart, may become inflamed. Post-myocardial infarction pericarditis is a disorder that can lead to discomfort and chest pain.
- Ventricular Aneurysm: A weakened area of the heart muscle can balloon out and form an aneurysm. This can lead to further complications and may require surgical intervention.
- Kidney Problems: Reduced blood flow to the kidneys during a heart attack can lead to acute kidney injury (AKI) or worsen existing kidney problems.
- Thrombus or Embolism: Blood clots may form within the heart chambers or blood vessels, potentially leading to stroke or other embolic events.
- Pulmonary Edema: The condition of pulmonary edema causes fluid to accumulate in the lungs and significantly obstruct breathing, necessitating emergency medical attention.
- Depression and Anxiety: The emotional impact of a heart attack can lead to depression and anxiety, which can affect a person's overall quality of life and recovery.
- Recurrence: Individuals who have experienced one heart attack are at an increased risk of having another in the future if preventive measures are not taken.
- Complications of Treatment: Interventions such as angioplasty and stent placement may carry risks of complications, including bleeding, infection, or damage to blood vessels.
- Long-Term Health Issues: Survivors of a heart attack may face ongoing health challenges, including the need for cardiac rehabilitation, medication management, and lifestyle changes to prevent further heart problems.
Prevention Of Heart Attack
To avoid a heart attack, adopt a heart-healthy lifestyle and manage risk factors. You may considerably reduce your chance of having a heart attack by adopting the following measures, even if it's not always possible to totally eliminate risk factors:Healthy Diet
- Consume a well-balanced diet rich in fruits, vegetables, whole grains, lean proteins, and low-fat dairy products.
- Limit saturated and trans fats, cholesterol, and sodium in your diet.
- Choose heart-healthy fats such as those found in olive oil, avocados, and nuts.
- Aim for at least 75 minutes of vigorous physical activity or 150 minutes of aerobic exercise at a moderate level per week.
- Strength training and aerobic (cardio) workouts should both be a part of your fitness regimen.
- Achieve and maintain a healthy body weight by balancing caloric intake with physical activity.
- Losing excess weight can reduce the strain on your heart and lower the risk of heart disease.
- To keep your blood pressure within a healthy range, monitor it frequently and heed the advice of your healthcare practitioner.
- Blood pressure may be lowered by making lifestyle adjustments like cutting back on salt and minimizing stress.
- Try eating a heart-healthy diet and, if prescribed, follow your doctor's instructions for taking medication to lower your cholesterol.
- High levels of LDL ("bad") cholesterol and low levels of HDL ("good") cholesterol are both risk factors for heart disease.
- Smoking increases the risk of heart disease. One of the most crucial actions you can do to safeguard your heart is to stop smoking.
- If you do consume alcohol, do it sparingly. For women, this often implies no more than one drink per day and no more than two for males.
- If you have diabetes, work with your doctor to properly control your blood sugar levels. Heart disease risk is decreased by managing diabetes.
- By practicing relaxation exercises like yoga, meditation, and deep breathing, you may lower your stress levels.
- Heart disease risk might increase with ongoing stress.
- If prescribed medications for conditions like high blood pressure, high cholesterol, or diabetes, take them as directed by your healthcare provider.
- Attend regular checkups with your healthcare provider to monitor your heart health, discuss risk factors, and make necessary adjustments to your preventive plan.
- Be aware of your family's history of heart disease, as genetics can play a role. Share this information with your healthcare provider.
- Educate yourself about heart health and stay informed about the latest research and guidelines for cardiovascular disease prevention,
FAQs About Heart Attack (Acute Myocardial Infarction)
What is a heart attack (myocardial infarction)?A heart attack, also known as a myocardial infarction, happens when the blood supply to a part of the heart muscle is suddenly cut off, causing injury or death to the heart tissue.
What causes a heart attack?
The majority of heart attacks are brought on by blood clots that form in coronary arteries, often as a result of the rupture of an arterial plaque deposit. As a result, there is a disruption in blood flow to the heart muscle.
What is the immediate treatment for a heart attack?
Immediate treatment often includes administering aspirin to reduce blood clot formation and nitroglycerin to relieve chest pain. In some cases, emergency procedures like angioplasty or thrombolytic therapy may be performed.
What are the common symptoms of a heart attack?
Chest pain or discomfort that may extend to the arm, neck, jaw, or back are typical signs of a heart attack. Breathing difficulties, nausea, lightheadedness, shortness of breath, fuzziness, and cold chills are further red flags.
Is chest pain always present during a heart attack?
No, chest pain is not always present. Some individuals, particularly women, may experience atypical symptoms like shortness of breath, fatigue, or nausea without chest pain.
What are the risk factors for a heart attack?
High blood pressure, high cholesterol, smoking, being obese, having diabetes, having a family history of heart disease, and leading a sedentary lifestyle are risk factors.
How is a heart attack diagnosed?
An electrocardiogram (ECG or EKG), blood tests to evaluate cardiac enzymes, and other imaging procedures like echocardiography or coronary angiography are frequently used in the diagnosis of heart attack.
What is the "golden hour" in heart attack treatment?
The "golden hour" refers to the critical first hour after the onset of a heart attack. Rapid treatment during this period can significantly improve the chances of minimizing heart muscle damage.
Can heart attacks be prevented?
Yes, heart attacks can be prevented by managing risk factors through lifestyle changes like a healthy diet, regular exercise, smoking cessation, and controlling conditions like high blood pressure and diabetes.
What is cardiac rehabilitation, and who should consider it?
A monitored program called cardiac rehabilitation aids people in their recovery following a heart attack or heart surgery. It is suggested for persons who have heart disease or are at risk and consists of exercise, education, and support.
Is it possible to survive a heart attack?
Yes, many people survive heart attacks with prompt medical attention and adherence to a heart-healthy lifestyle and treatment plan.
What should I do if I suspect someone is having a heart attack?
Call 911 immediately. While waiting for medical help, have the person sit down, keep calm, and, if available, administer aspirin if they are not allergic.
If you found our exploration of acute myocardial infarction insightful, you won't want to miss our latest article, "Heart Attack Emergency: A Guide to Quick First Aid." Building on the foundational knowledge of heart attacks provided in our previous piece, this latest guide offers practical and essential information on immediate first aid measures during a heart attack. Delve into the details and equip yourself with the knowledge needed to respond swiftly and effectively in emergency situations. Enhance your understanding of heart health by seamlessly transitioning to our new article through this link: Heart Attack Emergency: A Guide to Quick First Aid. Together, these articles aim to empower you with comprehensive insights into heart health and emergency response strategies.