A heart attack is known as myocardial infarction in the medical fraternity. The word ‘Myo’ means muscle while ‘cardial’ denotes heart. ‘Infarction’, on the other hand, refers to death of tissue caused by insufficient blood supply. The death of tissue may lead to a long-lasting damage of cardiac muscles. Heart attack is a condition which usually occurs when the blood supply to the heart is blocked suddenly due to complete blockage of the artery supplying blood to the cardiac muscles. This causes the heart muscle cells to die. The blockage of artery is often caused by plaque formation (deposition and hardening of fatty substances and cholesterol on the walls of arteries) resulting in coronary heart disease (CHD). If left untreated it can be fatal.
The severity of damage to the heart tissues caused by a myocardial infarction or heart attack depends on the longevity of the attack. The earlier you receive medical care, the lesser is the damage. So it is crucial to identify the symptoms as early as possible to ensure fast access to medical intervention.
Some of the symptoms of heart attack include chest pain and tightness, shooting pain up and down the left side of your body, anxiety, cough, fainting, heavy pressure, palpitations, shortness of breath and sweating. Most people tend to ignore the initial symptoms of heart attack which causes greater damage to the heart. If you experience the warning signs of heart attack, you should call your local emergency number right away.
Age is a major risk factor behind heart attack. A man over 45 and a woman above 55 are more vulnerable to this condition. Smoking and obesity are also like to increase one’s chances of being affected by this condition.
CAUSES OF HEART ATTACK
The muscles of your heart constantly need oxygen-rich blood which is ensured by your coronary arteries. This blood supply gets blocked when your arteries become narrow due to the build-up of plaque. It is formed by fat, calcium, proteins, and inflammatory cells. The outer layer of the plaque deposit is hard while the inner layer is soft. The outer shell breaks in case the plaque is hard. This is known as rupture, a condition that leads to the formation of blood clots around the plaque. If a blood clot blocks your artery, then blood supply to your heart is cut which, in turn, depletes the cardiac muscles of oxygen. This causes the muscle to die, resulting in permanent damage. The intensity of damage depends on the time gap between treatment and the attack. After a heart attack the cardiac muscles start repairing themselves. On an average, it takes them about 2 months to heal.
Apart from this, there could be another condition that can lead to a heart attack: Spasm in your coronary artery (ischemia). This can also restrict blood supply to the heart and can occur even if you don’t have any coronary artery disease. However, this is a rare occurrence.
RISK FACTORS BEHIND A HEART ATTACK
There could be many risk factors behind a heart attack. Here, we guide you on the most prominent ones:
Age: This plays an instrumental role in increasing your risk of a heart attack. Evidences suggest that men over 45 and women above 55 are more likely to experience heart attack.
Gender: Men are 2-3 times more likely to have a heart attack than women. The female hormone, oestrogen, works as a shield in case of women.
Genetic predisposition: If you have a first-degree relative (a parent, brother or sister) with a history of heart disease – such as angina, heart attack or stroke – you are twice as likely to develop similar problems, compared to the general population.
High blood pressure: Uncontrolled blood pressure levels over a long period of time can damage your blood supplying arteries making you vulnerable to heart attack.
High levels of bad cholesterol and triglyceride: Bad cholesterol or LDL has a narrowing effect on your arteries. Moreover, a blood fat known as triglyceride, can also increase your chances of getting a heart attack. Both these factors are largely related to your diet. So, eating mindfully is crucial to reduce your risk of heart attack.
Obesity: Excessive body weight is likely to increase your LDL, triglyceride levels while increasing your chance of developing diabetes. All these are potential risk factors behind heart attack. Staying physically active and eating mindfully are the cornerstones of maintaining ideal body weight.
Diabetes: This condition is marked by high blood sugar levels, another condition that can make you vulnerable to heart attack.
Stress: It is known to elevate your blood pressure levels which, as already mentioned, is a major risk factor behind myocardial infarction.
Smoking: It tightens your arteries and raises your blood pressure levels. All these increase your heart attack risk.
SYMPTOMS OF HEART ATTACK
The classic symptom of a myocardial infarction is chest pain or discomfort. But there are other signals too. Here is a low-down on the crucial ones.
Upper body pain
If you have pain, discomfort or pressure in your chest, that branches out to your arms (especially left arm), jaw, throat and shoulder blades, chances are that you are getting a myocardial infarction.
Breaking out in cold sweats
Don’t ignore if you suddenly break out in a cold sweat, especially when you are going through the other symptoms of a heart attack.
Starting from empty stomach to dehydration, a lot of things could trigger dizziness or light-headedness. But if your feeling of unsteadiness is associated with chest discomfort, it could well be the sign of a heart attack. Evidences suggest that women are more likely to feel this way during a myocardial infarction.
A racy heart could be the result of many factors including excessive caffeine intake and poor sleep among others. But if you feel that your heart is beating faster than normal for more than just a few seconds, seek medical intervention immediately.
Stubborn cough and cold
Normally, cold and flu symptoms aren’t considered to be an alarm bell for a heart attack. But if you are in the high-risk group for the condition (have a family history, obese, or are suffering from diabetes), then this can be a warning sign for sure. If you experience flu-like symptoms that don’t go, get your mucus tested. A pink mucus could indicate your heart isn’t functioning to its maximum potential. That’s why blood is leaking back in the lungs.
DIAGNOSIS OF A HEART ATTACK
A heart attack is usually suspected by typical clinical symptoms and is confirmed by carrying out the following tests:
ECG: Electrocardiogram or ECG is a diagnostic test which measures electrical signals that travel through the heart, causing it to pump blood through its chambers. These impulses are recorded in the form of a graph showing waves in a distinct pattern. Depending on the shape of these waves, doctors can evaluate any abnormal condition of the heart.
Blood test: Bloodwork is needed to detect the presence of cardiac enzymes which are raised during a heart attack. With the help of these readings, your doctor is able to identify the size and time of the attack. Some blood tests also measure the levels of certain heart cell proteins that are released when damage occurs due to the lack of blood supply.
Echocardiography: This is an imaging test performed during and after a heart attack. It tells your doctor whether or not your heart is pumping well. This test also reveals if any part of your heart is injured during the attack.
Angiogram: This is an imaging test to detect blockage in the arteries. It is rarely used to diagnose a heart attack. In this test, a liquid dye is injected into your heart arteries with the help of a tube known as catheter.
Cardiac CT or MRI: These imaging tests reveal the extent of damage to your cardiac muscles.
TREATMENTS FOR HEART ATTACK
A heart attack requires emergency assessment and treatment. It is important that you are treated quickly to minimise damage to your heart. The line of treatment, which varies depending on the severity of the condition, includes medicines, surgical intervention and other procedures.
Your doctor prescribes drugs to prevent clot formation, relieve pain, regularise your heart rhythm, broaden blood vessels, regulate blood pressure levels, so on and so forth. While your doctor may suggest many medicines, we guide you about the most common ones:
Aspirin: This emergency medicine reduces blood clotting, ensuring blood flow through the narrow artery.
Thrombolytics: These drugs also help in busting clots that cut off blood supply to your heart. Thrombolytics, administered on time, increase your chance of survival.
Antiplatelet agents: They not only keep new clots at bay but also prevent existing clots from getting bigger.
Pain relievers: Morphine is commonly used for reducing chest pain.
Beta blockers: They ensure better functioning of the heart by relaxing your heart muscles , regulating heartbeat and blood pressure levels. Beta blockers can also be instrumental in preventing future heart attacks.
ACE inhibitors: These medicines function as blood pressure lowering agents while reducing your heart’s stress level.
Statins: They keep your blood cholesterol levels under control.
SURGERY AND OTHER PROCEDURES
Along with drug therapy, you may need any of the following procedures:
Angioplasty: This involves performing a coronary angiography, locating the blocked artery and opening the block with a balloon and finally implanting a stent at the site of the block, to keep the artery open and your blood flowing freely.
Bypass surgery: In this procedure, the surgeon sews your veins or arteries in a location away from the blocked or narrowed artery. A bypass surgery allows your blood to reach your heart after bypassing the narrowed area. It can be performed at the time of a myocardial infarction or a few days later.
PROGNOSIS FOR HEART ATTACK
The prognosis of a heart attack depends upon several factors:
- How early the patient reached the hospital
- Post heart attack complications: Irregular or abnormal heart rate, low blood pressure, lung congestion, need for ventilator support, etc.
- Body's response to the treatment
Broadly speaking, with early recognition and timely treatment, the prognosis in heart attack patients worldwide has improved.
PREVENTION OF HEART ATTACK
Modifying your lifestyle and taking up a few healthy habits can go a long way in preventing or reducing your risk of a heart attack. Here are a few small steps that will help for sure:
- Eat a healthy, balanced diet (avoid excess fat/ oil/ meat; include more of green veggies, fruits, nuts, fish).
- Avoid smoking and excessive alcohol intake.
- Keep your blood pressure, blood sugar levels and cholesterol within normal limits.
- Exercise regularly. This is extremely necessary to maintain a healthy body weight. Obesity is a major risk factor behind heart attack.
- Manage stress by practising meditation, breathing techniques and yoga exercises.
- Yearly health check-ups with a physician.
The content has been verified by Dr. Nilesh Gautam, Senior Interventional Cardiologist, Head of Department of Preventive Cardiology and Rehabilitation at the Asian Heart Institute, Mumbai.