What is Heart Attack

INTRODUCTION

A heart attack (also called “myocardial infarction”) occurs when a blood vessel supplying blood to a part of the heart becomes blocked, resulting in permanent damage to the heart muscle due to the lack of blood flow. The blood vessel can become blocked from advancing atherosclerotic plaque lesions, a sudden formation of a blood clot, or from the spasming of a coronary artery – an artery that supplies blood to the heart.

Most people believe that a heart attack is caused by a slow, progressive build-up of plaque, comforting themselves that it takes a lifetime to become completely clogged – but this just isn’t true for a majority of heart attacks. Heart specialists now believe that most heart attacks occur when an unstable, atherosclerotic plaque lesion, filled with cholesterol and fat, suddenly breaks apart, thus forming an open wound within the artery wall. Blood platelets and clotting proteins rush to the wound and form a clot — called a thrombus. The clot can enlarge in a matter of moments, causing obstruction of blood flow to the heart with resultant angina (chest pain). If the blood flow becomes completely obstructed, a heart attack ensues.

Surprisingly, it is the small plaques that can be the most lethal. A person with a 50% blockage who suddenly becomes obstructed is at much greater risk of having a large amount of heart damage than a person with a slowly progressive blockage. A person with a 90% blockage that was slow to progress has probably had a chance to develop “collaterals”–– smaller blood vessels that grow to take over the job of the big vessel that has been gradually closing down.

Is it an Emergency ?????

Every Second Counts
A heart attack is a life–threatening event. With immediate medical intervention — preferably within the first hour of onset of symptoms – heart damage may be averted or reduced. A new blood test measuring “troponin” – a chemical released into the blood during a heart attack – allows doctors to diagnose a heart attack more quickly and accurately than ever before. Time equals muscle is the theme that resounds in emergency rooms and treatment is aimed at quickly restoring blood flow to the heart muscle to prevent permanent damage.

Risk Factors ????

1) Increased LDL/HDL ratios (i.e.,, elevated LDL and low HDL levels)Cholesterol

2) Smoking

3) Diabetes

4) Hypertension

5) Obesity

6)  Stress (i.e., stress or depression)

7) Failure to eat fruits and vegetables daily

Failure to Exercise

9) Failure to drink Moderate Alcohol (complex relationship between alcohol and the heart.)

10) Metabolic syndrome.

11) Increased CRP ( C reactive Protein)

12) Taking Birth Control Pills

13) Complicated Pregnancy

Non modifiable Risk factors?????????

• A family history of premature CAD (generally, CAD that has occurred in male relatives before the age of 50, or in female relatives before the age of 60.)
• Age 55 or older (men), or 65 or older (women)
• For women, being post-menopausal, or having your ovaries removed.
• Chronic kidney disease.

Is there a recent rise Of Heart Attack patients in INDIA???

Yes Bcoz of the Follwing Reasons :

1. Economic Progress

2. Better standard living

3. Westernisation

4. Change of food habits

5. More prone genetics

6. Small vessel Coronary Artery Disease

7. High incidence of Diabetes

8. More Smokers

Symptoms ?????

A unique fact about heart disease is that, in general, the more serious the condition the more remote from the heart are the symptoms.   Amongst danger signals that may, but not necessarily do, betoken heart disease and invite prompt medical attention are:

1 Shortness of breath after slight exertion.

2  Pain or tightness in the chest, often running down the left arm.

3  Swelling in the ankles and abdomen.

4  Dizziness, light-headedness, or vertigo.

5  Seeing double (a particularly dangerous sign).

6  Indigestion that is vague and hangs on.

7  Persistent head-ache.

8  Fatigue without otherwise explained origin.

SIGNS?????

• Bradycardia to Tachycardia
• Angina
• Arrythmia
• Low cardiac Output
• Rales in case of Pulmonary edema
• Cyanosis
• Cold extremities

DIAGNOSIS ???

Essentials of Diagnosis

• Sudden but not instantaneous development of prolonged (> 30 minutes) anterior chest discomfort (sometimes felt as “gas” or pressure) that may produce arrhythmias, hypotension, shock, or cardiac failure.
• Sometimes painless, masquerading as acute CHF, syncope, stroke, or shock.
• ECG: ST-segment elevation or depression, evolving Q waves, symmetric inversion of T waves.
• Elevation of cardiac markers (CK-MB, troponin T, or troponin I).
• Appearance of segmental wall motion abnormality by imaging techniques.

Treatment ????

1)Aspirin and Clopidogrel All patients with definite or suspected myocardial infarction should receive aspirin at a dose of 162 mg or 325 mg at once regardless of whether thrombolytic therapy is being considered or the patient has been taking aspirin. Chewable aspirin provides more rapid blood levels. Patients with a definite aspirin allergy should be treated with clopidogrel; a 300 mg (or 600 mg) loading dose will result in faster onset of action than the standard 75 mg dose.

2) Thrombolytic Therapy: Streptokinase is not commonly used for treatment of acute myocardial infarction since it is less effective at opening occluded arteries and less effective at reducing mortality. It is non-fibrin-specific, causes depletion of circulating fibrinogen, and has a tendency to induce hypotension, particularly if infused rapidly. This can be managed by slowing or interrupting the infusion and administering fluids. There is controversy as to whether adjunctive heparin is beneficial in patients given streptokinase, unlike its administration with the more clot-specific agents. Allergic reactions, including anaphylaxis, occur in 1–2% of patients, and this agent should generally not be administered to patients with prior exposure.

3) Nitrates: Nitroglycerin is the agent of choice for continued or recurrent ischemic pain and is useful in lowering BP or relieving pulmonary congestion. However, routine nitrate administration is not recommended, since no improvement in outcome has been observed in the ISIS-4 or GISSI-3 trials, in which a total of over 70,000 patients were randomized to nitrate treatment or placebo. Nitrates should be avoided in patients who received phosphodiesterase inhibitors (sildenafil, vardenafil, and tadalafil) in the prior 24 hours.

4) Beta Blockers  : Although trials have shown modest short-term benefit from intravenous -blockers given immediately after acute myocardial infarction, it has not been clear that this provides a major advantage over simply beginning an oral -blocker. The Chinese COMMIT/CCS-2 trial involving 45,000 patients found no overall benefit to intravenous followed by oral metoprolol; the aggressive dosing (three 5 mg intravenous boluses followed by 200 mg/d orally) appeared to prevent reinfarction at the cost of increasing shock in patients presenting with heart failure. Thus, -blockade should be avoided in patients with decompensated heart failure, decompensated asthma, or high degrees of AV block. The CAPRICORN trial showed the benefits of carvedilol following the acute phase of large myocardial infarction with contemporary care.

5)ACE Inhibitors: A series of trials (SAVE, AIRE, SMILE, TRACE, GISSI-III, and ISIS-4) have shown both short- and long-term improvement in survival with ACE inhibitor therapy. The benefits are greatest in patients with low EFs, large infarctions, or clinical evidence of heart failure. Because substantial amounts of the survival benefit occur on the first day, ACE inhibitor treatment should be commenced early in patients without hypotension, especially patients with large or anterior myocardial infarction.

6) Calcium Channel Blockers : There are no studies to support the use of calcium channel blockers in most acute myocardial infarction patients—and indeed, they have the potential to exacerbate ischemia and cause death from reflex tachycardia or myocardial depression. One exception is that diltiazem and verapamil appear to prevent reinfarction and ischemia in the subset of patients with non-Q wave infarction. Diltiazem is preferable because it causes less myocardial depression. The dosage is 240–360 mg daily. Otherwise, long-acting calcium channel blockers should be reserved for management of hypertension or ischemia as second- or third-line drugs after -blockers and nitrates

7) Surgery:

Prevention>>>

How Can a Heart Attack Be Prevented?

Lowering your risk factors for coronary artery disease (CAD) can help you prevent a heart attack. (See “Who Is At Risk for a Heart Attack?“) Even if you already have CAD, you can still take steps to lower your risk of heart attack.

Reducing the risk of heart attack usually means making healthy lifestyle choices. You also may need treatment for medical conditions that raise your risk.

Healthy Lifestyle Choices

Healthy lifestyle choices to help prevent heart attack include:

• Following a low-fat diet rich in fruits and vegetables. Pay careful attention to the amounts and types of fat in your diet. Lower your salt intake. These changes can help lower high blood pressure and high blood cholesterol.
• Losing weight if you’re overweight or obese.
• Quitting smoking.
• Doing physical activity to improve heart fitness. Ask your doctor how much and what kinds of physical activity are safe for you.

Treat Related Conditions

In addition to making lifestyle changes, you can help prevent heart attacks by treating conditions you have that make a heart attack more likely:

• High blood cholesterol. You may need medicine to lower your cholesterol if diet and exercise aren’t enough.
• High blood pressure. You may need medicine to keep your blood pressure under control.
• Diabetes (high blood sugar). If you have diabetes, control your blood sugar levels through diet and physical activity (as your doctor recommends). If needed, take medicine as prescribed.

Have an Emergency Action Plan

Make sure that you have an emergency action plan in case you or someone else in your family has a heart attack. This is especially important if you’re at high risk or have already had a heart attack.

Talk with your doctor about the signs and symptoms of heart attack, when you should call 9–1–1, and steps you can take while waiting for medical help to arrive.