Heart Attack (Myocardial Infarction) Does chest pain always mean a heart problem? Angina and Heart Attack * What is a heart attack? * What are the symptoms of a heart attack? * Does a heart attack always cause severe chest pain? * What is angina? * What should I do if I have the symptoms of a heart attack? * What is nitroglycerin? * If I'm not sure I am having an attack, should I call my local emergency telephone number? * What medical treatment can I expect? What is a heart attack? A heart attack (or myocardial infarction) occurs when a coronary artery, one of the blood vessels that supply oxygen-rich blood to the heart muscle, becomes blocked. The area of heart muscle that does not receive blood begins to die. The seriousness of a heart attack depends on how much of the heart is affected. Often the surrounding healthy muscle keeps working, allowing the heart to keep pumping while the injured muscle heals and recovers some of its strength. What are the symptoms of a heart attack? The signs of a heart attack can be subtle and hard to identify. Many people don't recognize the symptoms even when they are in the middle of a major heart attack. The amount of time that passes before you receive treatment can mean the difference between life and death. Learn about the symptoms of heart disease and your own risk factors. Get help immediately even if you are not sure you are having a heart attack. Does a heart attack always cause severe chest pain? A heart attack feels different to different people. Even if you have already had a heart attack, a second one may not feel the same. You may feel pain in any of the areas of the body shown below. Or you may feel pain only in your arms, jaw, or back. Other warning signs of a heart attack include dizziness, fainting, sweating, nausea, or weakness. What is angina? Angina--a feeling of pain, heaviness, tightness, burning, or squeezing in your chest--is an indication that you have heart disease and are at risk of having a heart attack. Angina occurs when the heart muscle does not receive enough oxygen because of a temporary narrowing of one of the coronary arteries that supply it with oxygen-rich blood. Angina usually occurs during physical exertion or emotional stress. Tell your doctor immediately if you have any symptoms of angina, which are similar to those of an actual heart attack. Prompt treatment for angina can prevent you from having a heart attack. Many people experience angina for years, but do not seek treatment and eventually have a heart attack. What should I do if I have the symptoms of a heart attack? Getting prompt treatment for a heart attack can be lifesaving. If you experience one or more symptoms of a heart attack, act quickly and take the following steps: * Sit down or lie down. * If symptoms persist for 2 minutes, call your local emergency telephone number and say you may be having a heart attack. Leave the phone off the hook so that medical personnel can locate your address if you should become unconscious. * If you have nitroglycerin tablets, take up to three pills, one at a time every 5 minutes. * Ambulances are well equipped to provide emergency care for people who are having heart attacks. It is usually better to have medical personnel come to you than for you to start off for the hospital. * If you can get to the hospital faster by car than by ambulance, have someone drive you. Do not drive yourself--it could be dangerous. * Do not delay getting medical treatment, even if you are not sure you are having a heart attack. A delay can cause permanent damage to your heart muscle or even death. Let the doctor determine whether or not you are having a heart attack. * If your breathing or pulse stops, any person who is trained in cardiopulmonary resuscitation (CPR) should immediately begin the procedure. Call your local emergency telephone number first. * When you arrive at the emergency room, you or the person who brought you should announce clearly that you may be having a heart attack. Make sure you are seen at once. What is nitroglycerin? Nitroglycerin is a drug that reduces the pain of angina by widening blood vessels to allow more blood to reach the heart muscle. You place nitroglycerin tablets under your tongue whenever you feel the pain of angina or anticipate it coming on. People who have angina should have nitroglycerin with them at all times and should take it immediately if they feel pain in their chest. If I think I might be having a heart attack, but I'm not sure, should I call my local emergency telephone number? A heart attack does the most damage in the first 2 hours. The longer you delay seeking treatment, the more damage your heart is likely to sustain. Responding promptly to signs of a heart attack can dramatically increase your chances of recovery. If your symptoms last more than 2 minutes, call your local emergency telephone number . Here are some common reasons why people delay calling for help, and the facts in each situation: Reason for delay: You think that only men have heart attacks. Reality: Heart disease is the most common cause of death in women as well as men. If you have symptoms, call for help. Reason for delay: You are not sure it is a heart attack. Reality: Call anyway--heart attack symptoms can be vague. Reason for delay: It feels like heartburn. Reality: If you have a history of heart disease, angina, or high blood pressure, the heartburn you feel may actually be a heart attack. Call for help immediately. Reason for delay: You'd feel embarrassed if it turned out you didn't need medical help after all. Reality: Never feel embarrassed about calling for help. A little embarrassment might save your life. Reason for delay: You're hoping that it is not a heart attack. Reality: Wishful thinking can be deadly. You can't wish a heart attack away, and getting treatment quickly can save your life. Most people who survive a heart attack can return to their normal life, including work, within 3 months. What medical treatment can I expect if I have to go to the hospital for a heart attack? Much can be done to help you recover from a heart attack, but you must take the first and most important step--getting medical help immediately. At the hospital, the emergency room staff will determine if you have had a heart attack by doing a test called an electrocardiogram (ECG) and by taking a blood sample to test for chemicals that are secreted by damaged heart muscle. You may be given drugs immediately to help dissolve a clot that may be causing the blockage. If your heartbeat is abnormal, the doctor may need to restore a normal rhythm with a defibrillator, which delivers an electric current to your heart. If your heart has stopped, doctors will compress your chest rhythmically to try to maintain normal pumping action until your heartbeat has been reestablished. Later, you may be given blood-thinning medications to help prevent a clot from forming again or to prevent new clots from forming. Your care will continue in the coronary care unit until you are out of danger. Myocardial infarction Introduction: Myocardial infarction is the technical name for a heart attack. The heart is responsible for pumping blood, which carries oxygen, to every organ in the body, including the heart itself. A heart attack occurs when an artery leading to the heart becomes completely blocked and the heart doesn' t get enough blood or oxygen. Cells in that area of the heart start to die (called an infarct). A heart attack is a medical emergency. If you, or someone you know, has any of the symptoms below, call 911 immediately. Waiting even 15 minutes can be fatal. But if you get prompt medical treatment, you can limit damage to your heart. Although heart attack is the leading cause of death in the United States, up to 95% of people who are hospitalized with a heart attack survive. Most heart attacks are caused by blood clots, which are in turn caused by atherosclerosis (stiffening and narrowing of the arteries). High blood fats (triglycerides) and LDL or “bad” cholesterol form plaque inside arteries, narrowing the passageway and reducing the amount of blood that can flow through. Your lifestyle plays a crucial role in preventing a heart attack or recovering from one. Eating a heart healthy diet and getting at least 30 minutes of exercise 5 days a week (or more) can reduce your risk of heart attack. Signs and Symptoms: * Squeezing pain, heaviness, tightness, pressure in center of chest * Pain that spreads to your back, left arm, jaw, neck * Shortness of breath * Dizziness, weakness * Nausea, vomiting * Irregular heartbeat * Sweating * Feeling of doom Women may experience different symptoms than men. In women, along with chest pain, symptoms can include: * Heartburn or pain in the abdomen * Unusual fatigue * Clammy skin Causes: Heart attacks happen when an artery supplying your heart with blood becomes blocked. Without blood, the heart doesn' t get enough oxygen and cells in the heart start to die. The most common cause of blocked arteries is atherosclerosis. No one knows the exact cause of atherosclerosis, but most researchers believe it begins with an injury to the innermost layer of the artery, known as the endothelium. The following factors are thought to contribute to the damage: * High blood pressure * Elevated LDL ("bad") cholesterol * An accumulation of homocysteine (an amino acid produced by the human body, thought to be a risk factor for heart disease, stroke, osteoporosis, diabetes, and dementia) * Smoking * Diabetes * Inflammation Once the artery is damaged, blood cells called platelets build up there to try and repair the injury. Over time, fats, cholesterol, and other substances also build up at the site, which thickens and hardens the artery wall. The amount of blood that flows through the artery is decreased, and oxygen supply to organs also decreases. Blood clots may also form, blocking the artery. Rarely, a spasm in a coronary artery (one that supplies blood to the heart) stop blood flow and can cause a heart attack. Risk Factors: These risk factors increase your chances of developing atherosclerosis: * Smoking * High fat diet * High LDL “bad” cholesterol and triglycerides (fats in the blood) * Lack of exercise * Being overweight or obese * Family history of heart attack * Diabetes * High blood pressure * Being male, or a female who has gone through menopause * Stress Also, people who have elevated homocysteine, C-reactive protein (CRP), and fibrinogen levels seem to have an increased risk of heart attack. These are markers of inflammation, but researchers aren' t sure whether they contribute to heart disease or occur when you have heart disease. High homocysteine can be treated with folic acid (see Nutrition and Supplements). More research in these areas is currently underway. Diagnosis: If you think that you are having a heart attack, don' t wait to be sure -- call 911 immediately. Treating a heart attack quickly can save your life, while delay can be fatal. In the emergency room, a doctor will ask you about your symptoms and perform a physical examination. He or she will immediately run tests to determine your heart function. They may include: Electrocardiogram (ECG) -- the first test done to check for a heart attack; you may be hooked up to a monitor even as the doctor is asking you questions. An ECG measures electrical activity of your heart. Blood tests -- Your doctor may look for certain enzymes that are released into your blood when you have a heart attack. Other tests include: * Chest x-ray * Echocardiogram (uses sound waves to take a picture of your heart) * Coronary catheterization or angiogram (uses a liquid dye inserted through a catheter to see whether your arteries are blocked) * Stress test (involves walking on a treadmill while hooked up to an ECG machine to see how your heart responds to exercise) Preventive Care: You can reduce your risk of heart attack by: * Stopping smoking. * Getting aerobic exercise (such as walking, biking, or swimming) for at least 30 minutes 5 days per week. If you haven't exercised much in the past, walking is a great way to start. * Reducing stress and learning stress-reduction techniques such as deep breathing and meditation. Yoga and tai chi, two forms of exercise that emphasize stretching, breathing, and meditating, can also help you reduce your stress level. * Eating a diet low in saturated fat and rich in fruits, vegetables, and whole grains. * Losing weight or maintaining a proper weight. If you have high cholesterol, diabetes, or high blood pressure, follow your doctor' s instructions to keep these risk factors under control. You may need medications in addition to lifestyle changes. If you don't have heart disease yet or have not had a heart attack despite these risk factors, aggressive control can help prevent a heart attack. And, if you already have heart disease, aggressive control of these risk factors can prevent further heart attacks or other problems related to heart disease. Treatment Approach: The goal when treating a heart attack is to restore blood flow to the affected area of the heart immediately, to preserve as much heart muscle and heart function as possible. If your doctor has prescribed nitroglycerin, take it while you are waiting for emergency medical personnel to arrive. Once at the hospital, your doctor may use drug therapy, angioplasty (using one of several methods to clear the blocked blood vessel, such as inflating a balloon inside it or holding it open with a device called a stent), and surgery. Once you have been treated for a heart attack, making changes in your lifestyle (especially in your diet and exercise habits), and taking medications as prescribed, is very important for avoiding recurrent heart attacks and even death. Although certain herbal remedies as well as relaxation techniques may also be used, they should never be used alone to treat a heart attack. A heart attack always requires emergency medical attention. Lifestyle Making lifestyle changes can improve many of your risk factors for heart disease, including high cholesterol, high blood pressure, extra weight, high homocysteine, and elevated C-reactive protein. Cardiac rehabilitation programs generally involve teaching you about diet, physical activity, and relaxation techniques. To keep your risk factors low, you will need to follow the healthy habits taught in cardiac rehab, like exercise and eating properly, for the rest of your life. Medications Aspirin -- helps stop blood from clotting. You may be given aspirin in the ambulance or as soon as you get to the hospital. Aspirin should be continued indefinitely at a dose of 81 mg per day. Nitroglycerin -- helps dilate (widen) blood vessels. You may be given nitroglycerin in the ambulance or as soon as you get to the hospital. Pain reliever -- Morphine is often given intravenously (IV) to relieve pain. Thrombolytics -- “Clot busting” drugs may be used, depending on the type of heart attack. They are most effective when taken within 2 hours of the heart attack, and are not given after 12 hours have elapsed. These drugs may be given with other anticoagulants (blood thinners). Anticoagulants (blood thinners) -- Make your blood less likely to form clots. Heparin is often given by injection while you are in the hospital. After you recover, other drugs are used to lower your risk of having another heart attack. They include: ACE inhibitors -- widen blood vessels and make it easier on your heart to pump blood. Side effects can include chronic cough. ACE inhibitors include: * Benazepril (Lotensin) * Captopril (Capoten) * Fosinopril (Monopril) * Lisinopril (Zestril) * Enlapril (Vasotec) Beta-blockers -- slows heart rate, thus lowering blood pressure. These drugs include: * Acebutolol (Sectral) * Atenolol (Tenormin) * Bisoprolol (Zebeta) * Carteolol (Cartrol) * Metoprolol (Toprol XL) * Nadolol (Corgard) * Propranolol (Inderal) Statins -- help lower cholesterol. People who are pregnant or have liver disease should not take statins. They include: * Lovastatin (Mevacor) * Simvastatin (Zocor) * Pravastatin (Pravachol) * Atorvastatin (Lipitor) * Fluvastatin (Lescol) * Rosuvastatin (Crestor) Niacin (nicotinic acid) -- In prescription form, is sometimes used to lower cholesterol. Dietary supplements of niacin should not be used instead of prescription niacin, as it can cause side effects. Only take niacin for high cholesterol with your doctor's supervision. Bile acid sequestrants -- lowers cholesterol; people who have high levels of triglycerides (fats in the blood) should not take bile acid sequestrants. These drugs include: * Cholestyramine (Questran) * Colestipol (Colestid) * Colesevelam (Welchol) Fibric acid derivatives -- lower triglycerides and moderately lower LDL cholesterol. They include Gemfibrozil (Lopid). Anticoagulants (blood thinners) -- help keep clots from forming. Your doctor may prescribe aspirin, warfarin (Coumadin), or Clopidogrel (Plavix) Surgical Treatments Percutaneous coronary intervention (PCI) -- In primary PCI, the doctor performs a coronary angiogram (injecting dye into the arteries) to see where the artery is blocked. The doctor then performs balloon angioplasty (widening an artery with a balloon), often with stent placement, to keep the artery open. Coronary artery bypass graft (CABG) -- This surgery bypasses the blocked arteries by using a graft of another blood vessel (usually from your arm or leg) to restore blood flow to the heart. Nutrition and Dietary Supplements Healthy eating habits can help reduce high cholesterol, high blood pressure, and overweight -- three of the major risk factors for heart disease. The American Heart Association (AHA) has developed dietary guidelines that help lower fat and cholesterol intake and reduce the risk of heart disease and heart attack. The AHA does not recommend very low fat diets, because new research shows that unsaturated ("good") fats, such as those found in olive oil, are good for your heart. Many fad diets are popular, but they may not help you lose weight and keep it off -- and in some cases, they may not even be healthy. Any healthy diet will include a variety of foods. If a diet bans an entire food group (such as carbohydrates), it's probably not healthy. The AHA recommends the following for healthy eating: * Grains: 6 - 8 servings per day (half should be whole grains) * Vegetables: 3 - 5 servings per day * Fruits: 4 - 5 servings per day * Fat-free or low fat dairy: 2 - 3 servings per day * Lean meat, poultry, seafood: 3 - 6 oz. per day (about the size of a deck of cards) * Fats and oils: 2 - 3 tbsp. per day (use unsaturated fats such as olive oil or canola oil) * Nuts, seeds, legumes: 3 - 5 servings per week * Sweets, sugars: 5 or fewer servings per week (the fewer, the better) In addition, the AHA also recommends eating 2 servings of fatty fish (such as salmon or lake trout) per week; holding sodium (salt, including salt already added to food) to 2,400 mg per day or less; and limiting alcohol intake to one drink a day for women and two for men.
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