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Heart Attack (Myocardial Infarction)

What is a heart attack (myocardial infarction or MI)?

A heart attack, or myocardial infarction, occurs when one or more regions of the heart muscle experience a severe or prolonged decrease in oxygen supply caused by blocked blood flow to the heart muscle.

The blockage is often a result of atherosclerosis - a buildup of plaque, known as cholesterol, and other fatty substances. Plaque inhibits and obstructs the flow of blood and oxygen to the heart. Heart attacks typically occur when plaque in a coronary artery tears. A blood clot forms rapidly over the plaque, blocking blood and oxygen flow to the heart.

If the blood and oxygen supply is cut off severely or for a long period of time, muscle cells of the heart suffer severe and devastating damage and die. The result is damage or death to the area of the heart that became affected by reduced blood supply.

What are the risk factors for heart attack?

There are two types of risk factors for heart attack, including:

Inherited (or genetic):	Acquired:
These are risk factors you are born with that cannot be changed, but can be improved with medical management and lifestyle changes.	These are risk factors that are caused by activities that we choose to include in our lives that can be managed through lifestyle changes and clinical care.

Who is most at risk - inherited (genetic) factors?

• persons with inherited hypertension (high blood pressure)
• persons with inherited low levels of HDL (high-density lipoprotein) or high levels of LDL (low-density lipoprotein) blood cholesterol
• persons with a family history of heart disease (especially with onset before age 55)
• aging men and women
• persons with diabetes mellitus (type 1 diabetes)
• women (after the onset of menopause) - generally, men are at risk at an earlier age than women, but after the onset of menopause, women are equally at risk.

Who is most at risk - acquired risk factors?

• persons with acquired hypertension (high blood pressure)
• persons with acquired low levels of HDL (high density lipoprotein) or high levels of LDL (low density lipoprotein) blood cholesterol
• cigarette smokers
• people who are under a lot of stress
• individuals who lead a sedentary lifestyle
• persons overweight by 30 percent or more
• persons with type 2 diabetes

A heart attack can happen to anyone. It is only when we take the time to learn which of the risk factors apply to us, specifically, can we then take steps to eliminate or reduce them.

Managing heart attack risk factors

Managing your risks for a heart attack begins with:

• examining which of the risk factors apply to you, and then taking steps to eliminate or reduce them.
• becoming aware of conditions like hypertension or abnormal cholesterol levels, which may be "silent killers."
• modifying risk factors that are acquired, not inherited, through lifestyle changes. See your physician as the first step in starting right away to make these changes.
• consulting your physician soon to determine if you have risk factors that are genetic or inherited and cannot be changed, but can be managed medically and through lifestyle changes.
• using medication prescribed by your physician that lowers cholesterol and reduces the risk of heart attack.

What are the warning signs of a heart attack?

The following are the most common symptoms of a heart attack. However, each individual may experience symptoms differently.

Chest pain
This symptom can include the following sensations:

• severe pressure, fullness, squeezing, pain and/or discomfort in the center of the chest that lasts for more than a few minutes
• pain or discomfort that spreads to the shoulders, neck, arms, or jaw
• chest pain that increases in intensity
• chest pain that is not relieved by rest or by taking cardiac prescription medication
• chest pain that occurs with any/all of the following (additional) symptoms:
  • sweating, cool, clammy skin, and/or paleness
  • shortness of breath
  • nausea or vomiting
  • dizziness or fainting
  • unexplained weakness or fatigue
  • rapid or irregular pulse

Although chest pain is the key warning sign of a heart attack, it may be confused with indigestion, pleurisy, pneumonia, or other disorders.

Indigestion
Also known as upset stomach or dyspepsia, this painful or burning feeling in the upper abdomen that may be accompanied by:

• nausea
• abdominal bloating
• belching
• vomiting
• severe pain in the upper right abdomen
• discomfort unrelated to eating

Responding to heart attack warning signs:

If you, or someone you know exhibits any of the above warning signs, act immediately. Call 911, or your local emergency number. The earlier a heart attack is treated, the less the damage to the heart.

Treatment for a heart attack:

The goal of treatment for a heart attack is to relieve pain, preserve the heart muscle function, and prevent death. Treatment in the emergency department may include:

• intravenous medications
• continuous monitoring of the heart and vital signs
• oxygen therapy - to improve oxygenation to the damaged heart muscle
• cardiac medication - (i.e., to promote blood flow to the heart, prevent blood clotting, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure). These medications will decrease pain from a heart attack.
• thrombolytic therapy - intravenous infusion of a medication which dissolves the blockage, thus, restoring blood flow

Once the condition has been diagnosed and the patient stabilized, additional procedures to restore coronary blood flow may be utilized. Those procedures include:

• coronary angioplasty - with this procedure, a catheter is used to create a bigger opening in the vessel to increase blood flow. Although angioplasty is performed in other blood vessels, Percutaneous Transluminal Coronary Angioplasty (PTCA) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. There are several types of PTCA procedures, including:
  • balloon angioplasty - a small balloon is inflated inside the blocked artery to open the blocked area.
  • atherectomy - the blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter.
  • coronary artery stent - a tiny titanium coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open. Many stents used today are coated with medication that will reduce the chance that a new blockage will form at the site.
• coronary artery bypass - a surgical procedure in which small portions of veins or arteries are taken from one part of the body and transplanted into the heart to bypass clogged coronary arteries in the heart.