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What Every Adult Needs To Know About Heart Attack

More than one million Americans suffer heart attack each year.  But relatively few people know exactly what a heart attack is.  The following information is intended to provide the reader with a basic understanding of heart attack; its causes; and its treatments.

The heart is made of muscle. Like every muscle in the human body, the heart needs oxygen to function.  And just like every other muscle, the heart gets its oxygen from blood.  Without a constant supply of oxygen-rich blood, the tissue of the heart muscle will begin to die.  A heart attack is death of heart muscle tissue due to a break down or interruption in the supply of oxygenated blood.

What causes a heart attack?

The tissue of the heart muscle is supplied with oxygenated blood by many narrow blood vessels called coronary arteries.  As people age, their arteries, including their coronary arteries, begin to fill up with fatty plaques.  This process is called atherosclerosis.  The filling of the coronary arteries narrows the space for blood flow within the arteries.  This narrowing is called stenosis.  Significant narrowing of the coronary arteries can greatly reduce blood flow or even prevent it altogether.

The fatty plaques that build up in the coronary arteries are hard on the outside and soft on the inside.  Sometimes the hard outer shell of the plaque will crack.  When this happens, blood clots begin to form around the crack in the plaque.  This clotting can result in the complete blockage of the already narrowed artery thus preventing the flow of any blood.  Click here to see a video depiction of what happens within the coronary arteries when a heart attack occurs.

Each coronary artery supplies oxygenated blood to a different area of the heart.  If fatty plaque or clot completely blocks off a coronary artery, the heart muscle that gets its oxygenated blood from that particular artery will begin to die unless blood flow is immediately restored.

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What are the signs and symptoms of heart attack?

Not all heart attacks begin with sudden, crushing chest pain that is often shown on TV or in the movies.  Many heart attacks start slowly as mild pain or discomfort. Some people don’t have symptoms at all (this is called a silent heart attack).

One of the most common symptoms of heart attack is chest pain or discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. It can be mild or severe. Heart attack pain can sometimes feel like indigestion or heartburn.

Other common signs and symptoms of heart attack include upper body discomfort in one or both arms, the back, neck, jaw, or stomach; shortness of breath; nausea, vomiting; light-headedness or fainting; breaking out in a cold sweat; and anxiety.

How is a heart attack diagnosed?

The diagnosis of heart attack is based primarily on the presence of heart attack signs and symptoms and the results of diagnostic tests.  There are three main diagnostic tests for heart attack.

The first is EKG (electrocardiogram).  This test prints out a pattern on a sheet of paper that shows the electrical activity of your heart.  Certain changes in the visual appearance of the heart’s electrical activity pattern signify that you are having a heart attack.

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The second diagnostic test for heart attack is blood testing.  When heart muscle cells die during a heart attack, they emit certain proteins into the bloodstream. Higher than normal levels of these proteins in the bloodstream is evidence of a heart attack.

The third test used to diagnose heart attack is called coronary angiography.  Coronary angiography is a special x-ray exam of the coronary arteries. It’s often done during a heart attack to help pinpoint the location of blockages in these arteries.  Coronary angiography involves the insertion of a catheter (a thin, flexible tube) through an artery in your arm or groin (upper thigh). This catheter is then passed through that artery to your heart. A dye that can be seen on x ray is then injected into the bloodstream through the tip of the catheter. This dye enables the doctor study the flow of blood through the heart and the coronary arteries.

How is a heart attack treated?

Early treatment of a heart attack can prevent or limit damage to the heart muscle. Several treatments are usually started right away, even before you are actually diagnosed with a heart attack, if heart attack is suspected.  These early treatments include oxygen; aspirin (to prevent further clotting); nitroglycerin (to relax the arteries and improve blood flow through the coronary arteries); and pain medication.

Once the diagnosis of heart attack is confirmed or strongly suspected, treatments to try to restore blood flow to the heart muscle are started as soon as possible.  These treatments include medicines and medical procedures.  The medicines used to restore blood flow to the heart muscle include thrombolytics(also called clot busters), used to dissolve blood clots that are blocking the coronary arteries; beta blockers, used to decrease the workload on your heart and prevent heart attack-related cardiac arrhythmias (irregular heart beats); ACE inhibitors, used to lower blood pressure and reduce the strain on the heart; and anticoagulants and antiplatelet medications, used to prevent further clot formation.

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The medical procedures used to treat heart attack include angioplasty, stenting, and coronary artery bypass grafting.  During angioplasty, a catheter with a balloon on the end is threaded through a blood vessel all the way to the blocked coronary artery. The balloon is then inflated and passed through the blocked artery to push the plaque against the wall of the artery.  This widens the inside of the artery and restores blood flow.  During angioplasty a small mesh tube called a stent may also be placed in the artery to help keep it open

Coronary artery bypass grafting is a surgery in which arteries or veins are taken from other areas of your body and sewn in place on your heart to bypass, or go around, the blocked coronary arteries. This provides a new route for blood flow to the heart muscle.

Who is at risk of heart attack?

The risks for heart attack include age (heart attack risk begins to increase at age 50); male gender; hereditary factors (children of parents who suffer heart attack are more likely to suffer a heart attack); race (African Americans are more likely to suffer heart attack than whites); smoking; high LDL cholesterol; high blood pressure; physical inactivity; obesity; and diabetes.

What should you do if you suspect you are having a heart attack?

Heart doctors often say that “time is heart”.  By that they mean the more time it takes for a heart attack to be diagnosed and treated the greater the danger of permanent heart muscle injury and death.  Thus, if you suspect you are having a heart attack, you should get to the hospital as soon as you can.

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