Heart attack (patient information)

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Katherine Ogando; Jinhui Wu, M.D.

Overview
A heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.

Heart attack is a leading killer of both men and women in the United States. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 1 hour of the beginning of symptoms. If you think you or someone you’re with is having a heart attack, call 9–1–1 right away.

What are the symptoms of a heart attack?
It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include:


 * Chest discomfort - pressure, squeezing, or pain. The most common symptom 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.
 * Shortness of breath Shortness of breath may often occur with or before chest discomfort.
 * Discomfort in the upper body. Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.
 * Nausea, vomiting, dizziness, lightheadedness, sweating

Not all heart attacks begin with a sudden, crushing pain that is often shown on TV or in the movies. The warning signs and symptoms of a heart attack aren’t the same for everyone. 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).

What are the causes of a heart attack?
Heart attacks occur most often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty material called plaque builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.

Who is at risk for a heart attack?

 * Certain risk factors make it more likely that you will develop coronary artery disease (CAD) and have a heart attack. Some risk factors for heart attack can be controlled, while others can't.


 * Major risk factors for heart attack that you can control include:


 * Smoking
 * High blood pressure
 * High blood cholesterol
 * Overweight and obesity
 * Physical inactivity
 * Diabetes (high blood sugar)


 * Risk factors that you can't change include:


 * Age: Risk increases for men older than 45 years and for women older than 55 years (or after menopause).
 * Family history of early CAD: Your risk increases if your father or a brother was diagnosed with CAD before 55 years of age, or if your mother or a sister was diagnosed with CAD before 65 years of age.


 * Certain CAD risk factors tend to occur together. When they do, it’s called metabolic syndrome. In general, a person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone without metabolic syndrome.

How to know you have a heart attack?
The diagnosis of heart attack is based on your symptoms, your personal and family medical history, and the results of diagnostic tests.

This test detects and records the electrical activity of the heart. Certain changes in the appearance of the electrical waves on an EKG are strong evidence of a heart attack. An EKG also can show if you’re having arrhythmias (abnormal heartbeats), which a heart attack (and other conditions) can cause.
 * EKG (Electrocardiogram):

During a heart attack, heart muscle cells die and burst open, letting certain proteins out in the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins in the bloodstream is evidence of a heart attack.
 * Blood Tests:

Commonly used blood tests include:
 * Troponin tests,
 * CK or CK–MB tests, and
 * Serum myoglobin tests.

Blood tests are often repeated to check for changes over time.

Coronary angiography is a special x-ray exam of the heart and blood vessels. It's often done during a heart attack to help pinpoint blockages in the coronary arteries.
 * Coronary Angiography:

The doctor passes a catheter (a thin, flexible tube) through an artery in your arm or groin (upper thigh) and threads it to your heart. This procedure—called cardiac catheterization—is part of coronary angiography.

A dye that can be seen on x ray is injected into the bloodstream through the tip of the catheter. The dye lets the doctor study the flow of blood through the heart and blood vessels.

When to seek urgent medical care
You should seek medical care if you are experiencing chest discomfort or chest pain, upper body discomfort in one or both arms, the back, neck, jaw, or stomach, shortness of breath, nausea, vomiting, lightheadedness or fainting, or breaking out in a cold sweat.

Treatment options

 * Certain treatments are usually started right away if a heart attack is suspected, even before the diagnosis is confirmed. These include:
 * Oxygen
 * Aspirin to prevent further blood clotting
 * Nitroglycerin, to reduce the workload on the heart and improve blood flow through the coronary arteries
 * Treatment for chest pain


 * Once the diagnosis of heart attack is confirmed or strongly suspected, treatments to try to restore blood flow to the heart are started as soon as possible. Treatments include: medicines and medical procedures.

Medicines:
A number of different kinds of medicines may be used to treat heart attack. They include the following.


 * Thrombolytic Medicines:

These medicines (also called clot busters) are used to dissolve blood clots that are blocking the coronary arteries. To be most effective, these medicines must be given within 1 hour after the start of heart attack symptoms.


 * Beta Blockers:

These medicines decrease the workload on your heart. Beta blockers also are used to relieve chest pain or discomfort and to help prevent additional heart attacks. Beta blockers also are used to correct arrhythmias (irregular heartbeats).


 * Angiotensin-Converting Enzyme (ACE) Inhibitors:

These medicines lower blood pressure and reduce the strain on your heart. They also help slow down further weakening of the heart muscle.

These medicines thin the blood and prevent clots from forming in your arteries.
 * Anticoagulants:


 * Antiplatelet Medicines:

These medicines (such as aspirin and clopidogrel) stop platelets (a type of blood cell) from clumping together and forming unwanted clots.


 * Other Medicines:

Medicines may also be given to relieve pain and anxiety, and to treat arrhythmias, which often occur during a heart attack.

Medical Procedures:
If medicines can’t stop a heart attack, medical procedures—surgical or nonsurgical—may be used. These procedures include the following.


 * Angioplasty:

This nonsurgical procedure can be used to open coronary arteries that are blocked by a blood clot. During angioplasty, a catheter (a thin, flexible tube) with a balloon on the end is threaded through a blood vessel to the blocked coronary artery. Then, the balloon is inflated to push the plaque against the wall of the artery. This widens the inside of the artery, restoring blood flow.

During angioplasty, a small mesh tube called a stent may be put in the artery to help keep it open. Some stents are coated with medicines that help prevent the artery from becoming blocked again.


 * Coronary Artery Bypass Grafting:

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

Most people spend several days in the hospital after a heart attack. When you leave the hospital, treatment doesn’t stop. At home, your treatment may include daily medicines and cardiac rehabilitation (rehab). Your doctor may recommend lifestyle changes, including quitting smoking, losing weight, changing your diet, and increasing your physical activity, to lower your chances of having another heart attack.

Cardiac Rehabilitation:
Your doctor may prescribe cardiac rehab to help you recover from a heart attack and to help prevent another heart attack. Almost everyone who has had a heart attack can benefit from rehab. The heart is a muscle, and the right exercise will strengthen it.

But cardiac rehab isn’t only about exercise. It also includes education, counseling, and learning about reducing your risk factors. Rehab will help you learn the best way to take care of yourself after having a heart attack and how to prevent having another one.

The cardiac rehab team may include doctors (your family doctor, a cardiologist, and/or a surgeon), nurses, exercise specialists, physical and occupational therapists, dietitians, and psychologists or other behavioral therapists.

Diseases with similar symptoms
Heart attack symptoms have commonly been confused with the following conditions :
 * Indigestion
 * Gastric Reflux
 * Anxiety attack
 * Panic attack
 * Panic disorder
 * Pneumonia
 * Bronchitis
 * Esophagitis
 * Heartburn
 * Angina

Where to find medical care for heart attack
Directions to Hospitals Treating Heart Attack

Prevention of heart attack

 * Lowering your risk factors for coronary artery disease (CAD) can help you prevent a heart attack. Even if you already have CAD, you can still take steps to lower your risk of heart attack.

Lifestyle choices:
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 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.

What to expect (Outlook/Prognosis)
Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. CAD, which often results in a heart attack, is the leading killer of both men and women in the United States.

Many more people could recover from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital.

Further Resources

 * Causes of Heart Attacks
 * Basics of Heart Attacks from British Heart Foundation
 * What Happens During a Heart Attack?