What is Heart Attack?
Acute coronary syndrome or heart attack is a serious heart disorder when the heart muscle doesn’t get enough blood flow. This condition will interfere with the function of the heart in circulating blood throughout the body. In medicine, a heart attack is also known as a myocardial infarction.
Heart attacks occur due to obstruction of blood flow to the heart muscle. The main cause of this condition is coronary heart disease, which is blockage of the blood vessels that supply blood to the heart (coronary blood vessels), due to cholesterol deposits that form plaques on the walls of blood vessels. This is the reason why high cholesterol can put a person at risk for heart disease.
Heart Attack Symptoms
A heart attack can appear suddenly with the following symptoms:
- Left chest pain like pressure or squeezing. These symptoms can spread to the neck, jaw, arms, or back.
- Hard to breathe.
- A cold sweat.
- Dizzy.
- Digestive disorders, such as nausea, vomiting, or stomach pain.
- Feeling very restless and anxious.
- Loss of consciousness.
However, heart attacks do not always appear suddenly. Sometimes, a few days or weeks earlier, the patient has felt chest pain (angina) that appears when the patient is active and subsides when resting.
People with heart attacks can also experience no symptoms at all, especially in people with diabetes, women, and the elderly.
Causes of Heart Attack
A heart attack occurs when the blood supply to the heart muscle is interrupted. The heart needs a constant supply of oxygenated blood, as do other organs and tissues in the body.
If the heart does not get enough blood supply, the heart muscles will be damaged and eventually the heart will not be able to circulate blood throughout the body.
Below are the causes of a heart attack:
Coronary Heart Disease
Coronary heart disease is the main cause of heart attacks. Coronary heart disease is a condition in which one or more of the blood vessels that supply blood to the heart (coronary arteries), are blocked by cholesterol plaque buildup (atherosclerosis) and blood clots.
Drug Abuse
Drugs, such as cocaine, amphetamine, and methamphetamine, can cause narrowing of the coronary arteries to trigger a heart attack.
Lack of Oxygen in the Blood (Hypoxia)
Oxygen levels in the blood can decrease due to carbon monoxide poisoning or damage to lung function. As a result, the heart muscle will be deprived of oxygen and a heart attack occurs.
Risk Factors
Coronary heart disease is the main cause of heart attacks. There are several conditions that are at risk of causing fat accumulation and narrowing of blood vessels (atherosclerosis) in coronary heart disease, including:
- Elderly (men aged 45 years and over or women aged 55 years and over)
- Rarely exercise
- Smoke
- Suffering from hypertension
- Suffering from high cholesterol or high triglycerides
- Having diabetes
- Experiencing obesity
- Experiencing stress
- Have a family member who has had a heart attack
In addition, the risk of a heart attack is also higher in people who suffer from autoimmune diseases, such as lupus and women who develop preeclampsia during pregnancy.
Heart Attack Diagnosis
People who experience symptoms of a heart attack need to be immediately taken to the emergency room of the nearest hospital for treatment.
The doctor will confirm the diagnosis and initiate the initial treatment as soon as possible. There are several tests that the doctor will do to confirm a heart attack, including:
- ECG or Electrocardiogram.
Examination of the heart record or EKG is done to see the electrical activity of the heart. - Blood Test
This test aims to check for the presence of a protein marker of a heart attack and find out how severe the heart damage is. - Chest X-Ray
A chest X-ray is conducted to look for other causes of symptoms, such as fluid-filled lungs (pulmonary oedema). - Coronary Angiography or Cardiac Catheterization
Cardiac catheterization aims to find out if there is a blockage or narrowing in the coronary arteries, and determine the location of the blockage or narrowing.
Several other tests are carried out to assess the ability of the heart, after the patient’s condition has stabilized, including:
- Echocardiography
Cardiac ultrasound or echocardiography. This is done to determine the location of damage to the heart and its effect on heart function. - CT scan or MRI
Both of these examination procedures can be conducted to check for disorders of the heart and see the damage caused by a heart attack. - Treadmill ECG
This test is done a few days or weeks after a heart attack occurs, to measure the response of the heart and blood vessels when doing activities.
Heart Attack Treatment
There are several ways that doctors will do to handle or treat a heart attack. For example:
- Surgery and procedures for handling heart attacks.
- Drugs used.
- Recovery after a heart attack.
The length of recovery from a heart attack depends on the condition of the damage that occurs to the heart. Generally, people with heart attacks will recover after treatment and medication for 2 weeks. However, in others it can take up to months.
Surgery
The following are heart surgery procedures that may need to be performed to treat a heart attack:
- Installation of a heart ring (stent) or coronary angioplasty
In this procedure, a catheter with a balloon at the end is inserted into a large vein in the groin or arm. Then the catheter will be directed to the narrowed blood vessel. - Heart bypass surgery or Coronary Artery Bypass Graft (CABG)
Heart bypass surgery is performed when there are multiple blockages in the coronary arteries or when the coronary arteries are abnormally shaped. CABG is performed by creating a new blood vessel, taken from another blood vessel in the leg, as an alternative pathway for blocked blood flow.
Drugs
The following are drugs that will be given to treat a heart attack.
- Antiplatelet drugs, such as aspirin and clopidogrel, to prevent blood clots, so that blood can still flow through the narrowed blood vessels.
- Blood vessel widening drugs, such as nitroglycerin, to widen blood vessels thereby increasing blood flow to the heart.
- Painkillers, such as morphine, to relieve pain felt by sufferers.
- Blood clot-busting medications, such as streptokinase, to dissolve blood clots that are blocking blood flow to the heart muscle.
- Anticoagulant drugs, such as enoxaparin, to prevent blood clots from occurring again.
- Cholesterol medications, such as atorvastatin, to lower cholesterol levels.
- ACE inhibitors, such as ramipril, to dilate blood vessels and lower blood pressure, thereby reducing the burden on the heart.
- Beta-blocking hypertension drugs, such as bisoprolol, to lower the heart rate and reduce blood pressure, thereby reducing the work of the heart.
Recovery after a Heart Attack
The cardiac rehabilitation program will start from the time the patient is in the hospital, until several weeks or months after the patient returns home. The main goal of this rehabilitation is to restore the patient’s physical fitness so that he can continue his daily activities, and reduce the risk of complications and heart attacks again.
Heart Attack Complications
Heart attacks that are not treated promptly can lead to various complications, even death. Complications of a heart attack can include arrhythmias or abnormal heart rhythms, heart tears, to heart failure. This heart failure can make the heart not work effectively to pump blood throughout the body.
The following are some of the complications that may occur in people with a heart attack:
Arrhythmia
A heart attack can damage the heart muscle and interfere with the electrical signals that control the heartbeat, resulting in arrhythmias. Arrhythmia is a condition in which the heart beats abnormally, either too slowly, fast, or irregularly.
Heart Failure
A heart attack can trigger heart failure. This condition makes the heart unable to effectively pump blood throughout the body. Symptoms include shortness of breath, feeling tired quickly, and swelling of the legs.
Cardiogenic Shock
Cardiogenic shock occurs when blood flow throughout the body is so reduced that the organs of the body do not function properly. This condition is similar to heart failure, but more dangerous. Symptoms include pale skin and shortness of breath.
Heart Tears
Tearing of the heart muscle or heart valves from a heart attack is very rare, but very dangerous. These complications can appear about 1-5 days after a heart attack.
Heart Attack Prevention
Heart attacks can be prevented by adopting a healthy lifestyle, such as:
- Increase consumption of unsaturated fats and fiber
Foods that are good for heart health include foods high in unsaturated fats, such as fish, avocados, or whole grains; and high-fiber foods, such as brown rice, whole grains, or vegetables. - Reduce consumption of sugar and salt
The recommended daily consumption of salt is a maximum of one teaspoon. While the consumption of sugar per day, a maximum of 6-9 teaspoons. - Treating diabetes and hypertension
By controlling blood sugar levels and blood pressure, the risk of coronary heart disease which is the main cause of heart attacks is also reduced. - Quit smoking
Smoking contributes to the process of atherosclerosis in blood vessels. - Do not abuse drugs
Methamphetamine and cocaine can constrict the heart’s blood vessels, causing a heart attack. - Managing stress
Learn techniques to control stress, such as muscle relaxation techniques and breathing techniques. If necessary, consult a psychiatrist to deal with stress, because stress is one of the risk factors for heart attack.
A heart attack is an emergency that needs to be treated as soon as possible. Immediately go to the emergency department of the nearest hospital if you experience symptoms of a heart attack.
If you find a person who is unconscious and experiencing cardiac arrest (no heartbeat and pulse), call for help immediately. While waiting for medical help arriving, perform first aid in the form of cardiopulmonary resuscitation (CPR).
In some people, the symptoms of angina can precede the symptoms of a heart attack. Consult a cardiologist if symptoms of angina appear before a heart attack, which can be fatal.
References:
- Hajar R. (2017). Risk Factors for Coronary Artery Disease. Historical Perspectives. Heart Views, 18(3), pp. 109-114.
- Li, et al. (2016). Work Stress and Cardiovascular Disease: A Life Course Perspective. J Occup Health, 58(2), pp. 216-9.
- American Heart Association (2015). About Heart Attacks.
- NHS UK (2016). Health A-Z. Heart Attack.
- Mayo Clinic (2018). Diseases and Conditions. Heart Attack.
- Harvard Medical School (2017). The sweet danger of sugar.
