My cellphone rang at 2 a.m.
That’s always a bad thing. Usually, it meant a medical emergency.
My uncle was on the line. “Your aunt’s having some chest discomfort for around ten minutes.” I snapped fully awake at the words, suspecting a heart attack. “It’s getting worse. Not really chest pain, but…”
I interrupted. “Take her to ______ hospital right away,” I said, naming a specialty hospital nearby where there would be facilities to investigate her for an acute coronary syndrome and treat it.
For reasons best known to him, uncle chose another smaller hospital nearer home. It was a decision that almost cost her life!
An inexperienced junior doctor, who also played “cardiologist on call”, mismanaged her case. The episode of unstable angina, which might have been reversed with prompt treatment, evolved into a full-blown heart attack.
Treatment was lengthy and expensive. Aunt survived with little damage to her heart. She was lucky. Many are not. That’s why it is important to learn all about a heart attack and understand what to do if you notice signs of heart attack.
What Is a Heart Attack?
Heart muscle is supplied with oxygen and nutrients by small channels called coronary arteries. When these coronary arteries are narrowed by the deposit of atherosclerotic plaque on their walls, the tube becomes obstructed and less blood flows to the heart, causing angina (chest pain) and other symptoms.
Sometimes, the coronary arteries become completely and suddenly occluded by a blood clot. This catastrophic reduction of blood flow to heart muscle leads to a heart attack or myocardial infarction. Left untreated, the affected heart muscle will die, leading to serious complications.
What Are Signs of Heart Attack?
Typically, a heart attack manifests as severe chest pain which is crushing or compressing in nature.
The pain is unlike any other kind of pain one may have experienced before, often radiating from the chest to the neck, jaw, left arm or back. It is often accompanied by profuse sweating, dizziness or light headedness, breathlessness, and a sense of deep anxiety and impending doom.
But not all heart attacks are so dramatic.
Some are ‘silent’ heart attacks, presenting as extreme fatigue, sleeplessness, or stomach ache and indigestion.
Pain may be absent in women, diabetics and elderly heart attack victims. Rarely a heart attack may lead to sudden collapse due to heart failure or deadly heart rhythm disturbances like ventricular fibrillation.
A heart attack can strike at any time, while at work, play or even at rest. It can happen at any time of the day or night. A heart attack may be precipitated by sudden shock or excitement. Some people may recall subtle warning signs like chest pain or tiredness for a few days or weeks prior to the heart attack.
What To Do In a Heart Attack?
The very first step to take if you suspect a heart attack is to rush the patient to hospital. This can be life-saving, with most deaths from heart attack happening in the first hour after the onset, usually before reaching hospital.
Rather than driving oneself to get medical care, it is best to call for an ambulance or the medical emergency hotline (911 in the United States).
If available, a nitroglycerin tablet may be taken as instructed by the physician. A crushed tablet of aspirin can help reduce platelet stickiness and could help break up a clot in the coronary arteries that causes heart attacks. In any case, aspirin is to be taken on the advice of a physician, who will weigh the interactions with other medication.
If a heart attack victim has collapsed, cardiopulmonary resuscitation (CPR) must be instituted by someone experienced in it. Defibrillation (delivering a shock to the chest) may be required to reverse a heart rhythm problem like ventricular fibrillation.
What Causes a Heart Attack?
Cholesterol deposited on the walls of the coronary arteries causes narrowing of the blood vessel. During a heart attack, these plaques may rupture. At the site of the rupture, blood clots inside the coronary artery, obstructing it.
If the clot completely occludes the coronary artery, there is no blood flow to heart muscle and a heart attack occurs. Risk factors for heart attack include:
- age – men older than 45 and women above 55 are at higher risk
- smoking – all forms of smoking increase heart attack risk
- high blood pressure – when uncontrolled, hypertension is a serious risk factor
- high cholesterol levels – deposited in artery walls, they lead to an attack
- diabetes – untreated diabetes vastly increases heart attack risk
- family history – some forms of heart attacks are genetically determined
- lack of exercise – a sedentary lifestyle predisposes one to heart attacks
- stress – a high-stress lifestyle creates a recipe for disaster
- illegal drugs – cocaine and amphetamines are sometimes implicated
Dangers of Heart Attack
Because coronary artery blood flow to the heart muscle is completely stopped during a heart attack, the muscle will eventually die. This can cause several serious complications.
- Heart failure is a direct consequence of the loss of tissue. Since heart muscle is responsible for pumping blood to various organs, its death during a heart attack leads to a failing pump.
- Abnormal heart rhythm (arrhythmia) is another problem caused by dying heart muscle, which interrupts the normal pathway of circulation for the weak electrical current that makes the heart beat regularly.
- Cardiac rupture is a deadly complication when the weakened wall of the heart chamber affected by a heart attack suddenly gives way, causing blood to spill out of the heart. It is instantly fatal.
- Heart valve damage, especially acute leaks of the mitral valve, are another serious complication of heart attacks which are caused by rupture of muscle and dilation of the ventricular chambers.
Treatment of Heart Attack
A heart attack is a medical emergency.
The sooner a patient can be given expert medical care, the higher are the chances of survival and faster cure. The first step in hospital will be to confirm the diagnosis of a heart attack.
This may require tests like:
- EKG (or ECG) – an electrocardiogram often indicates a heart attack
- Enzyme levels in blood – elevated troponin suggests heart muscle damage
- Echocardiogram – for evaluation of heart function and valve leaks
- Coronary angiography – to identify the area of blockage in coronary arteries
- Exercise stress test – used in stable cases where the diagnosis is uncertain
- Cardiac CT or MRI – a non-invasive alternative to angiography
- Nuclear perfusion scans – to assess blood supply of various parts of the heart
Not all tests may be necessary for every patient, and the priority of testing will be decided by the physician in charge of the case.
The idea is to confirm the diagnosis of a heart attack, and initiate treatment which quickly restores blood flow to the affected heart muscle to try and prevent death of tissue, or minimize the extent of damage, while preventing and treating any complications.
Medications for Heart Attack
Aspirin can help reduce stickiness of platelets in the blood, and could help break up clots inside the coronary artery, thus restoring blood flow beyond the area of obstruction.
Clopidogrel (Plavix) and other platelet aggregation inhibitors are similar in their effect to aspirin, but more powerful.
Thrombolytics (also called ‘clot busters’) are a special category of medicines that act directly on blood clots, and dissolve them to restore blood flow in occluded arteries. These drugs can only be used in specialist units which can handle the complications that might ensue when the clot is dissolved.
Nitroglycerin helps by widening the coronary arteries through an action on the wall of the blood vessels. Beta blockers, ACE inhibitors and calcium blockers are sometimes used for a synergistic effect.
If pain is severe and unrelenting, narcotics like morphine can help as an analgesic and anxiety relieving drug to reduce the harmful effects on a heart attack sufferer.
Surgery and Invasive Procedures for Heart Attack
If access to a fully equipped medical institution is available, a more aggressive approach may be adopted to the treatment of heart attack. The goal in such cases is to completely prevent heart muscle damage by restoring blood flow through the obstructed coronary artery quickly enough after the heart attack.
Coronary angioplasty (PTCA) is a procedure where a balloon mounted on a catheter is introduced through an artery (femoral in the thigh, or radial at the wrist) and negotiated past the area of obstruction in the coronary artery. The balloon is then inflated under pressure, opening up the narrowed area and crushing the plaque against the wall of the coronary artery, creating a passage through which blood can now start flowing again.
Because the angioplasty weakens the artery, it is sometimes necessary to insert a metal stent across the ballooned region. These coronary stents act as scaffolding to keep the coronary artery open.
In some circumstances, angioplasty is not a good option. In such cases, surgical repair by coronary artery bypass grafting (CABG) surgery can be performed to revascularize the area of the heart affected by the heart attack.
Prevention of Heart Attack
A healthy lifestyle and modification of the risk factors can prevent a heart attack and reduce the chance of recurrence.
- Quit smoking
- Check blood pressure and cholesterol regularly
- Keep blood pressure under control through meditiation, yoga, and medication
- Control high cholesterol level with diet and drugs
- Exercise regularly
- Maintain health weight
- Treat diabetes and control blood glucose levels
- Eat nutritious, heart-healthy food
- Control stress
- Drink only in moderation, if at all
Those who have already had a heart attack must take medication regularly.
Blood thinners, aspirin and drugs for high BP and cholesterol may be prescribed by the cardiologist at the time of the heart attack, and must be continued until otherwise instructed.
A heart attack forces some lifestyle changes. It’s why we use the common expression, “as serious as a heart attack”. But the changes are healthier choices that are guaranteed to give you a longer, happier life.
So take control of your heart health – and avoid a heart attack.