What is Heart Attack
Heart attack is development of clot in Coronary arteries. We call it Acute Myocardial Infarction. It is the death of muscle fibres of heart as they do not get blood supply.
heart is a muscle and it keeps on pumping daily for one lakh time with significant force. This requires continuous supply of oxygen and Blood. The blood vessels supplying blood to this working muscles are called coronaries. Coronary arteries are 3 to 5 mm in size and they are sufficiently large enough to increase this blood supply by 3 to 5 times from resting value.
Diabetes, cholesterol, smoking, hypertension, ageing factors, and many other unknown factors affects coronary arteries. This results in deposition of fat like substances within the wall of this blood vessels. This deposition of fat within the wall of coronary is called PLAQUE.
Plaque causes narrowing of coronary lumen and blood flowing through the coronary decreases. This situation leads to angina.
Now when blood clots over this plaque, suddenly the blockages of 70 % , becomes to 90 or 100 %, and blood can’t flow ahead. Part of the heart muscle develops blackening and gangrene. It Stops functioning and throws electric sparks, sufficient to kill the person.
Why the blood clots over the plaque ? blood has thickened ? majority will think this way and yes, medical practitioners have given us this simplified answer. But science have given different answer.
The rupture of this fatty plaque causes blood to clot over it. This is main mechanism of heart attack.
This is also the reason for heart attack in seemingly normal individual. You must have heard of a tragic incidence in which one of young person in forties died suddenly, he was looking fit and was active and apparently his health check up were normal. Most likely he had minor plaque 30-40%, which was small enough not to causing angina. He was able to continue his all activities without any limitations, and his stress tests were also normal, but then his plaque ruptured and suddenly clot developed over that plaque rupture resulting in massive heart attack. How to prevent this plaque rupture ? frankly we have very limited answers, and that is lifestyle prevention and control of conventional coronary risk factors, mainly smoking in young adults.
What are symptoms of heart attack
Symptoms of heart attack are mainly chest pain and breathlessness but we need to know that not all chest pain are heart attack and not all breathless is due to heart attack.
New onset chest pain, sudden onset, severe pain, in the centre of chest with characteristic like heaviness or tightness, which increases with exertion and relieves mildly with rest, not relieved or increased with local pressure.
- This pain may radiate to left arm, neck , jaw, or back.
- Pain may mimic like heartburn, acidity or Gabhraman.
When Heart attack is large, it results in fluid accumulation in lungs. This is called pulmonary oedema in medical terms. This congestion causes air hunger and breathlessness. This is ominous sign in case of heart attack.
- Unusual perspiration
- fatigue, tiredness
- syncope ( loss of consciousness )
- Only back pain or breathlessness.
How to diagnose heart attack
Act Fast, its an emergency
So now we know that heart attack is the death of working muscle of heart, as they do not get blood and oxygen. Death process of muscles of heart is completed within few hours if not reversed. We call this hour as golden hour. Each minute lost is muscle fibre lost. Action taken on time , in this golden hours gives very good result in preservation of muscle fibres and their good working condition.
When you think you have unusual chest pain or breathlessness, the first action should be to call for the help, do not drive to hospital. Take Aspirin if available at home. Do not go to medical shop to buy aspirin. Ask for 108 or ask friend to drive to hospital which is having robust cardiology services 24×7
ECG is the most important investigation in establishing or ruling out the diagnosis of heart attack. On arrival to ER, doctor will get your ECG and will decide next action based on ECG findings.
Do not go back home after one normal ECG. This is the big mistake people do. One normal ECG in patient with chest pain do not rule our heart attack.
Echocardiography shows the extent of Heart attack and any other associated damage due to heart attack.
Some patients do have classical chest symptoms but ECG not showing significant abnormality. This could be a heart attack of back side of the heart, missed easily on ECG. Echocardiography can pick up this.
Troponin is the protein of heart muscle and it is usually absent in blood. Presence of even minute amount of troponin in blood suggests damage to heart muscles. Elevated blood troponin levels directly correlate with the extent of damage caused by heart attack.
At our ER we order two ECG at hour apart and send blood test, troponin. Having two ECG normal 1 hour apart with negative(Normal) troponin blood report, rules out heart attack with great precision and patient is safe to go home.
What are treatment options of heart attack
Once the diagnosis of Heart attack is confirmed, patient is immediately started on ECG monitoring with availability of defibrillator by the side of patient.
Patient is given blood thinner tablets which can be multiple in number. This is a loading dose to get the blood thinning effect as early as possible. groin and wrist shaving is done to prepare the patient for Emergency angioplasty.
Those patient who can not reach to hospital with Cardiac Cathlab facility, receives this older treatment option. This is a clot buster injection, which when given causes small clots to lyse within entire body.
Efficacy of this type of injection varies 33 to 50% and failure of injection is a situation in which patient become very sick.
Side effect of injection also can be fatal. Bleeding is the major complication of this type of treatment.
PAMI, Emergency angioplasty
When available, Emergency Angioplasty is the best treatment option for the major heart attack. Patient is taken to Cathlab and Angiography is performed. The blocked, clotted artery is opened with help of balloon and stent and Angioplasty is completed within 60 to 90 minutes of patient’s arrival to hospital. This reduces chances of death to great extent.
Recovery after Heart Attack
Patient is shifted to ICU for a day or two for monitoring. First 24 hours are important as chances of clot formation again are very high. The patient is observed with cardiac monitors and oxygen levels and blood pressure monitoring. He is continued on blood thinner injections and his sugar levels and blood pressures are tightly controlled.
Patient is ambulated on next day and planned for Cardiac Rehab and discharge after deciding treatment plan depending on the severity of heart attack.
Medicines are prescribed for keeping blood thin, reducing cholesterol, controlling sugar and blood pressure. Laxatives and mild dose of anti anxiety drugs are also added as per need.
You should inform to your doctor if you have noted any drug side effects in past
It is utmost important to continue this medicines and hence if affordability is an issue, you should inform this to your doctor.
At home, after heart attack
Ask for Cardiac rehabilitation before discharge. It is good to start exercise under observation and to get the suitable dietary advice by qualified dietitian.
- Cardiac rehab programme will help you to come back to your normal life rapidly, without taking any undue risk.
- Exercise, diet, lifestyle changes and quitting smoking are the main components of Cardiac rehab. See our Cardiac Rehab post for further details
- For advice regarding driving, joining your office, resuming your personal life require discussion with your doctor and be vocal for this.
- Take this opportunity for lifetime lifestyle changes for you and for your entire family and get well soon.
- Do not stop medicines without informing your treating cardiologsit.
- Watch for any bleeding from any site in the body.
- Monitor your symptoms and report if any breathlessness or swelling over the body.
- I hope this has cleared your doubts