Acute heart attacks, also known as myocardial infarctions, are a leading cause of death worldwide. They occur when a blood clot blocks one of the coronary arteries, which supply blood to the heart muscle. When the heart muscle does not receive enough blood, it begins to die.
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| heart attack : 2023 guide |
What is a heart attack?
A heart attack, also known as a myocardial infarction is a serious medical condition that occurs when the blood supply to the heart muscle is suddenly blocked.
Causes of a heart attack
Blockage of the blood flow to heart muscle can be caused by a blood clot, which is the most common cause of heart attacks. Other causes of heart attacks include:
· Plaque buildup in the coronary arteries (coronary artery disease).
· A spasm (sudden tightening) of a coronary artery.
· A tear in the lining of a coronary artery.
· A blood clot that travels from another part of the body to a coronary artery.
· When the blood supply to the heart muscle is blocked,
the muscle begins to die. The longer the blockage remains, the more damage is done to the heart muscle. This damage can lead to heart failure, arrhythmias, and even death.
Why is a heart attack a medical emergency?
A heart attack is a medical emergency because it is a life-threatening condition. If you are having a heart attack, it is important to seek medical attention immediately. Early treatment can help to minimize the damage to the heart muscle and improve your chances of survival.
Symptoms of a heart attack
The most common symptom of a heart attack
is chest pain or pressure. This pain may feel like squeezing,
tightness, or aching. It may also spread to the shoulders, arms, back, neck,
jaw, teeth, or upper belly. Other symptoms of a heart attack may include:
· Shortness of breath
· Cold sweat
· Nausea or vomiting
· Lightheadedness or sudden dizziness
· Fatigue
Women and people with diabetes may experience different symptoms of a heart attack. Women are more likely to experience back or neck pain, shortness of breath, nausea, and vomiting. People with diabetes may have chest pain that is not as severe as in people without diabetes.
First aid for a heart attack
What to do if you or someone else may be having a heart attack
· Call 911 or your local emergency number. Don't ignore
the symptoms of a heart attack.
· Chew and swallow an aspirin while waiting for
emergency help. Aspirin helps keep your blood from clotting. When taken during a heart attack, it could reduce heart damage. Don't take aspirin if you are allergic to it or have been told by your health care provider never to take aspirin.
· Take nitroglycerin, if prescribed. If you think you're having a heart attack and your healthcare provider has previously prescribed nitroglycerin for you, take it as directed while waiting for emergency medical help.
· Begin CPR if the person is unconscious. If the person
isn't breathing or you don't find a pulse, begin CPR to keep blood flowing after you call for emergency medical help. Push hard and fast on the center of the person's chest in a fairly rapid rhythm — about 100 to 120 compressions a minute.
· If an automated external defibrillator (AED) is
immediately available and the person is unconscious, follow the device
instructions for using it.
Medications to treat a heart attack
Medications to treat a heart attack might include:
1. Aspirin. Aspirin reduces blood clotting. It helps
keep blood moving through a narrowed artery. If you call 911 or your local emergency number, you may be told to chew aspirin. Emergency medical providers may give you aspirin immediately.
2. Clot busters ( thrombolytics or fibrinolytics). These drugs help break up any blood clots that are blocking blood flow to the heart.
The earlier a thrombolytic drug is given after a heart attack, the less the
the heart is damaged and the greater the chance of survival.
3. Other blood-thinning medicines. A medicine called heparin may be given by an intravenous (IV) injection. Heparin makes the blood less sticky and less likely to form clots.
4. Nitroglycerin. This medication widens the blood vessels.
It helps improve blood flow to the heart. Nitroglycerin is used to treat sudden chest pain (angina). It's given as a pill under the tongue, as a pill to swallow, or as an injection.
5. Morphine. This medicine is given to relieve chest pain that doesn't go away with nitroglycerin.
6. Beta blockers. These medications slow the heartbeat and
decrease blood pressure. Beta-blockers can limit the amount of heart muscle damage and prevent future heart attacks. They are given to most people who are having a heart attack.
7.ACE inhibitors. Blood pressure medicines called
angiotensin-converting enzyme (ACE) inhibitors. These drugs lower blood pressure and reduce stress on the heart.
8. Statins. These drugs help lower unhealthy cholesterol levels. Too much bad (low-density lipoprotein, or LDL) cholesterol can clog arteries.
Initial Recognition and Management in the Emergency Department
· When the patient with suspected acute MI reaches the emergency department (ED), evaluation and initial management should take place promptly.
· Certainly no more than 20 minutes should elapse before an assessment is made.
· On arrival in the ED the patient with suspected acute MI should immediately receive:
(1) Oxygen by nasal prongs.
(2) Sublingual nitroglycerin:
(Unless systolic arterial pressure is less than 90 mm Hg or heart rate is less than 50 or greater than 100 beats per
minute [bpm]).
(3) Adequate analgesia:
With morphine sulfate or meperidine.
(4) Aspirin:
160 to 325 mg orally.
(5) A 12-lead electrocardiogram (ECG):
Should also be performed.
(6) ST-segment elevation:
(Equal to or greater than 1 mV) in contiguous leads provides strong evidence of thrombotic coronary arterial occlusion and makes the patient a candidate for immediate reperfusion therapy, either by fibrinolysis or primary percutaneous transluminal coronary angioplasty (PTCA).
(7) Symptoms:
Consistent with acute MI and left bundle branch block (LBBB) should be managed like ST-segment elevation. In contrast, the patient without ST-segment elevation should not receive thrombolytic therapy. The benefit of primary PTCA in these patients remains uncertain.
Long-Term Management
For an indefinite period after acute MI,
A -The patient should continue to receive
1. aspirin,
2. β-adrenoceptor blocker,
3. Selected dose of an ACE inhibitor.
B- The patient should be instructed to achieve
1. Ideal weight.
2. Smoking cessation.
3. Stress management.
4. Diet low in saturated fat and cholesterol.
The patient with a low-density lipoprotein (LDL) cholesterol measurement greater than 130 mg/dL despite diet should be given drug therapy with the goal of reducing LDL to less than 100 mg/dL.
5. Participate in a formal rehabilitation
program.
Plan to engage in 20 minutes of exercise at the level of brisk walking at least three times a week.
Prevention of heart attacks
There are a number of things you can do to help prevent a heart attack, including:
This means eating plenty of fruits, vegetables, and whole grains, and
limiting saturated and trans fats, cholesterol, and sodium.
· Exercise regularly. Aim for at least 30 minutes of moderate-intensity
exercise most days of the week.
· Maintain a healthy weight.
· Don't smoke.
· Get regular checkups.
· Get enough sleep.
· Avoid secondhand smoke.
· Limit alcohol consumption.
· Manage diabetes.
· Get regular dental checkups.
· Be aware of your family history of heart disease
In addition to these lifestyle changes, there are a number of medical
conditions that can increase your risk of heart attack, such as high blood
pressure, high cholesterol, and diabetes. If you have any of these conditions, it is important to work with your doctor to manage them.
Resources for heart attack patients and their families
There are a number of resources available for heart attack patients and their families. These resources can provide information, support, and guidance as you navigate the recovery process and work to live a healthy life after a heart attack.
Here are some examples of resources for heart attack patients and their families:
· American Heart Association.
· National Heart, Lung, and Blood Institute.
· Mended Hearts.
· Women"s Hearts.
· Family Caregiver Alliance.
Conclusion
Heart attacks are a serious medical condition, but they are preventable.
By making healthy lifestyle choices and managing your risk factors, you can significantly reduce your risk of having a heart attack. If you do have a heart attack, it is important to seek medical attention immediately. With prompt treatment, most people make a full recovery.
If you have any questions or concerns about your heart health, please
talk to your doctor. They can help you develop a plan to reduce your risk of
heart attack and live a healthy life.
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