Heart attack

Overview

The heart of the matter

Heart attack — also called a myocardial infarction — is all too common in the United States. Knowing the early warning signs and getting prompt medical attention can increase your chances of survival.

A heart attack is the death of heart muscle from loss of blood supply. The most common cause is coronary artery disease. The coronary arteries supply oxygen to the heart muscle. Coronary artery disease develops when cholesterol and other fatty deposits — called plaque — are deposited on the artery walls. The accumulation of plaque over time causes narrowing of the coronary arteries, a process called atherosclerosis. When a blood clot forms on top of the plaque, blood can no longer pass through the artery, and a heart attack results. A heart attack can result in cardiac arrest — when the heart stops pumping completely.

Most people who survive for a few days after a heart attack can expect full recovery, but must make a serious commitment to lifestyle changes that address the underlying causes of the attack.

Detailed Description

A heart attack is a medical emergency and often occurs without warning. If you think you are suffering from a heart attack, there is no time to consider whether you have all the risk factors. You should, however, generally be aware that the chances of suffering from a heart attack are strongly associated with lifestyle and age. If you are an older man who eats a diet high in fat, does not exercise regularly, smokes, has high blood pressure, and has a family history of premature coronary disease, you are at increased risk of having one.

Heart attacks can occur anytime, but are most common between 4:00 a.m. and 10:00 a.m. due to larger adrenaline amounts being released in the morning hours. Half of all heart attack deaths occur in the first three to four hours after they begin. Time is critical. Prompt treatment increases the chances of survival. Therapies are most effective within six hours after heart attack symptoms begin, and most deaths occur because patients don't make it to the hospital in time. More than 90% of patients who make it to the hospital survive, and 88% of heart attack survivors under age 65 can return to work within three months.

However, the permanent death of some heart muscle from a heart attack is common. The amount and condition of the remaining heart muscle determine how well the patient will recover as well as his or her life expectancy.

Rehabilitation is an important part of recovery. After several days of rest, heart attack patients gradually increase their activity. Lowering risk factors for coronary artery disease and close monitoring for recurrence are critical to successful recovery.

How Common Are Heart Attacks?

The American Heart Association reports that every year more than one million Americans have a heart attack. About 650,000 of these will be first attacks and 450,000 will be recurrent attacks. About one-third of the people experiencing these attacks will die of them. The good news is that 12,000,000 people who have suffered heart attacks and/or angina pectoris are nonetheless alive today.

Conventional Treatment

Treatment Goals

Treatment for a heart attack occurs at two levels. The first is the immediate, emergency response to stabilize the patient's condition: open blocked arteries and restore blood flow. This includes administering oxygen to aid breathing and medication to clear a blocked coronary artery.

The second is the long-term rehabilitation and treatment of the underlying causes of the attack in order to prevent recurrence. In the short term, medications — and sometimes surgery — will open the artery blockage causing the heart attack. Prevention strategies to halt the progression of coronary artery disease include diet modification, exercise, and stress reduction.

The death of heart muscle from a heart attack is irreversible. However, the underlying causes of a heart attack can be addressed and controlled to help prevent another attack.

Treatment Overview

Therapies are categorized by those designed for immediate treatment and those for post-attack treatment.

Immediate treatment:

• Aspirin
• Thrombolytic drugs to dissolve the clot: streptokinase (Steptase), alteplase (Activase), anistreplase (Eminase), or reteplase (Retavase)
• Oxygen administration
• CPR and defibrillation to restart stopped heart
• Pain medication such as morphine for alleviation of pain and anxiety
• Surgery if needed

Post-attack treatment:

• Daily intake of aspirin
• Various drugs to decrease the heart's demand for oxygen
• Various drugs to discourage blood clot formation
• Surgery if needed

Therapies are prescribed according to your specific needs. It is usually important to address the underlying cause of the heart attack. The best therapy is making a transition to live a healthier life. Drugs are available to aid recovery. Anticoagulant medications are usually prescribed for three to six months after the heart attack to help prevent clotting. Other medications such as beta-blockers may also be prescribed to lower the risk of death and a second heart attack. Surgery is an option for severely damaged heart.

Procedures

The two most commonly performed procedures to unblock the blood vessels leading to the heart are angioplasty and coronary bypass surgery. Angioplasty is the fastest method of opening a blocked artery. It can be effective in 95% of patients, usually within an hour. But sometimes angioplasty is technically difficult or, when combined with medication, fails to remove the blockage. Then, coronary bypass surgery may be the only option.

A new procedure, transmyocardial revascularization has shown promising results and may be appropriate for people who are high-risk candidates for a second bypass or angioplasty, people whose blockages are too diffuse to be treated with bypass alone, and some patients with heart transplants who develop atherosclerosis on the graft. It is, however, still considered experimental.

• Angioplasty. A catheter with a balloon tip is inserted into the coronary arteries. When the catheter reaches a narrowed segment, the balloon is inflated to flatten the plaque and widen the artery. In one newer variation, a rotating blade shaves the plaque into tiny particles, and in another, a laser beam vaporizes the plaque.
• Coronary bypass surgery. This procedure is reserved for severe cases of coronary blockage that can't be addressed by any other means. Segments of healthy blood vessels, either from the chest or leg, are used to bypass the severely narrowed parts of the coronary arteries. The result is greatly increased blood flow to the heart muscle, reducing risk of a heart attack.
• Transmyocardial revascularization. In this relatively new procedure, a laser cuts a series of channels in the heart muscle of a sick heart to increase blood flow. A surgeon makes an incision on the left side of the chest and inserts a laser into the chest cavity. With the laser, the surgeon shoots from 15 to 30 holes, each a millimeter in diameter, through the heart's left ventricle, in between heartbeats. (The laser is fired when the chamber is full of blood so the blood can protect the inside of the heart.) Then the surgeon seals the outer openings but lets the inner channels stay open, allowing oxygen-rich blood to flow through the heart muscle.

Some patients may require an electronic implant (pacemaker) to regulate heartbeat, and in severe cases of heart muscle damage, heart transplant may be indicated.

Drug Therapy

Altace
Coumadin
Inderal
Lopressor
buy Plavix
Tenormin
Pravachol
Mevacor
Lipitor http://www.nmihi.com/a/atorvastatin.html
Zocor

Appropriate Healthcare Setting

A heart attack is a medical emergency that requires immediate hospitalization.

Healthcare Professionals Who May Be Involved in Treatment

Many health professionals and cardiac specialists participate in managing this disorder, including:

• Family physicians
• General internists
• Geriatricians
• Cardiologists
• Radiologists
• Cardiac surgeons
• Thoracic surgeons

Activity & Diet Recommendations

Post-attack, excitement, physical exertion, and emotional distress all place strain on the heart, making it work harder. Hospitals have cardiovascular rehabilitation programs that involve gradual increases in activity to strengthen your circulatory system.

The importance of diet in heart disease is well established and many experts recommend a low-fat, high-fiber diet for patients who have experienced a heart attack. Here are some general guidelines for healthier eating:

• Avoid foods high in saturated fats, such as meats, eggs, cheeses, and other dairy products
• Eat plenty of whole grains, breads, and cereals instead of white and refined grains
• Eat lots of fresh fruits and vegetables with meals and as snacks
• Eat legumes such as beans, peas, and lentils in soups and salads

Monitoring the Condition

Your family members should be educated about the signs of heart attack so they will be ready if subsequent heart attack occurs. Early recognition and treatment of a heart attack is important since the ultimate prognosis depends on how much heart muscle is dead and how impaired the heart function is after the heart attack. Close monitoring of heart function is strongly advised. Since monitoring methods should be tailored to your needs, consult your physician.

Possible Complications

Heart attacks can cause serious complications:

• Congestive heart failure
• Cardiogenic shock (characterized by decreased pumping ability and low blood pressure)
• Heart muscle rupture
• Blot clots
• Inflammation of the membrane surrounding the heart (pericarditis)
• Irregular heartbeat (dysrhythmia)
• Back flow of blood from heart valves (mitral regurgitation)
• Bulge on the wall of the heart (ventricular aneurysm)
• Dressler's syndrome (also known as postmyocardial infarction syndrome, a specific type of inflammation of the membrane — pericardium — surrounding the heart that occurs weeks or months after a heart attack)
• Cardiac arrest
• Death

Quality of Life

Depending on the severity of your heart attack and the related coronary artery disease, available treatments range from lifestyle adjustments to major surgery. Which treatment is right for you depends on your individual situation. Making lifestyle changes such as improving diet, gradually increasing exercise, and reducing stress can improve your overall quality of life as well as reduce your risk for a future heart attack. And even if you opt for surgery, you'll still need to make lifestyle changes to address the underlying heart disease.

Considerations for Children and Adolescents

Young people without any risk factors for heart attack might have one if they use cocaine or methamphetamines.

Considerations for Older People

Older people are at particular risk for heart attack. Risk factors such as high blood pressure build up over time. Also, the coronary arteries nourishing the heart become thicker and lose their elasticity with age. Stress associated with loneliness or depression can also increase your risk for heart attack. Finally, your age may impact which course of treatment your doctor chooses.

Alternative care

Supplements

• Vitamin E: Two landmark Harvard studies — one involving men, the other, women — showed that vitamin E (100 IU/day) substantially reduces the risk of heart attack. Compared with those who did not take the vitamin, the people who did suffered significantly percent fewer heart attacks — 37% in men, 41% in women. Vitamin E is a powerful antioxidant that also helps treat heart disease.
• Vitamin C: A major antioxidant, Vitamin C also helps prevent and treat heart disease.
• B vitamins: The B vitamins help reduce blood levels of homocysteine, a recently identified risk factor for heart attack. Researchers in Northern Ireland gave supplemental B vitamins to 101 men with high homocysteine levels. Eight weeks later, their homocysteine levels had dropped 28%, significantly reducing their risk of heart attack. Nutrition experts suggest 3 mg of vitamin B-6 and 400 mcg of folic acid.
• Fish oil: you can get the omega-3 fatty acids found in cold-water fish without eating them if you take fish-oil supplements. In addition to preventing heart attack, fish oil also increases the effectiveness of angioplasty and coronary artery bypass surgery.

Relaxation

• Meditation is a key element of the Ornish program, and other studies also show its value. At the State University of New York, at Buffalo, researchers tested the exercise ability of 21 people with heart disease, and then taught them Transcendental Meditation (TM). Eight months later, they could exercise 15% more strenuously before experiencing chest pain, indicating a decreased risk of heart disease.

  A great deal of research shows that the broad range of relaxation therapies helps prevent and treat heart disease. Practice whatever appeals to you: meditation, deep breathing, massage, hot baths, imagery/visualizations, progressive muscle relaxation, or self-hypnosis.

• Cherish your friends and family. The Ornish program includes a support group, since many studies show that social support helps prevent and treat heart disease. New York researchers followed more than 1,000 heart-attack survivors for four years. Among those who lived alone, 16 had a recurrence. But among those who lived with a spouse, the figure was only about half that.

Herbs

• Garlic: Some experts believe that garlic reduces cholesterol and blood pressure, and it makes blood less likely to form the clots that can cause heart attacks. Commission E, the German panel of doctors, pharmacists, and herbalists that judges the safety and effectiveness of herbal medicines for the German government, recommends one to four garlic cloves a day.
• Willow bark: Doctors recommend low-dose aspirin to prevent the internal blood clots that trigger heart attacks. You can gain the same benefit from a cup of willow-bark tea. Willow bark contains salicin, aspirin's herbal precursor. A half-teaspoon of willow bark contains about 100 mg of salicin, enough to provide aspirin's benefits.