Heart attack

Heart Attack (myocardial infarction) - occurs when an area of heart muscle dies or is permanently damaged because of an inadequate supply of oxygen to that area.Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the heart muscle causes chest pain and pressure.

Years ago, a heart attack was often fatal. But today, thanks to better awareness of signs and symptoms and improved treatments, the vast majority of people who have a heart attack survive.

Your overall lifestyle — what you eat, how often you exercise and the way you deal with stress — plays a role in your recovery from a heart attack. In addition, a healthy lifestyle can help you prevent a first or subsequent heart attack by controlling risk factors that contribute to the narrowing of the coronary arteries that supply blood to your heart.

Signs and Symptoms

Heart attacks have many variable signs and symptoms. Not all people who have heart attacks experience the same ones or experience them to the same degree. Many heart attacks aren't as dramatic as the ones you've seen on TV or in the movies.

For example, heart attack symptoms in women, in older adults and in people with diabetes tend to be less pronounced. Some people have no symptoms at all. Still, the more signs and symptoms you have, the greater the likelihood that you may be having a heart attack.

Warning signs and symptoms of a heart attack include:

• Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
• Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
• Increasing episodes of chest pain
• Prolonged pain in the upper abdomen
• Shortness of breath
• Sweating
• Impending sense of doom
• Lightheadedness
• Fainting
• Nausea and vomiting

A heart attack can occur anytime — at work or play, while you're resting, or while you're in motion. Some heart attacks strike suddenly, but many people who experience a heart attack have warning signs and symptoms hours, days or weeks in advance. The earliest predictor of an attack may be recurrent chest pain (angina) that's triggered by exertion and relieved by rest. Angina is caused by temporary, insufficient blood flow to the heart. The medical term for insufficient blood flow to the heart is "cardiac ischemia."

More about Heart attack

The medical term for a heart attack is "myocardial infarction." "Myo" refers to "muscle;" "cardio" refers to "heart;" "infarct" refers to "death of tissue from lack of oxygen." Like any muscle, the heart needs a steady supply of blood. Without blood, heart cells are injured, causing pain or pressure. If blood flow isn't restored, heart cells can die and scar tissue can form, replacing working heart tissue. The lack of blood flow to the heart also may trigger irregular heart rhythms that can be fatal.

Your heart beats approximately once a second. During a day, your heart pumps about 2,000 gallons of blood through your circulatory system. Your circulatory system includes arteries and veins. Veins bring oxygen-poor blood back to your heart. Arteries deliver oxygen-rich blood to all of the tissues of your body — including your heart muscle.

A heart attack occurs when one or more of the tiny arteries supplying your heart with oxygen-rich blood (coronary arteries) become blocked. These arteries are called coronary arteries and encircle your heart like a crown. Blockages are usually due to a blood clot that forms suddenly where a coronary artery has narrowed over the years from a buildup of cholesterol and other substances.

This buildup of cholesterol and other substances — collectively known as plaques — in arteries throughout the body is called atherosclerosis. When the coronary arteries narrow due to atherosclerosis, the condition is known as coronary artery disease. Coronary artery disease is the major underlying cause of heart attacks.

Rarely, a heart attack can occur when a blood clot from inside a diseased heart breaks loose and lodges in a healthy or narrowed coronary artery. Another uncommon cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Drugs, such as cocaine, can cause such a life-threatening spasm.

A heart attack is not a static event. It's a dynamic process that typically evolves over several hours. With each passing minute, more heart tissue is deprived of blood and deteriorates or dies. However, if blood flow can be restored in time, damage to the heart can be limited or prevented.

Certain factors, called coronary risk factors, increase your risk of a heart attack. These factors contribute to the unwanted buildup of deposits (atherosclerosis) that narrows arteries throughout your body, including arteries to your heart. Coronary risk factors include:

• Tobacco smoke. Smoking and long-term exposure to secondhand smoke damage the interior walls of arteries — including arteries to your heart — allowing deposits of cholesterol to collect and hamper blood flow. Smoking also increases the risk of deadly blood clots forming and causing a heart attack.
• High blood pressure . Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure can be an inherited problem. The risk of high blood pressure increases as you age, but the main culprits for most Americans are eating a diet too high in salt and being overweight.
• High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol in your blood increases your risk of a heart attack. Low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A high LDL level is undesirable and is often a byproduct of a diet high in saturated fats and cholesterol. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable. However, a high level of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol), which helps the body clean up excess cholesterol, is desirable and lowers your risk of heart attack.
• Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. Conversely, people who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure.
• Obesity. Obesity involves having a high proportion of body fat. Obesity raises the risk of heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes.
• Diabetes. Diabetes is the inability of your body to produce or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes can occur in childhood, but it appears more often in middle age and among overweight people. Diabetes greatly increases the risk of a heart attack by speeding up atherosclerosis and negatively affecting blood cholesterol levels.
• Stress. You may respond to stress in ways that can increase your risk of a heart attack. If you're under stress, you may overeat or smoke from nervous tension. Too much stress, as well as anger, can also raise your blood pressure.
• Alcohol. Consumed in moderation, alcohol helps raise HDL levels — the "good" cholesterol — and can have a protective effect against heart attack. On the other hand, excessive drinking can raise your blood pressure and triglyceride levels, increasing your risk of heart attack.
• Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks, you may be at risk, too. Your family may have a genetic condition that raises unwanted blood cholesterol levels. High blood pressure also can run in families. In addition, families may contribute to coronary artery disease by practicing or promoting poor health habits, such as smoking or eating high-fat diets.
• Homocysteine, C-reactive protein and fibrinogen. People who have higher blood levels of homocysteine, C-reactive protein and fibrinogen appear to have an elevated risk of heart disease. These factors have only recently been identified as players in increasing cardiovascular disease risk. Research to pinpoint their exact role is ongoing. In the meantime, homocysteine levels can be reduced with folic acid supplements and a healthy diet. Fibrinogen and C-reactive protein levels may be reduced by modifying other risk factors for heart disease, such as quitting smoking, lowering cholesterol and exercising.

You can modify or eliminate many of these risk factors to reduce your chances of having a first or second heart attack. However, you can't change some risk factors, such as heredity and gender. Men are generally at greater risk than are women of heart attacks. However, the risk for women increases sometime after menopause , usually after age 55. If your father had heart disease before 55 or your mother had heart trouble before 65, your risk of developing heart disease is greater.

Ideally, your doctor should screen you during regular physical exams for risk factors that can lead to a heart attack.
If you're having a heart attack or suspect you're having one, screening and diagnosis will likely happen in another setting — an emergency room. Once there, you'll probably be asked to describe your symptoms and will have your blood pressure, pulse and temperature checked. Your doctor will listen to your heart and lung sounds with a stethoscope. You'll be asked about your health history and the history of heart disease in your family. Emergency room doctors may also want to conduct tests to determine whether your signs and symptoms, such as chest pain, signal a heart attack or another condition. These tests may include:

• Electrocardiogram (ECG). This is often the first test done to diagnose a heart attack. This test records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as "waves" displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.
• Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Emergency room doctors may take samples of your blood to test for the presence of these enzymes.

Additional tests

If you've had a heart attack or one is occurring, doctors will take immediate steps to treat your condition. You may also undergo these additional tests:

• Chest X-ray. An X-ray image of your chest allows your doctor to check the size and shape of your heart and its blood vessels.
• Nuclear scan. This test helps identify blood flow problems to your heart. Trace amounts of radioactive material, such as thallium, are injected into your bloodstream. Special cameras can detect the radioactive material as it flows through your heart and lungs. Areas of reduced blood flow to the heart muscle — through which less of the radioactive material flows — appear as dark spots on the scan.
• Echocardiogram. This test uses sound waves to produce an image of your heart. During an echocardiogram, sound waves are directed at your heart from a transducer, a wand-like device, held on your chest. The sound waves bounce off your heart and are reflected back through your chest wall and processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally or at peak capacity.
• Coronary catheterization (angiogram). Cardiac catheterization involves passing a catheter (i.e., a thin flexible tube) through an artery or a vein to the heart, and into a coronary artery. This procedure produces angiograms (i.e., x-ray images) of the coronary arteries and the left ventricle, the heart's main pumping chamber, and also can be used to measure pressures in the pulmonary artery and to monitor heart function, usually in critically ill patients (called right heart catheterization).
• In the days or weeks following your heart attack, you may also undergo a stress test. Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart similar to exercise. Stress tests help doctors diagnose coronaryheter) that's fed through an artery, usually in your leg, to arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray and videotape, revealing areas of blockage. Additionally, while the catheter is in position, your doctor may treat the blockage by performing an angioplasty, also known as coronary artery balloon dilation, balloon angioplasty and percutaneous coronary intervention. Angioplasty uses tiny balloons threaded through a blood vessel and into a coronary artery to widen the blocked area. In most cases, a mesh tube (stent) is also placed inside the artery to hold it open more widely artery disease, which can cause chest pain and may underlie a recent or future heart attack.
  

To prevent a heart attack:

Prevention

• Control your blood pressure.
• Control total cholesterol levels. To help with cholesterol control, your doctor may prescribe a medication of the statins group (atorvastatin, simvastatin).
• Stop smoking if you smoke.
• Eat a low fat diet rich in fruits and vegetables and low in animal fat.
• Control diabetes.
• Lose weight if you are overweight.
• Exercise daily or several times a week by walking and other exercises to improve heart fitness. (Consult your health care provider first.)
• If you have one or more risk factors for heart disease, talk to your doctor about possibly taking aspirin to help prevent a heart attack.
• After a heart attack, follow-up care is important to reduce the risk of having a second heart attack. Often, a cardiac rehabilitation program is recommended to help you gradually return to a "normal" lifestyle. Follow the exercise, diet, and medication regimen prescribed by your doctor.

How is a heart attack treated? Treatment of heart attacks include:

• Anti-platelet medications to prevent formation of blood clots in the arteries
• Anti-coagulant medications to prevent growth of blood clots in the arteries
• Coronary angiography with either percutaneous transluminal coronary angioplasty (PTCA) with or without stenting to open blocked coronary arteries
• Clot-dissolving medications to open blocked arteries
• Supplemental oxygen to increase the supply of oxygen to the heart's muscle
• Medications to decrease the need for oxygen by the heart's muscle
• Medications to prevent abnormal heart rhythms
  

Heart attack Medications

• Atacand
• Benace
• Benazepril
• Cozaar
• Diovan
• Diovan-HCTZ
• Lisinopril
• Lisinopril HCTZ
• Lopresor-SR
• Lotensin