heart attack
 


Heart Attack


Almost all heart attacks occur when a blood clot suddenly and completely blocks a coronary artery.

This condition is called a coronary thrombosis, or simply a coronary. The part of the heart muscle nourished by the blocked artery becomes damaged by lack of oxygen.

Unless blood flow returns within minutes, muscle damage increases. Heart cells begin to die after four to six hours without blood. The damage can affect the heart's ability to pump and may cause the patient's death. If the clot can be dissolved within four to six hours, damage to the heart can be reduced. Symptoms. Some people have no warning signs at the beginning of a heart attack. But many people experience angina, dizziness, indigestion, or other symptoms. Most heart attacks cause severe pain. Patients describe the pain as a dull, crushing ache in the chest, but discomfort may extend into the neck, jaw, arms, or back.

The pain may last from a few minutes to several hours. Anyone with chest pain who suspects the pain may be due to a heart attack should seek medical help immediately.

Some patients may stop breathing, and their hearts may stop beating. A first-aid technique called cardiopulmonary resuscitation (CPR) can maintain breathing and circulation until a patient can be taken to a hospital. But CPR should be performed only by someone trained in the technique.

Diagnosis and treatment.

Injured heart muscle causes abnormal ECG waves. Soon after a patient reaches the hospital, doctors administer an ECG to determine that symptoms result from a heart attack and not some other disorder. Doctors also use certain blood tests to detect a heart attack. But these tests are not useful until a few hours after an attack. Doctors may administer a strong painkilling drug, such as morphine, to relieve the pain of a heart attack. They also use drugs to dissolve clots in the blocked artery or may perform emergency angioplasty or bypass surgery.

After doctors stabilize the condition of a heart attack patient, they admit the person to the hospital and monitor him or her for complications in the intensive care unit. Some hospitals have a specialized intensive care unit called a coronary care unit for heart patients. Two major complications are heart failure and arrhythmia. Heart failure occurs if the heart cannot pump enough blood because of extensive damage to the heart muscle. In most cases, heart failure can be successfully treated. In arrhythmia, the heart's electrical system produces an abnormal pattern of beats. Most arrhythmias can be readily treated, but a type called ventricular fibrillation can cause sudden death. Ventricular fibrillation occurs when electrical signals in the ventricles fire randomly.

More than 20 percent of heart attack patients who do not get medical care die. Some people die before they can reach a doctor, but other patients ignore their symptoms and delay treatment. The death rate among hospitalized patients ranges from 5 to 10 percent. Heart attack patients with ongoing chest pain, arrhythmias, or heart failure have a greater risk of another attack than do patients without these problems.

Source : World Book 2005


 




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If you've had a heart attack, you will probably go home from hospital with lots of new medicines. This can be confusing. If you're not sure what they all are, ask your doctor. The medicines you are most likely to take are listed below.You will probably need to take them for many months, and maybe years.

Aspirin makes your blood less sticky, so you are less likely to get a blood clot that could cause a heart attack. Research shows taking one low-dose aspirin every day cuts your risk of having another heart attack by about a third. If you're allergic to aspirin or can't take it for some other reason, your doctor may give you another drug to stop your blood clotting, for example clopidogrel (Plavix) or dipyridamole (Persantin).

Beta-blockers slow your heart down and make it beat less strongly. Because it's working less hard, it needs less oxygen. This reduces your risk of having another heart attack. There are lots of different types. Some common ones are atenolol (Tenormin), carvedilol (Eucardic) and metoprolol (Lopresor).

Statins reduce the amount of cholesterol in your blood. They reduce the risk of heart attacks for most people. People who are at highest risk of having another heart attack seem to benefit the most. Some names of statins are atorvastatin (Lipitor), pravastatin (Lipostat) and simvastatin (Zocor).

ACE inhibitors keep your blood vessels from getting narrower. They are especially useful if your heart is not pumping as well as it used to. They should reduce your risk of another heart attack. But they're not used for everyone. Some names of ACE inhibitors are captopril (Capoten) and enalapril (Innovace).

All these drugs can cause side effects. As you read this, remember you won't get all of them. If you are troubled by side effects, talk to your doctor.You may be able to switch to another medicine, or a lower dose.

Aspirin can cause stomach upsets. Also, because it makes your blood less sticky, you may find cuts bleed for longer. There is a small chance you could get bleeding from the stomach. But this is not very likely, because the dose of aspirin is low.

Beta-blockers lower your blood pressure. This can make you feel tired, and you might feel dizzy if you stand up quickly. Some men find beta-blockers make it difficult for them to get an erection. And beta-blockers can make some lung problems worse. If you have asthma or chronic bronchitis, make sure your doctor knows before you take beta-blockers.

Most people don't get side effects from statins. But they can cause muscle pain or damage.Tell your doctor if you get muscle pain when taking statins. Some people taking statins have had liver and kidney damage, but doctors are not sure that the statins caused the problems.

Many people find ACE inhibitors can cause a dry cough.They may also cause low blood pressure and kidney problems.

Other treatments

Some people who have a heart attack have an operation called an angioplasty, to widen the artery that got blocked. It can be done as an emergency operation, instead of dissolving the blood clot with drugs.

If you didn't have an angioplasty, but tests show that your heart arteries are narrow, you might have an angioplasty at a later stage. This can reduce your chances of having chest pain (angina) and of having another heart attack. Or you might have an angioplasty if you start getting chest pain after you've gone home from hospital.

To carry out an angioplasty, a surgeon feeds a thin deflated balloon into your heart artery, through a tube into a blood vessel in your groin. When the balloon is in the right place, the surgeon inflates it, so it widens the artery. Then it's taken out again. Sometimes a small metal tube (called a stent) will be inserted, to keep the artery open.



What will happen to me?

How you get along after a heart attack depends on how much of your heart has been damaged.Your recovery also depends on how well you stick with your drug treatment and your plans to have a more healthy life. Some people who have had a heart attack get chest pain (angina) and feel short of breath from time to time. Angina happens when your heart needs more blood, for example when you exercise or go out in the cold. It goes away with rest.Your doctor can give you medicine to help with angina pain. Shortness of breath may mean your heart is not pumping as well as before the heart attack. About 6 in 10 people who've had a heart attack say they get short of breath occasionally. About one-third of people who have heart attacks say they feel depressed soon afterward. If you feel depressed, talk to your doctor. There are effective treatments for depression.

Doctors look at four things to predict how well you'll do after a heart attack:

• Is your heart pumping properly?
• Where has your heart been damaged? Attacks that damage the front of your heart are more dangerous than those that affect the back or base of your heart.
• What was your blood pressure and how fast was your heart beating when you were admitted to hospital? If you had low blood pressure and your heart was beating quickly, you probably had a serious heart attack.
• How old are you? The older you are, the more likely it is that your heart attack was dangerous. Two-thirds of people who die of coronary heart disease (which includes heart attacks) are 75 or older.

Remember that you are over the first hurdle: you survived your heart attack. Now you have the chance to make changes that can help you live a longer, healthier life.


Source : BJM Group. http://besttreatments.bmj.com/

 

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