Heart Attack

Cardiovascular

A heart attack, also known as an acute myocardial infarction, is the blockage of blood supply and oxygen to the heart muscle causing irreversible tissue damage. The blockage usually occurs in the coronary arteries, the main blood vessels leading to the heart muscle. Heart attacks are the leading cause of death in the United States affecting both men and women. Worldwide, three million people have a heart attack each year, with more than one million of those deaths occurring in the United States alone. Lowering risk factors and early intervention can help lower these numbers and save lives. Once the heart tissue dies, there is no way of bringing it back or repairing the damage. You can have one or several heart attacks and they can be fatal if not treated right away. Symptoms of a heart attack should never be ignored neither should you attempt treatment at home. This is a medical emergency and if you or someone you know has symptoms of a heart attack call 9-1-1 right away.

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Symptoms

Please note that the symptoms of heart attacks can be vague. Women also experience them differently than men do. If you have any of the following symptoms and you feel like something is not  right, get emergency medical attention:

Chest pain/Chest discomfort. One of the most prominent symptoms of a heart attack is chest pain or a tightening in the chest. This is usually felt on the left side of the chest and may radiate to the back and down the left arm. The pain, discomfort, or pressure may come and go or persist. Some people think it is heartburn and ignore the pain. The chest area may feel like there is:

  • Fullness
  • Pain
  • Squeezing
  • Pressure

Some people describe it as feeling like a “toothache.” If you have any symptoms of chest pain seek medical care immediately.

Radiating discomfort/upper body. Chest pain may radiate to the jaw, neck, shoulder, or upper abdomen. It may also radiate down the left arm.

Trouble breathing. You may feel like you can’t get your breath and feel winded. This occurs without any type of physical activity that normally makes you short of breath.

Nausea. Women commonly feel this symptom and it is often their only symptom, but both men and women may experience nausea with a heart attack.

Cold sweats. You may feel clammy and break out in cold sweats, even if the weather is cold and you do not feel warm.

Dizziness. Feeling lightheaded or dizzy for no apparent reason can be a sign of a heart attack.

Fatigue. Excessive fatigue, especially for days before other symptoms, could be the onset of a heart attack. This symptom is also very common in women before a heart attack.

Impending doom. Feeling like something very bad is about to happen.

The combination of two, three, or more of the above symptoms raises the possibility that you are having a heart attack.

Types

Acute myocardial infarctions (heart attacks) are divided into two categories – a STEMI or an NSTEMI – related to what your emergency care provider interprets from an electrocardiogram (ECG). The electrocardiogram is a device that measures the electrical activity of your heart. An ECG reading can detect abnormal heart rhythms, narrow or blocked arteries in your heart, and a past or occurring heart attack. Your physician will interpret readings from the ECG to diagnose whether you are having a STEMI or an NSTEMI by looking at the ST-segment ( a section that is elevated in a classic heart attack) on the electrocardiogram readout. NSTEMIs are diagnosed in the hospital after ruling out a STEMI from an ECG and through lab results of blood work. The two types of heart attacks are:

ST-elevation myocardial infarction (STEMI). Considered a “classic” heart attack, a STEMI occurs when the plaque ruptures and blocks a major coronary artery causing serious heart damage.

non-ST-segment elevation myocardial infarction (NSTEMI). Presenting with similar symptoms as a STEMI, an NSTEMI occurs when ruptured plaque blocks either a minor coronary artery or partially blocks a major coronary artery. This type of heart attack results in less extensive heart damage than as a STEMI.

Risk Factors

There are many risk factors for heart attacks. Many are also reversible with healthy and stress-reducing lifestyle choices. Risk factors include:

Age. Heart attacks tend to rise after the age of 45 in men and 55 in women.

Smoking. The use of tobacco and/or breathing secondhand smoke increases heart attack risk.

High cholesterol. If you have a low level of HDL “Happy Cholesterol” or high-density lipoprotein and an elevated level of LDL (low-density lipoprotein) then you are at a high risk for heart attack. You also need to watch your triglyceride levels that may be related to a high-fat diet.

Hypertension. High blood pressure combined with other health conditions speeds up the process of arterial damage.

Genetics. A history of heart disease in your family (direct relatives) increases your risk of a heart attack.

Diabetes. If you do not produce enough insulin your body does not control your blood sugar levels. Elevated blood sugar over time damages blood vessels and arteries and can lead to a heart attack if left untreated or poorly controlled.

Obesity. If you are overweight, you most likely have high cholesterol and are at higher risk for diabetes and high blood pressure. All of these can raise the risk of a heart attack. It is advised that people who are overweight try to lose at least 10 percent of their body weight.

Little to no exercise. Exercise can help keep your weight in a healthy range, keep the heart pumping effectively, lower cholesterol, and lower blood pressure. People who exercise have a much lower risk of heart disease overall.

Preeclampsia in pregnancy. Women who suffer from preeclampsia in pregnancy are at a higher risk of heart disease throughout their lifetime.

High stress. Increased stress levels increase inflammation in your body, and this includes inside the blood vessels.

Autoimmune disorders. Autoimmune disorders occur when your body’s immune system attacks itself for unknown reasons. Disorders like lupus and arthritis increase inflammation in the body and the immune system can attack delicate organs like the heart.

Amphetamine use. Methamphetamine and cocaine can greatly increase stress to the heart and cause coronary spasms and lead to heart attacks (even in younger people).

Diagnosis

If you have one or more of the above symptoms and it is new for you, you need to get emergency medical help. Time can save your life. People whose heart attacks are treated within six hours of the event have a greater chance of survival and better recovery times. The following tests are used to diagnose a heart attack:

Electrocardiogram (ECG or EKG). Even if you are in the ambulance while en route to the hospital, you will be hooked up to an electrocardiogram to check your heart rhythm. Certain rhythms can show that you are having a heart attack right away. It can also show if you have had a previous heart attack.

Laboratory Tests. Your blood will be checked for certain proteins that are by-products of heart muscle damage. Tests for this include troponin levels, creatine kinase, myoglobin, and tests for blood clotting. Elevated levels in any of the previously listed help doctors diagnose a heart attack.

Angiogram/catheterization of the heart. If your ECG is abnormal and your blood tests show possible heart damage, you will most likely be sent for an angiogram. The doctor will pass a catheter through an artery in your groin up into the arteries around the heart muscle. A special dye will be injected and the doctor can see the arteries on a screen to see if they are blocked. You will be given a sedative to help you tolerate the procedure. If you only have a minor blockage, the doctor can even perform minor treatments during the procedure. You will have to apply pressure on your upper thigh to prevent bleeding for approximately 15-20 minutes and then there is about a six-hour recovery time.

Treatments

The first line of treatment during a heart attack is to take baby aspirin. Always have a bottle of baby aspirin in your house if you are at risk for a heart attack. If you have to call 9-1-1, the operator will ask you to take the aspirin while waiting on the ambulance. If you do not have aspirin at home, the EMTs will give you some once they make contact with you. This will stop blood-clotting and help improve blood flow because aspirin is a blood thinner. Once you reach the hospital and after your diagnosis, the following treatments will be given:

Nitroglycerin. When you arrive at the hospital, they may place a nitroglycerin tablet under your tongue to help relax your blood vessels and improve blood flow. If you had a heart attack, these may be prescribed for you to use at home if you have re-occurring symptoms after discharge. You will be instructed on when and how to use them.

Thrombolytic drugs. The doctors may not wait until after all the tests to give you these drugs. This is because they need to be given early on in treatment. If the doctors believe you are having a heart attack, these will be given soon after you arrive at the hospital. They can quickly dissolve blood clots and increase blood flow to the heart muscle and provides oxygen. When given early, a thrombolytic decreases damage to the heart muscle and can save your life.

Antiplatelet drugs. These are another powerful type of blood thinner that can be given to stop blood clotting and will reduce the size of blood clots you already have while preventing new ones from forming. After diagnosis, you may be given a platelet-inhibitor drug that will stop a clot or clots from forming again.

Injectable blood thinners. There are injectable blood thinners that you may be given in your IV in the hospital and some that you can use at home for a few weeks to keep your blood thin while you recover.

Pain medications. During your hospital stay, you may be given pain medications in your IV. The doctor may send you home with a prescription for pain medication to help make you comfortable.

Blood pressure medication. The doctor may give you blood pressure medications like beta-blockers and ACE-inhibitors to help relax the blood vessels and lower your blood pressure. This medication reduces the workload of the heart to aid in recovery.

Stents and angioplasty. During the heart catheterization, the doctor places a balloon-like stent in the occluded artery to open it up and to increase blood flow to the heart.

Coronary artery bypass grafting (CABG). If the blockage to your heart cannot be relieved with a stent and you are at risk for more severe heart damage, you may need bypass grafting surgery. The surgeon harvests a vein from your leg or thigh area and grafts it into the blood vessels leading to the heart. This will improve the blood flow to your heart. You may need one or more to improve blood flow. This type of open-heart surgery has improved tremendously in recent years and many people go home from the hospital days after surgery. The benefits of the surgery far outweigh the risk of death. Life expectancy for people who have CABG is lengthened further over those people who do not have the surgery.

Alternative Treatments and Home Remedies

Make sure you talk to your doctor about using natural supplements or alternative medicine. Your medical treatments are very important to help your heart recover and there can be drug interactions with herbal supplements. Keep in mind that there is no medical proof that supplements can prevent heart attacks. However, some alternative treatments may lower your risk when used before a heart attack. They may help to lower cholesterol levels, keep your blood pressure in the normal range, manage diabetes, and thin the blood. If you are on blood thinners, use caution with some supplements. Some alternative treatments that can complement your medical treatment include:

Vitamin B6, B12, and folic acid. Taking 25 to 100 mg daily of vitamin B5, 2 to 100 mcg daily of B12 and 400 mcg daily of folic acid may help lower the levels of the amino acid homocysteine. Higher levels of this amino acid may increase the risk of blood vessel disease linked to heart attacks and strokes.

Beta-sitosterol. This plant-based sterol may help lower cholesterol levels by stopping its absorption in your intestinal tract. Studies have shown that people who use beta-sitosterol may have lower LDL levels in the body after supplementation.

Omega-3 fatty acids. Taking 1,000 to 4,000 mg daily may help reduce inflammation in the body and thus lowering the formation of plaque in the arteries. Omega-3 fatty acids may also lower triglyceride levels and blood pressure. This should not be used without your doctor’s consent if you are already on blood thinners. You can get daily requirements from just eating fatty cold-water fish (like salmon) at least twice weekly.

Co-Q10. This may help prevent blood clot formation and increase antioxidants. Taking them near the time a heart attack occurs may help prevent recurring heart attacks.

Psyllium. This form of high fiber is most often used as a laxative but may also help reduce cholesterol levels and keep your blood sugar stable.

Garlic. Garlic is a natural blood thinner and anti-inflammatory. Taking 900 mg daily may help reduce blood clot formation and get rid of arterial plaques. It should not be used in conjunction with blood thinners.

Prevention

If you have any risk factors for heart disease, you should practice a healthy lifestyle to help prevent heart attacks. Making changes now can save your life in the future. Follow these helpful prevention tips to reduce your risk:

Live and eat healthily. Commit to taking care of your body and your body will take care of you!

Get plenty of exercise. Even if it just means incorporating a daily walk. Your body needs exercise to keep off excess weight and burn off fats and calories. It also keeps your heart strong.

Quit smoking and stay away from secondhand smoke. Do not let people smoke in your home or your car. It is better for everyone and your heart will thank you.

Lose excess pounds. Being overweight puts you at risk for diabetes, heart disease, and strains your heart. If you start eating a “heart-healthy” diet, you can lose some extra pounds just by eating healthier.

Eat whole grains, fresh fruits, and vegetables. Choose lean meats, beans, and fish for proteins. Only use fat-free or reduced-fat dairy. Reduce your intake of saturated fats, cholesterol, transfats, refined sugar, and salt.

Take care of high-risk health conditions. If you have diabetes, hypertension, or high cholesterol, take the needed steps to bring them under control. You may need to take medications to help, but once you start eating healthier and exercising some of these conditions are reversible.

Lifestyle Changes

  • Quit smoking
  • Reduce alcohol intake
  • Lower your salt intake
  • Keep your weight in a healthy range
  • Stay on a heart-healthy eating plan (no trans or saturated fats and low cholesterol)
  • Keep your blood pressure and cholesterol in a normal range
  • Maintain strict control of your blood sugar (if you have diabetes)
  • Keep your appointments, especially if you are on blood thinners
  • Get regular exercise like walking, swimming, or riding a bike
  • Practice stress reduction techniques (yoga, meditation, breathing exercises)

References

Centers for Disease Control. (2015, August 10). Heart Disease Facts. Retrieved from Centers for Disease Control: https://www.cdc.gov/heartdisease/facts.htm

Hwang, C. (2014, Spring). ECG diagnosis: ST-elevation myocardial infarction. Permanente Journal, 18(2), e133. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022571/

Mayo Clinic. (2014, November 15). Heart attack: Causes. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/heart-attack/basics/causes/con-20019520

Mechanic, O. J. & Grossman, S. A.(2020, November 20). Acute myocardial infarction. Retrieved from StatPearls: https://www.ncbi.nlm.nih.gov/books/NBK459269/

National Heart, Lung, and Blood Institute. (2013, December 17). What Are The Symptoms of a Heart Attack? Retrieved from National Institute of Health: https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/signs

University of Maryland Medical Center. (2014, August 12). Heart Attack. Retrieved from University of Maryland Medical Center: https://umm.edu/health/medical/ency/articles/heart-attack

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