Myocardial infarction

Symptoms & causes Diagnosis & treatment Doctors & departments Care at Vejthani

Overview

Myocardial infarction, also known as a heart attack, occurs when the blood supply to the heart is significantly decreased or blocked. The accumulation of fat, cholesterol, and other chemicals in the heart’s (coronary) arteries is what causes the obstruction.

Plaques are the name given to the fatty, cholesterol-containing deposits. Atherosclerosis is the name for the process of plaque accumulation. A plaque may occasionally burst and generate a clot that restricts blood flow. Part of the heart muscle can be harmed or destroyed by a lack of blood flow.

To avoid mortality, a heart attack requires prompt treatment. If you believe you could be having a heart attack, call for emergency help right away.

Symptoms

Heart attack symptoms can vary, from none, to mild and serious. Typical heart attack signs include:

Pain in the chest that may feel like pressure, tightness, discomfort, squeezing or hurting
Dizziness that suddenly occurs
Lightheadedness
Nausea
Shortness of breath
Cold sweat
Fatigue
Heartburn or indigestion
Discomfort or pain that radiates to the shoulder, arm, back, neck, jaw, teeth, or even the upper abdomen.

Atypical symptoms in women can include back, arm, or neck discomfort that is sudden. Sudden cardiac arrest can occasionally be the initial indication of a heart attack.

Heart attacks can happen suddenly. However, many people have warning symptoms and signals hours, days, or even weeks in advance. A brief reduction in the amount of blood flowing to the heart is what causes angina. An early warning sign of angina is persistent chest pressure or pain that does not go away with rest.

Consult a doctor if you think you are experiencing a heart attack, get immediate medical attention. Do the following:

Request immediate medical assistance. Call for emergency help as soon as you suspect a heart attack. Have someone transport you to the closest hospital if you do not have access to emergency medical care.
Take nitroglycerin if a doctor has advised it for you. While awaiting assistance, take it as directed.
If aspirin is advised, take it. By inhibiting blood clotting, aspirin use during a heart attack may lessen cardiac damage.

Aspirin and other medications can interact. If neither your healthcare physician nor emergency medical personnel advise it, do not take an aspirin. Call for emergency help immediately after taking an aspirin. Make an urgent call for assistance.

What to do if you spot a potential heart attack victim
Call your emergency number first if you believe someone is experiencing a heart attack while they are unconscious. Next, make sure the individual is breathing and has a pulse. Only then should you start performing CPR if the victim is not breathing or you cannot feel their pulse.

If you do not have any CPR training, perform hands-only CPR. This implies quick and forceful compressions to the person’s chest at a rate of 100 to 120 compressions per minute.
If you have had CPR training and feel competent in this area, begin with 30 chest compressions before administering two rescue breaths.

Causes

Most heart attacks are brought on by coronary artery disease. One or more of the heart’s (coronary) arteries are clogged in coronary artery disease. Plaques, which are cholesterol-containing deposits, are typically the cause for this. Plaques can cause artery narrowing, which reduce heart blood flow and may rupture resulting in a cardiac blood clot.

A cardiac (coronary) artery blockage may be fully or partially responsible for a heart attack. If an electrocardiogram (ECG or EKG) reveals any specific changes (ST elevation) which need urgent invasive treatment, that electrocardiogram can be used to identify heart attacks. ECG readings may be used by your doctor to describe these kinds of heart attacks.

Complete blockage. An ST elevation myocardial infarction (STEMI) is typically indicated by an immediate full blockage of a medium or large heart artery.
Partial blockage. A partial blockage frequently indicates that you have experienced a Non-ST Elevation Myocardial Infarction (NSTEMI). However, a complete blockage can occur in some NSTEMI patients.

Blocked arteries are not the only reason for heart attacks. Additional factors include:

Coronary artery spasm. This is a condition where coronary artery severely constricted but not blocked and has cholesterol plaques or has early vascular hardening from smoking or other risk factors. Prinzmetal’s angina, vasospastic angina, or variant angina are other names for coronary artery spasms.
Some infections. Viral infections like COVID-19 and others can harm the heart muscle.
Spontaneous coronary artery dissection (SCAD). This potentially fatal illness is brought on by a tear inside a cardiac artery.

Risk factors

These are the risk factors that may lead to heart attack:

Age: Elderly men and women are more likely to get a heart attack.
Using tobacco: This covers both smoking and prolonged passive smoking exposure.
High blood pressure: The arteries leading to the heart might become damaged over time by excessive blood pressure. The risk is much higher when high blood pressure coexists with other diseases such as diabetes, high cholesterol, or obesity.
High cholesterol or triglycerides: Such as a high level of Low-Density Lipoprotein (LDL) cholesterol, also known as “bad” cholesterol. The risk of heart attack is also increased by excessive triglyceride levels in the blood. If your High-Density Lipoprotein (HDL) cholesterol, or “good” cholesterol, levels are within the normal range, your chance of having a heart attack may decrease.
Obesity. Diabetes, high triglyceride and bad cholesterol levels, and low good cholesterol levels are all associated with obesity.
Diabetes. When the body cannot properly use the hormone insulin or does not produce enough of it, blood sugar levels increase. Heart attacks are more likely to occur when blood sugar levels are high.
Metabolic syndrome. Having central obesity, high blood pressure, low good cholesterol, high triglycerides, and high blood sugar are all contributing factors.
Family history of heart attacks. You may be at higher risk if a sibling, parent, grandparent, or parent had a heart attack before age 55 for men and 65 for women.
Less exercise. More likely to occur in people who lead sedentary lifestyles and lack of physical activity. Heart health is improved by regular exercise.
Unhealthy diet. Heart attacks are more likely to occur in people who consume a diet rich in sweets, animal fats, processed foods, trans fats, and salt. Physician usually advise to consume lots of fruits, veggies, fiber, and good fats.
Stress. Extreme emotional stress, including rage, can raise your risk of having a heart attack.
Using illegal drugs. Stimulants include cocaine and amphetamines may result in a heart attack by causing a coronary artery spasm.
Preeclampsia history. During pregnancy, this syndrome raises blood pressure which causes a long-term risk of heart disease.
Autoimmune disease. A heart attack risk increase as you have lupus or rheumatoid arthritis.

Diagnosis

Normally, a doctor should assess you for risk factors for heart attacks during routine exams. In an emergency situation, a heart attack is frequently identified. If you’ve had or are experiencing a heart attack, doctors will treat you right away.

In order to diagnose a heart attack, blood pressure, pulse, and temperature are taken. Tests are performed to examine the heart’s overall health and the rate at which it beats.

Heart attack diagnosis tests include the following:

Electrocardiogram (ECG or EKG). This initial test for heart attack diagnosis which will capture electrical signals as they move through the heart. Electrodes with sticky patches are placed to the chest, and occasionally the arms and legs. Waves that are displayed on a monitor or printed on paper are used to record the heart’s signals. If you are experiencing or previously had a heart attack, an ECG can detect it.
Blood tests. With cardiac damage following a heart attack, some heart proteins gradually leak into the circulation. These proteins can be examined via blood testing (cardiac markers).
Chest X-ray. The size and condition of the heart and lungs can be seen on a chest X-ray.
Echocardiogram. Ultrasound produces images of the beating heart and can demonstrate how the heart and heart valves function, and determining the heart’s damage.
Coronary catheterization (angiogram). In order to reach the heart, a long, thin tube (catheter) is placed into an artery, typically through the groin area. In order to improve the visibility of the arteries on test images, dye runs via the catheter.
Cardiac Computed Tomography (CT) or Magnetic Resonance Imaging (MRI).  Images of the heart and chest are produced by these tests. X-rays are used in cardiac CT scans. A magnetic field and radio waves are used in cardiac MRI to produce images of your heart. You typically lie on a table that glides within a long, tube-like machine for both examinations which aid in demonstrating the extent of heart damage.

Treatment

Following a cardiac attack, more heart tissue is harmed or dies every minute. Blood flow needs to be fixed immediately in order to increase the oxygen levels. Oxygen is administered right away. Whether there is a partial or total blockage of blood flow will determine the specific heart attack treatment.

Medications

These are the medication used treat a heart attack.

Aspirin. Blood clotting is reduced by aspirin. It aids in maintaining blood flow through a constricted artery. You might have been instructed to swallow aspirin if you contacted an emergency contact number.
Thrombolytics or fibrinolytics. These medications aid in dissolving any blood clots obstructing the heart’s blood supply. Following a heart attack, the sooner thrombolytic medication is administered, the less the heart is harmed and the higher the likelihood of survival.
Other blood-thinning medications. Heparin is a medication that can be injected or given intravenously. Heparin reduces blood clotting risk by making the blood less sticky.
Nitroglycerin. The blood vessels are widened by this drug. It enhances the heart’s ability to receive blood. Sudden chest pain (angina) can be treated with nitroglycerin. It can be administered as an injection, a pill to swallow, or a pill under the tongue.
Morphine. Chest pain that does not go away with nitroglycerin is treated with this medication.
Beta blockers. These drugs lower blood pressure and slow the heartbeat. Beta blockers can reduce the degree of heart muscle deterioration and stop more heart attacks. Most people who are suffering a heart attack receive them.
ACE inhibitors. These medications lessen heart stress by lowering blood pressure.
Statins. These medications aid in reducing high cholesterol levels. Low-density lipoprotein, or LDL, or bad cholesterol, when in excess, can clog arteries.

Surgery and other procedures

A surgery or procedure to unblock a clogged artery may be performed if you’ve suffered a heart attack. The following surgeries and processes are used to treat a heart attack:

Coronary angioplasty and stenting. The aim of this surgery is to clear blocked cardiac arteries, also known as Percutaneous Coronary Intervention (PCI). This technique is frequently carried out if you’ve had a heart attack as part of a procedure to locate blockages (cardiac catheterization).

A cardiologist directs a thin, flexible tube (catheter) to the constricted area of the heart artery during angioplasty. To help expand the narrowed artery and enhance blood flow, a small balloon is inflated.

During angioplasty, a tiny wire-mesh tube (stent) may be inserted into the artery. The artery is kept open by the stent. It lessens the possibility of the artery narrowing once more. Some stents have a drug coating that keeps the arteries open.

Coronary Artery Bypass Graft surgery (CABG). This is an open-heart surgery to construct a new pathway for blood in the heart, a surgeon pulls a healthy blood artery from another section of the body. The blocked or constricted coronary artery is then bypassed. When a person is having a heart attack, CABG may be performed as an urgent procedure.

Cardiac rehabilitation

After having heart surgery, patients can learn how to enhance their heart health through cardiac rehabilitation which focuses on stress reduction, physical activity, a heart-healthy diet, and a gradual return to regular activities. Majority of hospitals start their cardiac rehabilitation patients there.

After a heart attack, those who participate in cardiac rehab live longer and are less likely to experience problems or have another heart attack.

Diseases & Conditions Myocardial infarction