Heart attack

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Heart Attack (Myocardial Infarction)

The biggest delay usually occurs not during transportation of the patient from home to hospital but rather between onset of pain & the patient's decision to call for help. This delay can only be reduced by public education.

** Let's understand the basic terminology--

** ATHEROSCLEROSIS--

It is a disease process in which the vessels in the body get slowly blocked.

** ANGINA--

It is a chest pain caused due to decrease in the blood supply to the heart. The heart has not suffered any damage as yet.

** MYOCARDIAL ISCHEMIA--

Condition in which heart receives much lesser blood supply as compared to it's requirement.

** MYOCARDIAL INFARCTION-- (HEART ATTACK)--

The heart has suffered some irreversible damage due to the low blood supply.

** ISCHEMIC HEART DISEASE--

The spectrum ranges from angina to myocardial infarct.

WHY DOES HEART ATTACK OCCUR?-- THE PATHOLOGY
Due to atherosclerosis--> lumen of the arteries supplying the heart decreases-->low blood sypply to the heart-->angina.
If the decrease i.e. sudden & severe-->heart attack

WHEN TO THINK OF HEART ATTACK?
Think of heart attack if--

Severe chest pain especially if it is spreading to the left upper limb.
Association of vomiting
Association of sweating
Pain continues even after 5 minutes of rest
Only temporary relief with tablets taken sublingually

THE CRITICAL PERIODS--
The first hour is the most critical period as it is associated with the maximum mortality. That also means that what may be dividing line between life & death is the decision to contact the physicians early as possible.
The next critical period is the next 24 hours.

WHY DOES ONE DIE OF HEART ATTACK?
The damage caused to the heart may be severe enough to cause failure of the heart to pump the blood. Once this happens death is inevitable. One of the most common reasons for death is the development of arrhythmias. Arrhythmias are electrical disturbances in the heart.

WHAT IS AN ECG?
ECG stands for electrocardiography.
The basic function of the heart is to pump the blood to all parts of the body. For this it needs to relax & receive impure blood from various parts & then contract to pump it to all parts. This contraction of the heart is caused due to electric currents.
These currents are recorded by the ECG machine.

ARE THERE PAINLESS HEART ATTACKS?--
YES... especially in advanced diabetes one can have painless heart attack due to affection of the nervous system.

WHAT CAN BE DONE TO PREVENT HEART ATTACK?--
Prevention of heart attack is basically the prevention of the risk factors.
That includes--
1) Avoid smoking.
2) Maintain normal body weight.
3) Taking drugs properly if already a patient of ischemic heart disease.
4) Proper management of diabetes.
5) Regular exercises.

What is coronary angioplasty ?--
In this procedure a catheter is passed into a peripheral vein. It is then advanced towards the heart.
Ultimately it is introduced in the coronary arteries & the block in the same is removed. The block removal is done using a balloon catheter.
Newer non balloon techniques use laser to clear the block.

What are stents ?--
These are metallic scaffolds that can be placed in the affected blood vessel across the block so as to maintain the blood supply.

What is coronary angiography ?--
In this technique a radioopaque dye is injected in the coronary artery & images are taken. The flow of the dye indicates the site of block.

What is Coronary artery Bypass Grafting ?--
In this a section of the vein is taken( usually a leg vein is used ). It is then to carry blood from other arteries to the coronary artery distal( beyond ) to the block. Thus in this way the block is bypassed & the blood supply to the affected part of the heart is maintained.