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




Self-Care at Home

If you think you are having a heart attack, seek help immediately. Do not ignore chest pain or discomfort. Time is of vital importance. Call 911 for emergency transport to the hospital. Do not try to drive yourself or being driven by someone else. If you have regular-strength or baby aspirin available and you are not strongly allergic, chew and swallow 1 regular aspirin or a baby aspirin.

• At this dose, aspirin may help maintain blood flow through a clot-filled artery by inhibiting blood clotting.
• Chewing gets the aspirin into your system faster than swallowing it whole.

If you have had angina and been given nitroglycerin, take as recommended by your health care provider. Exact instructions will depend on the form of the nitroglycerin. If you have had a heart attack before, or if you have several risk factors, the following steps may help prevent heart attacks and save you from severe disability or even death.

• Take a low-dose aspirin tablet (160 or 325 mg) every day. Aspirin increases the risk of bleeding in some people. Ask your health care provider before taking daily aspirin.
• If you smoke, quit. This is the single best lifestyle change you can make. After 3 years of not smoking, the risk of heart disease drops to the level of a nonsmoker. Your health care provider can help you quit smoking through behavioral changes, medications, or use of nicotine replacement products.
• Lower the cholesterol level in your blood. Lowering your cholesterol, especially the level of "bad" LDL cholesterol, keeps plaques from building up in the coronary arteries. The total cholesterol level should be kept below 200 mg/dL, and the LDL cholesterol level below 130 mg/dL (under 100 mg/dL in those with known heart disease or diabetes). Some people are able to control their cholesterol level by changing what they eat, lose weight, and exercise more; others require medication.
• Keep your intake of calories from fat under 30% of your total calories. This translates to an intake of less than 60 grams of fat per day for an adult. Most diets in Western countries contain more fat than is recommended.
• Control blood pressure. Uncontrolled high blood pressure is one of the most common causes of heart disease.
• Control diabetes carefully. Uncontrolled diabetes increases your risk of heart disease, heart attacks, and circulation problems.
• If you take hormone replacement therapy (HRT), talk with your health care provider right away. HRT is no longer considered to protect women from heart disease and heart attacks.

Medical Treatment

Medical treatment may be started immediately, before a definite diagnosis of a heart problem is made. General treatment measures include the following:
• Oxygen through a tube in the nose or face mask
• Nitroglycerin under the tongue
• Pain medicines (morphine or meperidine)
• Aspirin: Those with allergy to aspirin may be given clopidogrel (Plavix).

Clot-dissolving medicines: The tissue plasminogen activators (tPAs) can actually dissolve clots.
• The earlier these drugs are given, the better the chance of dissolving the clot and opening the blocked artery, protecting the heart muscle from further injury.
• If more than 12 hours has passed since the onset of chest pain, these drugs are less helpful.
• Potential risks of this therapy include bleeding.
• The most serious risk is a stroke (bleeding into the brain).

Angioplasty: Emergency coronary angiography and coronary balloon angioplasty (percutaneous transluminal coronary angioplasty, or PTCA) are available in hospitals equipped with a full-service cardiac catheterization laboratory. This is the most direct method of removing blockage in a coronary artery.
• Coronary angiography or cardiac catheterization is first done to identify the degree and number of blockages.
• Depending on the results, angioplasty may be done.
• Coronary balloon angioplasty is an extension of coronary angiography.
• A long, thin tube (catheter) is inserted in an artery in the groin or arm.
• At the tip of the catheter is a tiny, elongated balloon, which is threaded over a hair-thin guidewire into the narrowed coronary artery.
• Once the balloon is positioned at the blockage in the coronary artery, it is inflated.
• The balloon pushes aside the plaque and clot that are blocking the artery, allowing blood to flow more freely.
• The balloon is then deflated and removed with the catheter.

Stenting: A stent is a small, metal springlike device that may be inserted into a coronary artery after balloon angioplasty. After the catheter and balloon are removed, the stent stays in place, holding the artery open. A stent is better than angioplasty alone at keeping the artery from narrowing again. Atherectomy: Sometimes the plaques are too rigid, bulky, or calcified to be treated by balloon angioplasty. In these cases, the plaque often can be removed by cutting it out with a drill-like rotary blade or a laser or other tool. For some patients, angioplasty or stenting is not sufficient or appropriate and coronary artery bypass grafting may be recommended.

Source : eMedicineHealth.com First Aid Quick Reference | Heart Attack Treatment


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