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




If you've had a heart attack, it probably came as a big shock to you. Fortunately, excellent heart attack treatments are now available. This leaflet gives you information about heart attacks.You'll also learn about how you can recover and stay healthy afterwards. We've brought together the best and most up-to-date research about heart attacks to see what treatments work.You can use our information to talk to your doctor and decide which treatments are best for you.

What happens when you have a heart attack?

Your heart pumps blood around your body. It carries oxygen and energy to your muscles. Your heart is made of muscle, and needs a good blood supply to keep pumping.

When you have a heart attack, one of the blood vessels that carries blood to your heart gets blocked by a blood clot. So part of the heart doesn't get enough oxygen. This often causes bad chest pain and makes you breathless. If the blood supply is cut off for too long, part of the heart will die.

You'll have had emergency treatment in hospital to open up the blood vessel and get the blood flowing again. This is done by medicines, or by an operation called an angioplasty. These treatments can limit the damage to your heart. Then doctors keep a close watch over you to see if you develop any other problems. These can include having an irregular heart beat, or problems with how well your heart pumps. If a large amount of your heart muscle has been damaged by the heart attack, your heart may not pump so well as before. This is called heart failure.

The most risky time is the few hours after the heart attack. Once you are beyond that, you'll probably spend four or five days resting in hospital. During this time, doctors will do more tests to try to find out exactly what happened.

They'll find out which part of your heart has been damaged, and how much. If all goes well, you'll probably go home about a week after your heart attack. Having a heart attack is a big shock, especially if you were in good health beforehand. You may wonder why it happened to you.

Heart attacks are caused by blood clots which form in your arteries. Doctors don't know exactly why they cause problems for some people and not others. But you're more likely to have problems if your arteries are narrow because of clumps of fat on the artery wall.

Doctors call this atherosclerosis. Lots of people get it as they get older. If you have atherosclerosis in the arteries leading to your heart, this is called heart disease.You might have heart disease for many years without knowing it. A heart attack might be the first sign of trouble.

Heart attacks happen more often to men, from middle age onwards.You are more likely to have a heart attack if you have high blood pressure or high cholesterol (fat) in your blood, if you are overweight, smoke, or you don't take much exercise. A family history of heart attacks is also important. But sometimes heart attacks happen to people without any of these things.

What happens when you go home?

When you go home from hospital, you can start gradually getting back to your normal life. If you live alone, it may help to have someone stay with you for a few weeks, to help you adjust. You may feel anxious about what you can and can't do.

The key is to take it slowly.You will gradually be able to walk further and do more, without getting tired and breathless. It's normal to feel tired, anxious, angry or low, after a stressful event like a heart attack.

But if your low mood continues, talk to your doctor. People often become depressed after a heart attack, and there are treatments that may help you. Most people who live through a straightforward heart attack can return to their normal level of activity within six weeks.Younger people are usually back at work within three months.

Many areas run cardiac rehabilitation programmes. These are programmes where you get support from specialist nurses to help you recover. Before you leave hospital, you and your doctors should discuss how you can join a programme. If your doctors don't mention it, ask.

What treatments work?

There are lots of good treatments to help cut your risk of having another heart attack. Medicines are important. But you can also make changes yourself that will help you live a longer, healthier life.

Things you can do for yourself
Before you leave hospital, make sure you understand what has happened to you. Talk about your heart attack, test results and drugs with your doctors.
Learning about your heart attack and the treatment you need is an important part of getting better and lowering your risk of future trouble.Your hospital doctors, your GP and your specialist nurses can all help you learn more.

If you smoke, try hard to stop. Smoking narrows the arteries and makes you more likely to have another heart attack. Get help from a health professional, like your GP. There are lots of treatments that can help you stop.You might not stop on your first try. But it's important to keep trying. It could save your life.

Exercise improves stamina, strength, and makes you feel good. Over time, exercise makes your heart work better. It can also help you lose weight, if you need to.Your doctor or cardiac rehabilitation team can help you put together a safe exercise programme.You may need to be supervised at first. Many people can continue to exercise safely on their own after a few weeks.

Taking part in a cardiac rehabilitation programme can help you recover from your heart attack and keep your heart healthy. Cardiac rehabilitation will help you get better faster, get fit and make changes to your diet and lifestyle to reduce your risk of having another heart attack.You may also learn to manage stress or depression, if you feel bad. Research shows that people who survive a heart attack and then go on a cardiac rehabilitation programme are likely to live longer.

Everyone is different, so the rehabilitation team at your hospital will plan a programme that suits you. It may last six weeks, six months, or even longer.You need to be committed to taking part in the programme for it to work properly.

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


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