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Heart attack – what happens and how is it treated

Heart attack – what happens and how is it treated (Enlarge)
 A heart attack, or in clinical terms, myocardial infarction, is a condition in which the heart muscle is damaged following occlusion of one of the arteries that transport oxygenated blood to the heart. These arteries are called coronary arteries.


Following the occlusion, the area of the heart muscle that received a blood supply from that blocked artery undergoes necrosis and later a scar forms in the area. The affected scarified area loses its ability to contract and to take part in the normal activity of the heart muscle, as a pump that runs blood to the different organs of the body. This is where the name myocardial infarction comes from. Myocardium – heart; infarction – death.



The causes of heart attacks

In 90-95% of patients who have heart attacks, the primary cause is occlusion of a coronary artery by a blood clot. The clot forms in the area in which the artery is diseased and becomes narrow due to a process of atherosclerosis.

In a minority of patients, the heart attack is caused by a sudden spasm of the coronary arteries, in the area in which the artery is diseased and narrowed, but sometimes also in arteries that have no stenosis (narrowing). More rarely, the infarct is caused by emboli of small blood clots into the coronary arteries or by inflammation of the coronary arteries.



Signs of a heart attack

A heart attack usually features compressive pain of the chest, lasting more than 20-30 minutes. Sometimes the pain radiates from the chest to the shoulders, back, neck, arms, jaws or abdomen.

The pain may also be accompanied by sweating, nausea, vomiting, shortness of breath, palpitations, dizziness or even loss of consciousness. Sometimes, the heart attack occurs after exertion or unusual mental excitement, but sometimes also at rest and may also occur during one’s sleep.

Heart attack diagnosis
Diagnosis is based on a combination of characteristic complaints of the patient and other objective diagnostic findings, such as:

1. ECG – Records the electric activity of the heart and allows in most cases for diagnosis of a heart    

    attack as it forms, or signs of an old heart attack.

    A readily available, affordable measure that is used as a principal diagnostic tool.


2. Blood tests allow for diagnosing the presence of various enzymes in the blood, such as CPK, CPK-MB

    or signs such as troponin that are released into the bloodstream into the damaged heart muscle area.


3. Imaging studies – such as echocardiography or mapping of the heart.



Heart attack complications

Patients who have had a heart attack may develop complications that stem from the damage that is caused to the heart muscle, such as:

1. Electrical complications
    - Electrical blocks – disorder in the formation or transmission of the electrical stimulus that is normally

      required for the contraction of the heart.
    Cardiac arrhythmias – which result from irregular electrical activity of the electric stimulus.

      Cardiac arrhythmias originate from the atriums or ventricle of the heart.


2. Mechanical disorders in the functioning of the heart – a direct result of the damage to the heart

    muscle tissue, such as:
    - Decrease in the cardiac output with the development of heart failure.
    - Rupture of the heart muscle tissue – sometimes a rupture forms in the muscle in the area of the damage

      to the heart muscle tissue.

      The rupture location may be in the septum (partition) separating the two ventricles, in the area of the

      muscles that support the mitral valve that separates the left atrium from the left ventricle,

      or a rupture in the free wall of the heart, in which case blood gushes out of the heart’s chambers.

3. Pericarditis – inflammation of the sheath surrounding the heart (the pericardium).

4. Blood clots – the appearance of a blood clot in the chambers of the heart, primarily in the left ventricle.



Treatment for heart attack

In any case of a suspected heart attack, medical help should be called as soon as possible and the patient transferred with medical supervision to a hospital. Treatment has a number of aspects, according to the severity of the damage:

1. Pain management

2. Treatment for reducing the damage to the heart muscle

    improvement in the oxidation balance of the heart muscle tissue that is at risk, by:
    - Rest.
    - Administering oxygen.
    - Administering drugs that prevent the formation of the blood clot in the coronary arteries.
    - Administering drugs that reduce the oxygen consumption of the blood and improve the blood supply to

      the heart muscle.
    - Administering drugs that dissolve blood clots.
    - Dilation of the narrowed or blocked artery using a balloon and a stent in a catheterization procedure.
    - Bypass surgery to bypass the occluded artery.

3. Treatment of complications
    - Treatment of cardiac arrhythmias.
    - Treatment of heart failure.

4. Rehabilitation and preventive care

    - An explanation to the patient and his family on the nature of the disease, its risk factors and treatment.
    - Treatment
of risk factors: consultation for quitting smoking, management of diabetes mellitus,

      hypertension, hyperlipidemia and excess weight.

5. Education on physical activity and correct nutrition.

Patients after a heart attack must have periodical orderly cardiological follow up, owing to changes that occur after a heart attack in the electrical activity of the heart and in the blood flow to the heart muscle tissue.

By: Prof. Chanoch Hod, senior cardiologist and director of the Cardiac Intensive Care Unit at the Heart Center, Sheba Hospital, Tel Hashomer. Published by: