- Heart attack - symptoms
- Heart attack - causes
- Heart attack - diagnosis and auxiliary tests
- Heart attack - treatment
- Heart attack - rehabilitation
- Heart attack - complications and prognosis
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Myocardial infarction and its symptoms are a consequence of progressive ischemic heart disease, and at the same time its most dangerous form. About 100,000 people suffer from a heart attack each year, so it is worth expanding your knowledge about this disease. What is a heart attack? What are the causes and symptoms of a heart attack, what is the treatment and how to prevent a heart attack.
Myocardial infarction( of the heart muscle ), or actually an acute coronary syndrome, is caused by a sudden restriction of blood flow through the coronary arteries.
Coronary arteries , i.e. vessels supplying blood to the heart muscle, usually have two - the larger one - the left one and the smaller one - the right one.
The cause of symptoms in acute coronary syndrome is always myocardial ischemia. The degree of its severity is the basis for introducing types of myocardial infarction.
Changes in the ECG or no changes in the ECG correspond to the degree of vasoconstriction and this regularity allows the myocardial infarction to be divided into:
- acute coronary syndrome without ST segment elevation- when flow is reduced but preserved
- acute coronary syndrome with ST segment elevation- when the artery is completely closed
In both of the above cases, the biochemical markers are elevated, in both there may be changes in the ST segment on the ECG, but the division is based on the elevation of this segment.
A state similar to a heart attackin terms of symptoms is unstable angina. However, in this case neither ECG changes nor elevated markers occur, chest pain dominates.
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Heart attack - symptoms
The size of the coronary artery that will close and the degree of this closure determine how serious the infarction is. Thereforethe symptoms of a heart attackcan be varied.
When a small artery is blocked, we may not feel it at all, but closing a large artery can even be fatal.
The most important and characteristic symptom of a heart attack ischest painwhich is:
- caused by factors such as exercise, cold air or stress
- permanent
- strong
- baking
- crushing
- choking
- radiates to the neck, left arm, sometimes to the stomach
- does not go away after the cause has ceased to work, or nitroglycerin used by some patients with ischemic heart disease
A heart attack may be accompanied by:
- shortness of breath
- pallor
- poty
- palpitations
- heart beat faster
It happens that the symptoms of a heart attack are:
- fainting
- stomach ache
- nausea
- low fever
However, they are much less specific, and when they occur, a heart attack is suspected only after excluding other, more typical causes of such symptoms.
Of course, the aforementioned ailments may appear one at a time, several at a time, very rarely - all of them.
It happens thata heart attack has non-specific symptomsorthere are no symptoms at alland its occurrence is diagnosed only after a long time from on the basis of changes in ECG or imaging tests.
Heart attack - causes
The cause of a heart attack is most often atherosclerosis, i.e. a narrowing of the vessel due to the build-up of cholesterol, among others. However, atherosclerosis is slowly increasing, so why is it causing myocardial infarction, which is an emergency?
The reason isplaque damage . Some of them are so-called unstable plaques that break easily. This in turn, platelets recognize asvessel breakand begin to attach there. In addition, the artery contracts.
Both of these effects, when too intense, causevessel occlusionandischemia .
The risk factors for a heart attackinfluence the formation of atherosclerotic plaques and their cracking. The best known risk factors are:
- hyperlipidemia, or excess of "bad cholestrol" LDL
- smoking
- diabetes
- hypertension
- obesity
- lack of physical activity
- improper diet
We can modify all these factors and significantlyreduce the risk of a heart attackby leading a he althy lifestyle. There are also several factors beyond our control: age and gender (men and the elderly are more at risk), the occurrence of a heart attack in the family.
Less often they lead to heart attacks:
- spasm of the coronary artery
- inflammation of the coronary artery
- embolism (fragment of a clot from another place flowing downstream of the blood)
- anatomical defects
- very severe anemia
- severe aortic valve defects
In the last two cases, myocardial infarction is caused by insufficient oxygen supply in relation to myocardial demand.
Heart attack - diagnosis and auxiliary tests
The diagnosis of a heart attack is made on the basis of:
- symptoms, especially chest pain
- EKG
- blood tests (so-called heart attack markers)
In the ECG record, the doctorassesses mainly the ST segmentand depending on the changes in their scope, he can diagnose an infarction even without confirming it with blood tests. On the other hand, the EKG can sometimes tell you which of the coronary arteries has closed and which part of the heart is ischemic.
There are several markers of myocardial infarction , the most studied are the enzymes troponin and creatine kinase. Their increased level allows you to make a diagnosis.
Increase in markers usually does not occur simultaneously with the onset of symptoms, so sometimes an acute coronary syndrome can be confirmed witha series of blood tests at intervals of several hours .
It is important not only to exceed the norm, but also to change the number of determinations over time.
Echocardiography is a less commonly used test, which allows you to diagnose possible immediatecomplications of a heart attack , such as valve defects or damage to the heart wall. Computed tomography is performed exceptionally.
If an acute coronary syndrome is found on ECG and / or biochemical tests, coronary angiography (angiography of the coronary vessels) is performed.
This confirms the occurrence of an infarction, you can also find out which vessel is closed and start treatment immediately.
Coronary angiography consists in administering a contrast agent to the coronary arteries and making them visible through x-rays of the chest.
Heart attack - treatment
Treatment of a heart attackbegins even before the patient is admitted to the hospital.
If the emergency team suspects acute coronary syndrome, they give the patient medications, including acetylsalicylic acid and oxygen.
Hospital treatment depends on the type of infarction , the patient's condition and the technical capabilities of the hospital to which the patient was admitted.
In acute ST-segment elevation coronary syndrome, most commonly the patient undergoes percutaneous coronary angioplasty (PCI), preferably within 2 hours of admission to the hospital.
An alternative is fibrinolytic treatment, i.e. dissolving a blood clot with drugsadministered intravenously, rarely by-pass implantation.
The listed treatment strategies are always accompanied by pharmacological treatment - oral and intravenous. If an acute coronary syndrome is diagnosed without ST segment elevation, the patient's condition is critical, including heart rate, blood pressure, and markers of myocardial infarction.
Heart attack - rehabilitation
Rehabilitation after myocardial infarctionis an element of therapy, it can be carried out for about 2-3 months.
After treatment and rehabilitation are completed, remember to maintain physical fitness through regular exercise. The intensity of the effort must be adjusted to the patient's abilities.
- Cardiac rehabilitation: general principles
A moderate effort of half an hour is recommended, at least 3 times a week and preferably 5 to 7 times a week. The best activities are:
- march
- nordic walking
- cycling
- swimming
- dance
Heart attack - complications and prognosis
Despite advanced and more and more effective treatment methods, myocardial infarction is a serious disease that can have dangerous consequences. Complications do not happen often, such as:
- heart failure
- crack in the wall of the heart
- heart rhythm disturbance
- dysfunction of the valves
After a heart attack, it is necessary to continue the therapy: the aforementioned regular physical effort, reduction of the risk factors mentioned at the beginning of the article and pharmacological treatment, including the prevention of atherosclerosis and drugs that inhibit the activity of platelets.
- He survived a heart attack, but died because he did not receive treatment
Patients after a heart attack should remain under the constant care of a doctor, the frequency of visits varies, usually every 3-6 months.
About the author
Bow. Maciej GrymuzaA graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań. He graduated from university with an over good result. Currently, he is a doctor in the field of cardiology and a doctoral student. He is particularly interested in invasive cardiology and implantable devices (stimulators).