Heart

Heart Attack

What is a heart attack (myocardial infarction)?

A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because coronary arteries that supply the heart muscle with blood flow become narrrow from a buildup of fat, cholesterol and other substances that together are called plaque. When a plaque in a heart artery breaks, a blood clot forms around the plaque. The blood clot is the actual cause of the heart attack. If the blood and oxygen supply is cut off, muscle cells of the heart begin to suffer damage and start to die. The result is dysfunction of the heart muscle in the area affected by the lack of oxygen or cell death.

What are the symptoms?

  • Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back

  • Chest pain that is not relieved by rest or by taking nitroglycerin

  • Chest pain that occurs with any/all of the following (additional) symptoms:

    • Sweating, cool, clammy skin, and/or paleness

    • Shortness of breath

    • Nausea or vomiting

    • Dizziness or fainting

    • Unexplained weakness or fatigue

    • Rapid or irregular pulse

  • Trouble sleeping

  • Lightheadedness or dizziness

What treatment option is available?

The goal of treatment for a heart attack is to relieve pain, preserve the heart muscle function, and prevent death.

Treatment in the emergency department may include:

  • Intravenous therapy such as nitroglycerin and morphine.

  • Continuous monitoring of the heart and vital signs.

  • Oxygen therapy improves oxygenation to the damaged heart muscle.

  • Pain medication decreases pain, and, in turn, decreases the workload of the heart, thus, the oxygen demand of the heart decreases.

  • Cardiac medication, such as beta-blockers, promote blood flow to the heart, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure.

  • Fibrinolytic therapy is the intravenous infusion of a medication which dissolves the blood clot, thus, restoring blood flow.

  • Antithrombin/antiplatelet therapy is used to prevent further blood clotting.

Additional procedures to restore coronary blood flow may be used. Those procedures include:

  • Coronary angioplasty/percutaneous coronary intervention (PCI). With this procedure, a balloon is used to create a bigger opening in the blocked vessel to increase blood flow. This is often followed by the insertion of a stent into the coronary artery to help keep the vessel open. Although angioplasty is performed in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. There are several types of PCI procedures, including:

    • Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked area.

    • Coronary artery stent. A tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.

    • Atherectomy. The blocked area inside the artery is cut away by a tiny device on the end of a catheter.

    • Laser angioplasty. A laser used to "vaporize" the blockage in the artery.

  • Coronary artery bypass. Most commonly referred to as simply "bypass surgery" or CABG (pronounced "cabbage"), this surgery is often performed in people who have chest pain and coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft.

What are the patient outcomes?

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