Heart Attack/ Myocardial infarction

What Is Heart Attack/ Myocardial infarction?

Myocardial infarction (MI) is commonly referred to as a heart attack. It is one of the biggest causes of unexpected death and is often discussed in the media. It is possible to treat a heart attack and prevent death if managed at the right time, which is why there is a lot of emphasis on educating the public on symptoms of heart attack.

An MI occurs when there is decreased blood flow to the heart. This usually occurs because of a blockage in one of the blood vessels supplying the heart. If the blood supply is decreased, it causes injury to the heart's muscle (myocardium).

The severity of a heart attack depends on which blood vessels are affected, how extensively the heart's muscle is injured, as well as on which of the heart's chambers are affected. If the ventricles (which contract and pump blood to the rest of the body) are affected, it has worse outcomes.

Death due to a heart attack is caused by cardiac arrest.

The first investigation done in chest pain is an ECG (Electrocardiogram). Leads are placed on the chest, and the electrical conduction of the heart is measured. Distinct patterns are suggestive of possible heart damage.

If heart damage is suspected, it is confirmed by blood tests that measure the heart enzymes in the blood. The blood tests done are called Creatine Kinase (CKMB), Troponin T and I, Myoglobin.

What Are The Symptoms Of Heart Attack/ Myocardial infarction?

A heart attack may present as chest pain (angina).

Symptoms of a heart attack may be atypical or typical. Other diseases may mimic the symptoms of a heart attack. It is important to have undiagnosed chest pain investigated by a doctor.

The typical symptoms of a heart attack are:

• Acute onset, sudden, severe left sided chest pain (pain usually >7/10)
• The pain typically lasts more than 20 minutes
• The nature of the pain is usually compressive (imagine an elephant standing on your chest)
• The pain may spread to the jaw, left or right arm or hand
• You may experience numbness or altered sensation (paraesthesia) in your hands, chest, or jaw.
• Accompanying symptoms include: Nausea and vomiting, dizziness, profuse sweating
• An MI may present with atypical symptoms like abdominal pain, indigestion, and back pain.

What Are The Causes Of Heart Attack/ Myocardial infarction?

There are many reasons why the arteries in the heart may be damaged.

The commonest cause is atherosclerosis- hardening of the lining of blood vessels (endothelium), which may form clots or plaques, and eventually, over time may progress to block the blood vessels.

Smoking is a significant contributing factor to blood vessel damage as well as:

• High blood pressure
• Diabetes
• Dyslipidemia (high cholesterol/abnormal blood "fat" levels)
• Lack of exercise and sedentary lifestyle
• Stress
• Genetic factors or a family history of heart disease
• Illicit drug use- cocaine and other stimulants
• Age- men over 45 years and women over 55 years
• Ethnicity- MIs are more common in Caucasian and Indian populations.

People with a combination of the above factors are at highest risk of having a heart attack.

What Are The Things One Should Do To Manage Heart Attack/ Myocardial infarction?

• If you suffer from chronic medical conditions such as diabetes or high blood pressure- make sure they are well controlled.
• Go for an annual checkup to screen for high blood pressure, diabetes and cholesterol.
• Lower your alcohol intake.
• Reduce stress. Use techniques such as mindfulness and meditation. Find counselling to deal with stressful life events.
• Cardiovascular exercise.

What Are The Things One Should Avoid To Manage Heart Attack/ Myocardial infarction?

• Do not smoke. Smoke is one of the biggest causes of endothelium damage.
• Do not take an MI lightly if you had one. Serious lifestyle changes need to be addressed.
• Do not leave any form of chest pain undiagnosed or untreated.

What Are The Best Foods For Heart Attack/ Myocardial infarction?

• A healthy balanced diet is the most important part of preventing inflammation -the underlying process in atherosclerosis.
• High fibre foods such as fruits and vegetables, whole grain whole wheat grains and unrefined carbohydrates.
• Make sure to drink 2 litres of water a day.
• Maintaining a healthy blood lipid balance. Eat foods that contain unsaturated fatty acids ("healthy fats") such as avocado, nuts, coconut oil and virgin olive oil.
• Use alcohol in moderation. Red wine contains antioxidants that are beneficial in cholesterol (guidelines suggest one to four glasses of red wine/week).
• Teas that contain antioxidants such as green tea or rooibos tea may be beneficial.

What Are The Worst Foods For Heart Attack/ Myocardial infarction?

• High-fat food containing unsaturated fatty acids
• If you suffer from high blood pressure avoid foods that contain a high salt content. If you are diabetic, make sure to follow a low-carbohydrate diet and to control your blood sugar.

What Are The Medicines For Heart Attack/ Myocardial infarction?

You will usually be hospitalised for a couple of days to make sure that you are stable and to start you on chronic medication.

The mainstay of therapy is thrombolysis- the process of dissolving blood clots.

Medical management:

• Aspirin- works on platelets and may help to prevent further clotting of blood in the arteries.
• A thrombolytic agent may be used and administered intravenously.
• Other antiplatelet drugs such as clopidogrel or blood thinning medications like heparin.
• Opioids such as morphine are the analgesics of choice.
• Nitroglycerin spray or tablets. This drug causes the dilatation of blood vessels and increases blood flow to your heart.
• Surgical management:
• A coronary angiogram may be done. A dye is injected into your blood vessels under radiological screening so that the doctors can see the arteries supplying the heart. The doctors can remove the blood clot intravenously with either a stent or balloon. ("Closed" surgery).
• If a heart attack is very severe, the doctor may perform coronary artery bypass surgery. The doctor will take other blood vessels (grafts) found the legs/arms and replace or bypass the blocked arteries.
• Chronic medications:
• Beta blockers: Decrease your heart rate and reduce the load on your heart.
• Antihypertensive treatment: ACE inhibitors are used to reduce blood pressure and prevent progressive heart damage.

What Are The Tips To Manage Heart Attack/ Myocardial infarction?

High dose omega 3, coenzyme Q10, and magnesium decrease inflammation and to help prevent cardiovascular damage. Discuss with your doctor before taking.