Heart Attack

heart attack

Heart Attack (Myocardial Infarction)

What is Heart Attack?

Sudden pain or discomfort in the chest due to sudden loss of blood supply to the heart, results from blockage of the coronary arteries (blood vessel supplying blood to the heart).

What produces Heart Attack?

Blockage of blood supply to the heart occurs due to sudden spasm of the blood vessel or blood clot blocking the arteries or thickening of the arterial wall due to atherosclerosis (gradual deposition of fat on inner walls of blood vessels).

The symptoms felt by the patient.

The patient may have sudden pain under the sternum with excessive sweating. The pain may be of crushing type and may be felt in the left arm, neck, jaw or shoulder. Patient may have breathlessness and the patient may collapse. 20% of the patients may not feel the pain (Diabetic patients and elderly patients).

What to do?

  • Call the ambulance and shift the patient to coronary care unit of a hospital.
  • Make the patient sit in comfortable position.
  • Ask the patient, if he is already on medication for heart attack. Give him nitro-glycerine or isosorbide dinitrate tablet to keep under the tongue.
  • Make him chew or swallow aspirin tablet (avoid, if the patient is allergic of aspirin or having peptic ulcer.
  • If the patient is unconscious, give cardio pulmonary resuscitation or give chest compression at the rate of about 100 per minute until the arrival of medical team.

Investigations to be done.

  • ECG: (Electro cardiogram) ST elevation or depression may be seen. Q waves can be seen.
  • Echo cardiogram can be done to test the function of the heart and note regional wall motion abnormalities.
  • Cardiac troponin  and creatinine kinase test in blood, which may be elevated.
  • Coronary angiogram after the patient becomes stable to diagnose the site of blockage.

Treatment given.

  • Drugs like nitrates to dilate blood vessels.
  • Injection Morphine to reduce pain.
  • Oxygen through nasal mask.
  • Intravenous thrombolysis.
  • Injection streplokinase or urokinase can be given to dissolve the clot.
  • Coronary Angioplasty with stent insertion can be done.
  • Coronary artery bypass grafting can be done.

Prevention.

  • Stop smoking
  • Life style modification
  • Low fat Diet
  • Exercise

Post infarction care.

  • Psychological counselling for anxiety and depression.
  • Rehabilitation programs include exercise training, counselling occupational therapy to make the patient live independently.