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The heart is a muscle like any other in the body. Arteries supply it with oxygen rich blood so that it can contract and push blood to the rest of the body. When there isn’t enough oxygen flow to a muscle, its function begins to suffer. Block the oxygen supply completely, and the muscle starts to die.

Heart muscle gets its blood supply from arteries that originate in the aorta just as it leaves the heart.

The coronary arteries run along the surface of the heart and supply oxygen rich blood to the muscle.

The right coronary artery supplies the right ventricle of the heart and inferior (lower) portion of the left ventricle.

The left anterior descending coronary artery supplies the majority of the left ventricle, while the circumflex artery supplies the back of the left ventricle.

The ventricles are the lower chambers of the heart; the right ventricle pumps blood to the lungs and left pumps it to the rest of the body.

 

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Heart Attack Causes

Over time, plaque can build up along course of an artery and narrow the channel through which blood flows. Plaque is made up of cholesterol build up and eventually may calcify or harden, with calcium deposits. If the artery becomes too narrow, it cannot supply enough blood to the heart muscle when it becomes stressed. This ache or pain is called angina. It is important to know that angina can manifest in many different ways and does not always need to be experienced as chest pain. If the plaque ruptures, a small blood clot can form within the blood vessel, acting a dam and acutely blocking the blood flow beyond the clot. When that part of the heart loses its blood supply completely, the muscle dies. This is called a heart attack, or an MI – or Myocardial Infraction.

Heart Attack Risk Factors

The risk factors for ASHD are the same as those for stroke (cerebrovascular disease) or peripheral vascular disease. These risk factors include:

  • Family history or heredity
  • Cigarette smoking
  • High blood pressure
  • Diabetes
  • Previous history of other blood vessel problems such as stroke or peripheral vascular disease

Non-coronary artery disease cause of heart attack may also occur. Examples include:

Cocaine use. This drug can cause the coronary arteries to go into enough spasm to cause a heart attack.

Prinzmetal angina or coronary artery vasospasm. Coronary arteries can go into spasm and cause angina without a specific cause, which is known as Prinzmetal angina. Approximately 2 percent to 3 percent of patients with heart disease have coronary artery vasospasm.

Anomalous coronary artery. In their normal position, the coronary arteries lie on the surface of the heart. On occasion, the course of art the artery can dive into the heart muscle itself. When the heart muscle contracts, it can temporarily kink the artery and cause angina.

Inadequate oxygenation. Profound Anemia from bleeding or failure of the body to make enough red blood cells can precipitate angina symptoms.

Medical History

Important questions include:

  • When did the pain start?
  • What were you doing?
  • Did you have to stop?
  • Did the pain get better with rest?
  • Did the pain come back with activity?
  • Did the pain stay in your chest or did it move somewhere else, like the jaw, teeth, arm or back?
  • Did you get short of breath?
  • Did you become nauseous?
  • Were you sweating profusely?
  • Questions may be asked about changes in exercise tolerance that might provide clues as to whether heart disease is present:
  • Is shortness of breath or exertion?
  • Can you walk to get the mail?
  • Can you climb a flight of stairs?

Heart Attack Symptoms and Signs

Classic symptoms of a heart attack may include: Chest pain associated with shortness of breath, Profuse sweating, Nausea.

The chest pain may be described as tightness, fullness, a pressure, or an ache.

Unfortunately, many people do not have these classic signs. Other signs and symptoms of the heart attack may include: Indigestion, Jaw ache, Pain only in the shoulder or arms, Shortness of breath, or Nausea and vomiting.

Heart Attack Diagnostic Test Electrocardiogram

The electrocardiogram (ECG or EKG) will help direct what happens acutely in the ER. The EKG measures electrical activity and conduction in heart muscle. In a heart attack in which the full thickness of the heart muscle is involved, the EKG shows characteristic changes that establish the diagnosis of a myocardial infarction. Some heart attacks only involve small parts of the heart muscle; in these cases, the EKG can look relatively normal.

Blood tests

When heart muscle becomes irritated it may leak chemicals that can be measured in the blood. Levels of the cardiac enzymes myoglobin, CPK, and troponin are often measured, alone or in combination, to assess whether heart muscle damage has occurred.

 Chest X–ray

A chest X–ray may be taken to look for a variety of findings including the shape of the hearth, the width of the aorta, and the clarity of the lung fields.

Heart Attack Treatment

If the EKG shows that there is an acute heart attack (myocardial infarction), the goal is to open the blocked artery as soon as possible and restore blood supply to the heart muscle.

When a heart attack strikes, the key thing to remember is that the time equals muscle. The longer the delay in seeking medical care, the more heart muscle will be damaged. There is a window of opportunity to restore blood supply to the heart muscle by unblocking the affected heart artery. Treatments must be done in a hospital and include administration of clot-busting drugs to dissolve the clot at the site of the ruptured plaque and heart catheterization and angioplasty (in which the blood vessel is opened by balloon, often with adjunctive placement of a stent), or both.

HEART ATTACK EMERGENCY MEDICAL TREATMENT

Hospitals have established treatment plans to minimize the time to diagnose and treat people with heart attack. National guidelines suggest that an electrocardiogram (EKG) be done within 10 minutes of the patient’s arrival in the ER.

Many things will occur at the same time as the EKG being completed. The doctor will take a history and complete a physical exam while the nurses start an intravenous line (IV), place heart monitor lines on the chest, administer oxygen.

Medications are used to try to restore blood supply to the heart muscle. If it wasn’t taken prior to arrival in the ER, aspirin will be used for its anti-platelet action. Nitroglycerin will be used to dilate blood vessel. Heparin or Enoxaparin (Clexane) will be used to thin the blood. Morphine can also be used for pain control. Antiplatelet medications such as Clopidogrel (Plavix) or Prasugrel (Effient) are also recommended. There are two options (depending on the resources at the hospital) 1) if the EKG shows an acute heart attack (myocardial infarction), and 2) if there are no contraindications. Heart Catheterization The favored treatment is heart catheterization. Tubes are threaded through the femoral artery in the groin or through the brachial artery in the elbow, into the coronary arteries, and the area of blockage is identified. Angioplasty Angioplasty (angio=artery + plasty=repair) is then considered if possible. A balloon is placed at the blockage site and as it pens, it compresses the plaque into the blood vessel wall. Afterwards, a stent or a mesh cage is placed across the angioplasty site to keep it from closing down. Guidelines recommend that from the time the patient arrives at the hospital to having the blood vessel open be less than 90 minutes.

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