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HEART ATTACK
Contributing risk factors
Contributing risk factors have been linked to coronary artery disease, but their significance and prevalence are not known yet. Contributing risk factors are:
Diabetes mellitus.
The risk of developing coronary artery disease is seriously increased for diabetics. More than 80% of diabetics die of some type of heart or blood vessel disease.
Obesity. Excess weight increases the strain on the heart and increases the risk of developing coronary artery disease, even if no other risk factors are present. Obesity increases both blood pressure and blood cholesterol, and can lead to diabetes.
Stress and anger. Some scientists believe that stress and anger can contribute to the development of coronary artery disease. Stress, the mental and physical reaction to life's irritations and challenges, increases the heart rate and blood pressure, and can injure the lining of the arteries. Evidence shows that anger increases the risk of dying from heart disease and more than doubles the risk of having a heart attack right after an episode of anger.
More than 60% of heart attack victims experience symptoms before the heart attack occurs. These sometimes occur days or weeks before the heart attack. Sometimes, people do not recognize the symptoms of a heart attack or are in denial that they are having one. Symptoms are:
Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest. This lasts more than a few minutes, or may go away and return.
Pain that spreads to the shoulders, neck, or arms.
Chest discomfort accompanied by lightheadedness, fainting, sweating, nausea, or shortness of breath.
All of these symptoms do not occur with every heart attack. Sometimes, symptoms disappear and then reappear. A person with any of these symptoms should immediately call an emergency rescue service or be driven to the nearest hospital with a 24-hour cardiac care unit, whichever is quicker.
Diagnosis
Experienced emergency care personnel can usually diagnose a heart attack simply by looking at the patient. To confirm this diagnosis, they talk with the patient, check heart rate and blood pressure, perform an electrocardiogram, and take a blood sample. The electrocardiogram shows which coronary artery is blocked. Electrodes covered with conducting jelly are placed on the patient's chest, arms, and legs. They send impulses of the heart's activity through an oscilloscope (a monitor) to a recorder, which traces them on paper. The blood test shows the leak of enzymes or other biochemical markers from damaged cells in the heart muscle.
Treatment
Heart attacks are treated with cardiopulmonary resuscitation (CPR) when necessary to start and keep the patient breathing and his heart beating. Additional treatment can include close monitoring, electric shock, drug therapy, re-vascularization procedures, percutaneous transluminal coronary angioplasty and coronary artery bypass surgery. Upon arrival at the hospital, the patient is closely monitored. An electrical-shock device, a defibrillator, may be used to restore a normal rhythm if the heartbeat is fluttering uncontrollably. Oxygen is often used to ease the heart's workload or to help victims of severe heart attack breath easier. If oxygen is used within hours of the heart attack, it may help limit damage to the heart.
Drugs to stabilize the patient and limit damage to the heart include thrombolytics, aspirin, anticoagulants, painkillers and tranquilizers, beta-blockers, ace-inhibitors, nitrates, rhythm-stabilizing drugs, and diuretics. Drugs that limit damage to the heart work only if given within a few hours of the heart attack. Thrombolytic drugs that break up blood clots and enable oxygen-rich blood to flow through the blocked artery increase the patient's chance of survival if given as soon as possible after the heart attack. Thrombolytics given within a few hours after a heart attack are the most effective. Injected intravenously, these include anisoylated plasminogen streptokinase activator complex (APSAC) or anistreplase (Eminase), recombinant tissue-type plasminogen activator (r-tPA, Retevase, or Activase), and streptokinase (Streptase, Kabikinase).
To prevent additional heart attacks, aspirin and an anticoagulant drug often follow the thrombolytic drug. These prevent new blood clots from forming and existing blood clots from growing. Anticoagulant drugs help prevent the blood from clotting. The most common anticoagulants are heparin and warfarin. Heparin is given intravenously while the patient is in the hospital; warfarin, taken orally, is often given later. Aspirin helps to prevent the dissolved blood clots from reforming.
To relieve pain, a nitroglycerine tablet taken under the tongue may be given. If the pain continues, morphine sulfate may be prescribed. Tranquilizers such as diazepam (Valium) and alprazolam (Ativan) may be prescribed to lessen the trauma of a heart attack.
To slow down the heart rate and give the heart a chance to heal, beta-blockers are often given intravenously right after the heart attack. These can also help prevent the sometimes fatal ventricular fibrillation. Beta-blockers include atenolol (Tenormin), metoprolol (Lopressor), nadolol, pindolol (Visken), propranolol (Inderal), and timolol (Blocadren).
Nitrates, a type of vasodilator, are also given right after a heart attack to help improve the delivery of blood to the heart and ease heart failure symptoms. Nitrates include isosorbide mononitrate (Imdur), isosorbide dinitrate (Isordil, Sorbitrate), and nitroglycerin (Nitrostat).
When a heart attack causes an abnormal heartbeat, arrhythmia drugs may be given to restore the heart's normal rhythm. These include: amiodarone (Cordarone), atropine, bretylium, disopyramide (Norpace), lidocaine (Xylocaine), procainamide (Procan), propafenone (Rythmol), propranolol (Inderal), quinidine, and sotalol (Betapace). Angiotensin-converting enzyme (ACE) inhibitors reduce the resistance against which the heart beats and are used to manage and prevent heart failure. They are used to treat heart attack patients whose hearts do not pump well or who have symptoms of heart failure. Taken orally, they include Altace, Capoten, Lotensin, Monopril, Prinivil, Vasotec, and Zestril. Angiotensin receptor blockers, such as losartan (Cozaar) may substitute. Diuretics can help get rid of excess fluids that sometimes accumulate when the heart is not pumping effectively. Usually taken orally, they cause the body to dispose of fluids through urination. Common diuretics include: bumetanide (Bumex), chlorthalidone (Hygroton), chlorothiazide (Diuril), furosemide (Lasix), hydrochlorothiazide (HydroDIRUIL, Esidrix), spironolactone (Aldactone), and triamterene (Dyrenium).
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