Over 48,000 Australians and 10,000 New Zealanders will have a heart attack this year-- and about half of them will die from it. Thanks to improved emergency-care strategies, however, over 90 percent of those who make it to hospital in time will survive.
Relatively new medications, known as thrombolytics or 'clotbusting' drugs, can virtually stop the heart attack in progress by dissolving the deadly blood clot. If administered within the first half hour after onset, you may suffer little or no permanent damage to the affected part of your heart muscle. These revolutionary drugs--include alteplase, streptokinase and tenecteplase--have dramatically boosted heart attack survival rates. Their benefits significantly diminsh within two or three hours after the attack, but at this point, damage is irreparable, even if blood flow is restored.
You will also be given an anticoagulant, such as heparin, warfarin or the newer drug enoxaparin (Clexane), to prevent new clots from forming and causing another heart attack. To alleviate the pain, glyceryl trinitrate (in the form of tablets or a spray placed under the tongue) can widen the vessels leading to the heart, improving the delivery of oxygen and easing any chest pain (angina).
Once you're stabilised, your doctor may also prescribe anti-hypertensive drugs--beta-blockers, angiotensin--converting enzyme (ACE) inhibitors and diluretics--to reduce the rate and force of your
contractions so that the heart requires less oxygen. This helps to minimise the destruction of heart tissue. And when you leave the hospital, you should receive a prescription for long-term bet-blocker therapy. Studies show that these drugs can dramatically reduce your risk of a second heart attack, Cholesterol-lowering statin drugs and daily low-dose aspirin therapy can, too.
Procedures
As an alternative to thrombolytic drugs, doctors may decide to give you an emergency angioplasty (Percutaneous transluminal coronary angioplasty, or PTCA). This involves inflating a tiny ballon in the clogged artery to compress the blockage and restore the flow of blood through it (angioplasty). Studies show that emergency PTCA is about as effective as clot-busting drugs or more so, especially for patients who develop very low blood pressure. These days, more often than not, a stent will also be inserted at the same time. This small tube enables the vessel to stay open and maintains the blood supply to the heart muscle.
ASPIRIN: THE WONDER DRUG
Studies show that taking one adult aspirin (325 mg) every other day or a baby aspirin (81 mg) every day can reduce the chances of having a heart attack by up to 40% in high-risk patients. Likewise, if an aspirin is chewed shortly after the onset of a heart attack, the risk of imminent death drops by 25%.
Many doctors already advise a daily low-dose aspirin for men over age 40 and women over 50 who have at least one heart disease risk factor. If your doctor thinks that you are a good candidate for such therapy, be sure to take the aspirin with food to reduce the risk of gastro-intenstinal bleeding. Also, avoid alcohol, because it further promotes stomach upset and bleeding when taken with aspirin. If you develop heart-burn with regular aspirin, it's fine to use a buffered, enteric-coated or time-released formulation. Save money by buying a generic product.
In very rare cases, coronary artery bypass surgery may be performed if thrombolytics or angioplasty don't work well enough after a heart attack. However, it is generally better if this procedure can be postponed for a few days until your condition stabilises. Sometimes, a pacemaker (see atrial fibrilation) or implantable cardiac defibrillator may be warranted.
Lifestyle changes
While in hospital, you should gradually increase your physical activity and start to regain your strength--the sooner, the better. If recovery is uneventful and surgery isn't needed, you are likley to be discharged in about a week. Within about four to eight weeks, your may be able to resume normal activities (including work and sex), assuming you can handle moderate exertion, such as walking up two flights of stairs, without chest pain or shortness of breath.
Before leaving hospital, you will probably undergo a modified exercise stress test to help your doctor devise an individualised exercise plan to follow for the ensuing weeks. Your doctor may also recommend a supervised outpatient cardiac rehabilitation program, which involves low-intensity exercise to help you regain strength and endurance. A good program will also offer comprehensive, personalised advice and support on diet, smoking cessation and stress control, as well as emotional and psychological support for patients contending with anxiety, depression and family or occupational problems. If possible, you should take part in a rehabilitation program for at least two months.
What is happening
Every muscle in your body needs a steady supply of blood to function properly, and your heart is no exception. Coronary arteries nourish your heart is no exception. Coronary arteries nourish your heart muscle with plenty of oxygen and nutrients to keep it pumping day and night. But if one of these arteries becomes blocked--usually it's the result of a blood clot forming at a site where the artery has become narrowed by plaque--the heart muscle is deprived of blood and may begin to die. This tissue death is called a myocardial infarction (MI), or more commonly, a heart attack.
Unless the blockage in outer artery is cleared and blood flow is, your heart muscle cannot survive without a steady flow of blood for more than about three hours. Then the affected section will die, becoming useless scar tissue and permanently impairing your heart's ability to pump effectively. This can be fatal if a large enough portion of the heart is destroyed. For this reason, it is crucial to get medical care as quickly as possible at the first sign of a heart attack. Literally, every minute counts.
Most people are familiar with classic heart attack symptoms--crushing chest pain or shooting pains radiating along the upper left arm--but a heart attack can manifest itself in a variety of ways. Women, for example, tend to have more subtle symptoms, which may delay getting timely treatment. So be on the lookout for any of the following: uncomfortable pressure, pain or tightness in the chest that lasts for more than 10 minutes; pain in the shoulders, jaw, neck and arms (especially the left); chest pain (whether severe or mild) accompained by light-headness, cold sweat, shortness of breath, nausea or unusual feelings of dread or impending doom.
LIKELY FIRST STEPSUnless the blockage in outer artery is cleared and blood flow is, your heart muscle cannot survive without a steady flow of blood for more than about three hours. Then the affected section will die, becoming useless scar tissue and permanently impairing your heart's ability to pump effectively. This can be fatal if a large enough portion of the heart is destroyed. For this reason, it is crucial to get medical care as quickly as possible at the first sign of a heart attack. Literally, every minute counts.
Most people are familiar with classic heart attack symptoms--crushing chest pain or shooting pains radiating along the upper left arm--but a heart attack can manifest itself in a variety of ways. Women, for example, tend to have more subtle symptoms, which may delay getting timely treatment. So be on the lookout for any of the following: uncomfortable pressure, pain or tightness in the chest that lasts for more than 10 minutes; pain in the shoulders, jaw, neck and arms (especially the left); chest pain (whether severe or mild) accompained by light-headness, cold sweat, shortness of breath, nausea or unusual feelings of dread or impending doom.
- Call 000 in Australia or 111 in New Zealand immediately to get medical help and quick transport to the hospital emergency room.
- Chew an aspirin to reduce the severity of the attack; take glyceryl trinitrate for chest pain (angina).
- At hospital, doctors will administer thrombolytic drugs to dissolve artery--blocking clots and minimise tissue damage.
QUESTIONS TO ASK
- To what extent has my heart been permanently damaged?
- Can my heart disease be reversed?
- Am I a good candidate for a cardiac rehabilitation program?
- When will I be able to return to work? Drive a car? Resume having sex?
Treatments
The key to surviving a heart attack is quick action. If you or someone you're with experiences any of the symptoms of a heart attack for more than 1o minutes, seek emergency medical assistance right away. Most people admitted emergency rooms for a suspected heart attack turn out to have had severe heartburn, a panic attack or another problem. Still, it's better to err on the side of caution.
At the first sign of symptoms, chew and swallow an aspirin, unless you suffer from gastrointestinal bleeding or have had major surgery during the previous week. A single (325 mg) aspirin can help the blood clot start to dissolve; chewing the tablet helps it get into your bloodstream more quickly. Just be sure to let emergency personnel know you've taken the aspirin.
Paramedics will adminster supplementary oxygen through a mask or nasal tube in an effort to save oxygen-starved heart tissue. Likewise, they may perform cardiopulmonary resuscitation (CPR) or use an electrical defibrillator (a device that shocks the heart back to a proper rhythm) if your normal heartbeat is disrupted. Once you're in the hospital, the immediate goals of the emergency team will be to clear the blocked coronary artery and restore blood flow to your heart, as well as to ease your pain and discomfort.
MedicationsAt the first sign of symptoms, chew and swallow an aspirin, unless you suffer from gastrointestinal bleeding or have had major surgery during the previous week. A single (325 mg) aspirin can help the blood clot start to dissolve; chewing the tablet helps it get into your bloodstream more quickly. Just be sure to let emergency personnel know you've taken the aspirin.
Paramedics will adminster supplementary oxygen through a mask or nasal tube in an effort to save oxygen-starved heart tissue. Likewise, they may perform cardiopulmonary resuscitation (CPR) or use an electrical defibrillator (a device that shocks the heart back to a proper rhythm) if your normal heartbeat is disrupted. Once you're in the hospital, the immediate goals of the emergency team will be to clear the blocked coronary artery and restore blood flow to your heart, as well as to ease your pain and discomfort.
Relatively new medications, known as thrombolytics or 'clotbusting' drugs, can virtually stop the heart attack in progress by dissolving the deadly blood clot. If administered within the first half hour after onset, you may suffer little or no permanent damage to the affected part of your heart muscle. These revolutionary drugs--include alteplase, streptokinase and tenecteplase--have dramatically boosted heart attack survival rates. Their benefits significantly diminsh within two or three hours after the attack, but at this point, damage is irreparable, even if blood flow is restored.
You will also be given an anticoagulant, such as heparin, warfarin or the newer drug enoxaparin (Clexane), to prevent new clots from forming and causing another heart attack. To alleviate the pain, glyceryl trinitrate (in the form of tablets or a spray placed under the tongue) can widen the vessels leading to the heart, improving the delivery of oxygen and easing any chest pain (angina).
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Aspirin/nitroglycerin Chew aspirin right away; nitro for chest pain.
------------------------------------------------------------------------------------------------------------------------------------------
Thrombolytics Dissolve clots, can stop attack in progress.
-------------------------------------------------------------------------------------------------------------------------------------------
Anticoagulante Prevent clots and another attack.
-------------------------------------------------------------------------------------------------------------------------------------------
Narcotics For intense chest pain.
--------------------------------------------------------------------------------------------------------------------------------------------
Antihypertensives Improve heart function.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Emergency measures Call 000 (Aust), 111 (NZ); oxygen, CPR, defibrillator.
---------------------------------------------------------------------------------------------------------------------------------------------
Angioplasty w/wo stent Widens clogged artery; restores blood flow.
---------------------------------------------------------------------------------------------------------------------------------------------
Bypass surgery Only if drugs or angioplasty fail.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Exercise Start slowly, then follow doctor-directed pain.
----------------------------------------------------------------------------------------------------------------------------------------------
Cardiac rehabilltation For advice on diet, smoking cessation, stress.
TAKING CONTROL
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Aspirin/nitroglycerin Chew aspirin right away; nitro for chest pain.
------------------------------------------------------------------------------------------------------------------------------------------
Thrombolytics Dissolve clots, can stop attack in progress.
-------------------------------------------------------------------------------------------------------------------------------------------
Anticoagulante Prevent clots and another attack.
-------------------------------------------------------------------------------------------------------------------------------------------
Narcotics For intense chest pain.
--------------------------------------------------------------------------------------------------------------------------------------------
Antihypertensives Improve heart function.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Emergency measures Call 000 (Aust), 111 (NZ); oxygen, CPR, defibrillator.
---------------------------------------------------------------------------------------------------------------------------------------------
Angioplasty w/wo stent Widens clogged artery; restores blood flow.
---------------------------------------------------------------------------------------------------------------------------------------------
Bypass surgery Only if drugs or angioplasty fail.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Exercise Start slowly, then follow doctor-directed pain.
----------------------------------------------------------------------------------------------------------------------------------------------
Cardiac rehabilltation For advice on diet, smoking cessation, stress.
TAKING CONTROL
- Act quickly. Don't ignore your symptoms. About half of all heart attack patients wait too long--at least two hours--before getting help. Not waiting can make the difference between life and death.
- Plan ahead. know the location of your nearest hospital and check that they have emergency-care facilities.
- Plot out the route in advance. Make sure that you and your spouse (or someone close to you) know the fastest way to the best medical facility.
- Quit smoking. Cutting out tobacco, studies show, can reduce your risk of a heart attack by 50 to 70%.
- Get moving. Regular aerobic exercise nearly halves your risk of a heart attack (a 45% reduction), yet more than 60% of Australians and New Zealanders are sedentary.
- Ask your doctor about getting your C-reactive protein (CRP) level measured as part of your routine-blood work. Experts are finding that a high CRP indicates above-average inflammation, a scenario that raises your heart attack risk--even if your cholesterol is lwo. Statins, aspirin and other anti-inflammatories can lower CRP, as can certain lifestyle measures.
Once you're stabilised, your doctor may also prescribe anti-hypertensive drugs--beta-blockers, angiotensin--converting enzyme (ACE) inhibitors and diluretics--to reduce the rate and force of your
contractions so that the heart requires less oxygen. This helps to minimise the destruction of heart tissue. And when you leave the hospital, you should receive a prescription for long-term bet-blocker therapy. Studies show that these drugs can dramatically reduce your risk of a second heart attack, Cholesterol-lowering statin drugs and daily low-dose aspirin therapy can, too.
Procedures
As an alternative to thrombolytic drugs, doctors may decide to give you an emergency angioplasty (Percutaneous transluminal coronary angioplasty, or PTCA). This involves inflating a tiny ballon in the clogged artery to compress the blockage and restore the flow of blood through it (angioplasty). Studies show that emergency PTCA is about as effective as clot-busting drugs or more so, especially for patients who develop very low blood pressure. These days, more often than not, a stent will also be inserted at the same time. This small tube enables the vessel to stay open and maintains the blood supply to the heart muscle.
ASPIRIN: THE WONDER DRUG
Studies show that taking one adult aspirin (325 mg) every other day or a baby aspirin (81 mg) every day can reduce the chances of having a heart attack by up to 40% in high-risk patients. Likewise, if an aspirin is chewed shortly after the onset of a heart attack, the risk of imminent death drops by 25%.
Many doctors already advise a daily low-dose aspirin for men over age 40 and women over 50 who have at least one heart disease risk factor. If your doctor thinks that you are a good candidate for such therapy, be sure to take the aspirin with food to reduce the risk of gastro-intenstinal bleeding. Also, avoid alcohol, because it further promotes stomach upset and bleeding when taken with aspirin. If you develop heart-burn with regular aspirin, it's fine to use a buffered, enteric-coated or time-released formulation. Save money by buying a generic product.
In very rare cases, coronary artery bypass surgery may be performed if thrombolytics or angioplasty don't work well enough after a heart attack. However, it is generally better if this procedure can be postponed for a few days until your condition stabilises. Sometimes, a pacemaker (see atrial fibrilation) or implantable cardiac defibrillator may be warranted.
Lifestyle changes
While in hospital, you should gradually increase your physical activity and start to regain your strength--the sooner, the better. If recovery is uneventful and surgery isn't needed, you are likley to be discharged in about a week. Within about four to eight weeks, your may be able to resume normal activities (including work and sex), assuming you can handle moderate exertion, such as walking up two flights of stairs, without chest pain or shortness of breath.
Before leaving hospital, you will probably undergo a modified exercise stress test to help your doctor devise an individualised exercise plan to follow for the ensuing weeks. Your doctor may also recommend a supervised outpatient cardiac rehabilitation program, which involves low-intensity exercise to help you regain strength and endurance. A good program will also offer comprehensive, personalised advice and support on diet, smoking cessation and stress control, as well as emotional and psychological support for patients contending with anxiety, depression and family or occupational problems. If possible, you should take part in a rehabilitation program for at least two months.
Your article is fantastic and you have provided the depth sight about the heart attack symptoms . Knowing and understanding that heart attack health issue is serious and potentially deadly can help to save your life or the life of someone you love. Shortness of breath that occurs especially without activity during sleep or rest could be a sign of a serious heart failure. Thank you for this nice article.
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