Animation Movie Available]]>Related Media: Understanding Arterial Plaque]]>

Definition

A ]]>heart attack]]> occurs when an artery that carries oxygen-rich blood to the muscle of the heart (myocardium) becomes blocked. The resulting lack of oxygen causes tissue to die in the part of the heart supplied by the blocked artery. A heart attack is also called a myocardial infarction (MI).

Causes

Most heart attacks are indirectly caused by ]]>coronary artery disease]]> or atherosclerosis, a condition in which fatty deposits (plaques) build up on the walls of an artery. This narrows the arteries and restricts blood flow to the muscle of the heart. A heart attack is usually triggered by a tear or rupture of the plaque, which leads to the formation of a blood clot and then blocks the blood flow in the artery. Spasm of the artery can also contribute to the blockage.

Risk Factors

The risk factors for having a heart attack are similar to those for developing coronary artery disease.

Uncontrollable risk factors include:

  • Early ]]>menopause]]>
  • Postmenopausal status
  • Increasing age
  • African American, Mexican American, American Indian, native Hawaiian, or Asian ethnicity
  • Family history of cardiovascular disease

Risk factors that you can control through lifestyle or medical treatment include:

  • ]]>Smoking]]> or exposure to secondhand smoke (especially if taking birth control pills)
  • ]]>High blood pressure]]>
  • High levels of low-density lipoprotein (LDL) ]]>cholesterol]]>
  • Low levels of high-density lipoprotein (HDL) cholesterol
  • Sedentary lifestyle
  • ]]>Diabetes]]>
  • ]]>Obesity]]> and overweight (especially when focused around the waist)
  • Psychological stress

Symptoms

The symptoms of a heart attack may be far more subtle in women than in men. Chest pain or discomfort is typically the most common symptom in men and women. However, women may be more likely to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Common symptoms include:

  • Nausea and vomiting
  • Severe fatigue
  • Dizziness, fainting
  • Feelings of heartburn or indigestion in the upper abdomen
  • Pain that radiates into the arms (on the left side more than the right)
  • Pain high in the back, jaw, or neck
  • Heart palpitations
  • Profuse sweating
  • Shortness of breath
  • A fear of impending death

Diagnosis

The following tests may be done to confirm the diagnosis of a heart attack:

]]>Electrocardiogram (ECG)]]> —This test records the electrical activity of the heart; it is used to see if the heart muscle was damaged and where the damage is located.

Blood tests —These may include checking levels of enzymes, troponin, and albumin cobalt binding (ACB), which is a new test recently approved by the Food and Drug Administration.

]]>Echocardiogram]]> —This test uses high-frequency sound waves to visualize the heart's structure and function.

]]>Myocardial perfusion scan]]> —This scan uses small doses of a radioactive substance injected into the bloodstream to visualize how well blood is nourishing the heart muscle.

]]>Coronary angiogram]]> —This is an invasive test where a catheter is placed into the large artery in the groin and then advanced up the aorta and to the heart. IV contrast is injected into the arteries to visualize blockages.

Treatment

As with men, heart disease is the number one killer for women, too. Women account for nearly half the deaths from heart attack. This makes it especially important for women to recognize the symptoms and receive immediate care.

Medical attention within the first hour after the symptoms start can significantly reduce the amount of heart damage. An electric shock using a defibrillator along with intravenous medication may be administered if the heartbeat is dangerously irregular. Supplemental oxygen is usually given to increase oxygen in the blood and minimize tissue damage.

Additional drug and revascularization procedures are listed below.

Drugs

A number of drugs can reduce clotting and improve blood flow, thereby minimizing damage to the heart. These include:

Drugs that alleviate pain and dilate blood vessels around the heart, increasing blood flow:

Anticlotting drugs:

Drugs that dissolve blood clots:

  • Thrombolytic therapy (tissue plasminogen activator [tPA], streptokinase, alteplase, reteplase, anistreplase, urokinase)

Drugs that slow heart rate and/or lower blood pressure:

  • ]]>Beta-blockers]]> (metoprolol, esmolol, propranolol, carvedilol)
  • Angiotensin converting enzyme (ACE) inhibitors (captopril, cilazapril, enalapril hydrochloride, fosinopril, lisinopril, moexipril hydrochloride, perindopril, quinapril, ramipril, trandolapril)
  • Calcium-channel blockers (nifedipine, nicardipine, verapamil, diltiazem hydrochloride)

Cholesterol-lowering drugs:

  • ]]>Statins]]> (atorvastatin, fluvastatin, pravastatin, simvastatin)

Revascularization Procedures

In some cases, mechanically opening the blocked arteries may be required or recommended. The two most common of these procedures are:

Percutaneous coronary intervention (PCI) —A small balloon attached to a catheter is inserted into an artery in the groin and threaded to the site of blockage. The balloon is inflated and deflated to open the artery, and then it is removed. This makes more room in the artery for blood to flow through. Frequently a metal stent is also placed to help keep the artery open. Some new stents are coated with medication to help prevent renarrowing of the artery, called restenosis.

]]>Coronary artery bypass graft (CABG)]]> —This is a surgical procedure utilized when multiple vessels are blocked, a PCI cannot be done, or there is a critical blockage of the left main coronary artery. Saphenous veins from the leg or the internal mammary artery from the chest wall may be used to create an alternate blood flow around the blocked arteries.

Prevention

To decrease your chances of developing coronary artery disease, and thus having a heart attack, try to do the following:

  • Eat a ]]>diet]]> low in saturated fat and trans-fatty acids.
  • Eat plenty of fruits, vegetables, and whole grain foods.
  • Eat foods containing vitamins ]]>B12]]> , ]]>B6]]> , and ]]>folic acid]]> .
  • Maintain a ]]>healthy weight]]> .
  • ]]>Exercise]]> regularly.
  • ]]>Quit smoking]]> .
  • Control diabetes.
  • Control blood pressure and cholesterol levels.
  • Minimize psychological ]]>stress]]> .
  • Take aspirin daily if recommended by your doctor.
  • Drink alcohol in moderation (no more than one to two drinks per day).