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One of the essential internal organs of the body, the heart not only helps in pumping blood to all parts of the body through the help of the circulatory system but also helps in supplying oxygen. It also provides nutrients to the tissues, removes carbon dioxide and other impurities from the body. Thus, it becomes highly imperative to take care of one’s heart to maintain a healthy body.

What is a Myocardial Infarction or a Heart Attack?

The human heart requires a good supply of blood to stay healthy and perform all the vital functions smoothly. However, when there is a partial blockage or complete blockage of an artery, which supplies blood to the heart, a heart attack can occur. As a person grows older, the inner arteries of the heart can become narrow, or can get damaged to due fatty build-up or plague and may result in blood clots. When these blood clots completely block your blood flow to the heart or even severely reduce it, leading to unbearable pain in the chest cavity. This resulting condition is commonly known as a heart attack.

Coronary Artery Disease

The heart contains a network of blood vessels known as arteries on its surface, which helps in providing oxygen to the heart. However, sometimes, these coronary arteries that are responsible for supplying oxygen to the heart become too narrow or constrained as a result of excessive cholesterol or fat build up in the artery walls. This, in turn, increases the chances of formation of plaque. Sometimes these plague build-ups can result in breakage that may result in blood cells and blood particulars to stick on it, leading to a blood clot like formation. This is one of the main culprits in narrowing your arteries, and thus disrupting blood flow to the heart.  In a situation like this, the heart is unable to get ample oxygenated blood, especially while physical activity is being performed. This may initially result in a Coronary Heart Disease (CHD), or a Coronary Artery Disease, eventually leading to a heart attack.

What happens during a heart attack?

Heart attack, also known as Myocardial Infarction (MI), where ‘Myo’ refers to heart and ‘infraction’ refers to permanent damage or death of the tissue due to the disrupted flow of blood into the heart. The human heart is a muscle that requires a regular and uninterrupted supply of oxygen and nutrients to function correctly. Coronary arteries, which are a network of blood vessels, supply the heart with the much-needed oxygen and nutrients. When these arteries get clogged or blocked, it can lead to sudden decrease or blockage of blood flow to the heart, resulting in a heart attack. While certain heart attacks can begin slowly starting with mild discomfort and pain in the chest, others may occur all of a sudden with great intensity causing intense pain.

The seriousness of a heart attack is judged on the severity of the damage that may get caused to the heart muscle.

A cardiologist is someone who assesses the condition and establishes the damage through the process of echocardiography- an ultrasound scan of the heart. An echocardiography can help a cardiologist to not only understand the severity of the attack but also know about the type of heart attack for recommending the correct course of treatment.

Types of Heart Attacks

A heart attack can be classified into the following categories:

STEMI

A STEMI or ST-Elevation Myocardial Infarction is a very severe type of heart attack. During this kind of an attack, the coronary artery gets completely blocked, which means a significant portion of the heart gets deprived of oxygen. When a person undergoes this kind of a heart attack, it is crucial to seek immediate medical intervention because emergency and immediate revascularization may help in restoring the blood to the heart.

Revascularization can be done in two ways- while the first type can be done through thrombolytic drugs which are given intravenously, the second technique involves mechanical procedures like angioplasty that uses very thin tubes known as catheters, which are inserted in the arteries to open the blockage.

NSTEMI

An NSTEMI or Non-ST Elevation Myocardial Infarction is a different kind of heart attack which may not lead to severe damages to the patient’s heart, unlike a STEMI that causes severe damage to the heart. During an NSTEMI, the blockage to the heart is temporary or partial. The diagnosis is made on the basis of the presence of troponin- a type of protein that is released when any kind of damage is caused to the heart.

The treatment usually consists of medication; however, the right course of treatment may depend on the severity of the blockage. Sometimes cardiologists may suggest an angioplasty or a cardiac bypass graft surgery.

Coronary Artery Spasm

Also, known as a silent heart attack, a coronary spasm or unstable angina, a Coronary Artery Spasm is a occurs when the arteries tighten up, leading to a drastic decrease or a complete stoppage of blood flow to the heart. This type of a heart attack is a bit difficult to diagnose because it may not get identified during an angiogram – the test that is used to check for blockage in the arteries. Also, a Coronary Artery Spasm can reoccur since it does not result from a clot or a plaque build-up in the artery. The treatment of coronary artery spasms can be done through medication.

Demand Ischemia

A Demand Ischemia can occur when the heart requires more oxygen than the body can provide. This usually occurs in patients with anaemia, other infections or tachyarrhythmia. These heart attacks can be detected through blood tests since the presence of certain enzymes in the blood can help to establish any damage to the heart.

Symptoms of a Heart Attack

It is important to seek medical help under any condition pertaining to the heart. While sometimes certain symptoms of a heart attack are evident, in other instances, it becomes important to exercise extra caution. Here is a list of heart attack symptoms that cannot be overlooked under any circumstances.

  • Chest pain or discomfort: One of the most common and prominent signs of a heart attack is experiencing pressure, tightness or severe pain in the chest. Every person may experience this pain or discomfort in a different manner- while for some it may seem like a sharp shooting pain, for some it may appear as if a heavy object has been placed on the chest.
  • Indigestion, stomach pain, heartburn or nausea: Some people may experience early symptoms of indigestion that may include, ache in the tummy, heartburns and vomiting. Though most of the times, the symptoms are associated with indigestion itself; however, if in case of other associated instances of chest pain, immediate medical consultation is suggested.
  • Pain in the chest that travels to the arm: One of the most common symptoms of a heart attack is the pain that radiates from the chest to the left arm. Most of the times, people mistake heart attacks to be a common pain in the arm.
  • Pain in the throat or jaw: Often pain in the throat or in the jaw is related to sinusitis. However, if the pain radiates from the chest and reaches up to the throat and jaw, it may be indicative of a heart attack

Other symptoms of a Heart Attack

  • Light-headedness or dizziness: While dizziness may result from multiple causes like standing up all of a sudden, or due to lack of proper nutrition; however, sudden unexplained and unsteady dizziness or light-headedness could be one of the symptoms of a heart attack. This may occur from a sudden decrease in blood pressure due to disrupted blood flow to the heart.
  • Sudden exhaustion: In case of sudden changes in health conditions during any kind of physical activity including climbing stairs or carry heavyweights, which could be done without any hassle earlier, gives a good enough reason to visit a doctor and get symptoms of a heart attack, deduced.  
  • A chronic cough that won’t go: Cough, in general, is not associated with a heart condition. However, if there’s an unexplained cough is persistent that refuses to go and it accompanied by pink or white mucus, it may be one of the symptoms of heart failure.
  • Excessive sweating: Sweating profusely for no evident reason is a very prominent symptom of a heart attack that certainly should not be ignored. Therefore, in cases of excessive sweating out of no reason, along with other associative heart attack symptoms, medical attention is recommended at once.
  • Irregular heart rhythm or beat:  While a racing or an irregular heartbeat is common during any physical activity; in case this phenomenon is experienced more often, one should get in touch with their doctor immediately.

Symptoms of a Heart Attack in women

Most common symptoms of a heart attack in women may include sudden chest pain or discomfort, shortness of breath, nausea, vomiting, back pain or jaw pain.

Major Causes of a Heart Attack

One of the main reasons that may result in heart attacks or coronary heart diseases is when one of the major arteries gets blocked due to fatty deposits of cholesterol. The blood clot of plague may rupture in the artery leading to a drastic reduction in the blood supply to the heart – thus causing a heart attack.

Though the step-by-step process that can lead to a heart attack has not completely been established, however, here are some dietary reasons or lifestyle causes that may make a person susceptible to having a heart attack.

  • A high-fat diet: A diet that contains more than the required amounts of fat may lead to an increase in the cholesterol levels of the body. Increased cholesterol can lead to excessive fat build-up in the arteries leading to a heart attack.
  • Diabetes: Diabetes can cause a heart attack in certain cases. If the blood sugar levels are high for a long period of time, then it may lead to damage in the blood vessels and nerves of the heart.
  • Smoking: Smoking is dangerous for the heart since it can damage the lining of the arteries that may end up in fat build-up, which eventually may lead to narrowing of the arteries. This can lead to a heart attack or a stroke.
  • Obesity and being over-weight: Obesity is one of the main culprits of a heart attack. Excess amount of weight means more pressure on the heart to pump excess blood. This extra pumping often exerts an additional strain on the heart, sometimes leading to a heart attack.
  • High cholesterol: High amounts of cholesterol can lead to fatty deposits in the blood vessels. Sometimes these deposits can grow considerably in size, making it difficult for the blood to flow in the arteries. And at times these deposits can rupture suddenly, forming a clot that can cause a heart attack.  
  • High blood pressure: A condition of hypertension or high blood pressure may put extra stress on the heart and may lead to narrowing of blood vessels and fat build-up, thus making a person more prone to this condition.
  • Genetics: One of the major reasons one may have this condition is because of their genes. This means people who have a family history of heart ailments are a good amount of chance of having a heart attack.

Other causes of a Heart Attack

The above mentioned are common causes that may result in a heart attack; however, there are some lesser common reasons too that can result in one.

  • Hypoxia or insufficient oxygen in the blood: If a person experiences any a loss of lung functioning or decreased levels of oxygen in the blood due to carbon monoxide poisoning, the heart does not get ample oxygenated blood. This condition may damage the heart muscles and cause a heart attack.
  • Drug Misuse: Consumption of stimulant drugs such as methamphetamines, amphetamines, cocaine, and more can sometimes result in narrowing the coronary artery. This stops or reduces the blood flow to the heart to serious levels, causing a heart attack.

Risk factors

Wondering what can put one at an increased risk of having a heart attack? While some risk factors can be avoided, others may not be easy to evade. Also, there are certain people who are at more risk than others, and it majorly depends on your risk factors. Here are various factors that may put a person at an increased risk of having a heart attack.

  • Age factor: Men who have crossed the threshold of 45 years of age, or women who are more than 55 years of age, there lays an increased chance of the risk of having a heart attack.
  • Family history: If anyone in the family has had a heart condition, especially before the age of 55, then there is always an increased risk of having this condition.
  • Past record of coronary disease: People who have experienced any coronary heart diseases or a heart attack in the past; it increases their chances of having a heart attack to a considerable extent.

Other risk factors that can be controlled

  • People suffering from any kind of diabetes, such as Type 1 or Type 2, it is important that they keep their blood glucose levels under check, since higher glucose levels may damage the arteries and increase the risk of a heart attack.
  • Lack of any kind of physical activity that not only increases one’s chances of obesity but also puts them at risk of developing other health conditions such as hypertension, high cholesterol, diabetes, and more, are indirectly linked to increasing the chances of a heart attack.
  • Having high amounts of cholesterol in the blood can lead to fat deposits in the arteries that cause narrowing of arteries leading to a sudden decrease or blockage of blood flow. People suffering from high amounts of cholesterol, should always keep them under check and consult a doctor at regular intervals.
  • Smoking is one of the self-inflicted conditions that put a person at a higher risk of having a heart attack since the nicotine in the cigarette causes the coronary arteries of a person to become narrow.
  • Excess pressure in the blood known as high blood pressure or a condition of hypertension is something that can damage the arteries and lead to a heart attack.

Complications during a Heart Attack

While experiencing a heart attack, sometimes the concerned person may develop other complications too. Some of the common complications that may arise are:

Sudden cardiac arrest

This is a condition in which certain electrical disturbances can occur in the heart, which can lead to disruption of the heartbeat altogether. This condition can be fatal, and therefore, immediate medical intervention is required.

Abnormal heart rhythm

Arrhythmia or abnormal heart rhythm is a condition when the heartbeat is irregular, which means it is either slower or faster than the normal rate. Such a condition can quickly turn fatal because the blood can pool up, leading to clots. These clots are dangerous and may sometimes travel to the lungs causing pulmonary embolism or even travel to the brain, causing a stroke.  

Heart failure

A heart attack can damage the way in which the heart functions, and sometimes it may affect the pumping function of the heart by making it weaker. This condition disrupts the regular heart functions due to which the heart fails to pump ample blood required to meet the body’s needs.

Valve problems

The heart comprises of four valves, which help in pumping the blood to all parts of the body. A heart attack can sometimes damage one of these valves. This can lead to further problems in the valve functioning, including shortness of breath, dizziness, fatigue, swelling of the feet or ankles, and more.

May cause depression

Suffering from a heart attack can not only take a toll on one’s physical health, but it can also make them emotionally weak, leading to depression. It is seen that nearly 33% of people who have suffered a heart attack are most likely to suffer depression because of their ailment. Depression may sometimes get difficult to identify, however, if there are considerable changes in appetite, sleeping schedules or habits, social activities and other lifestyle changes post a heart attack, it is advisable to get in touch with a doctor.

It is advisable to keep a check on the blood sugar levels, blood pressure, cholesterol, and other such factors while also maintaining essential lifestyle choices to remain healthy.  

Diagnosis of a Heart Attack

A Myocardial Infarction, or in more simple terms, a heart attack, arises out of several symptoms. While some people are more susceptible to cardiac issues than others, the truth is that anyone could suffer a heart attack, due to any number of causes. Myocardial infarctions could be caused by anything, from genetics, to stress, to obesity and being overweight, to other underlying causes that may not have been spotted.

So, how does one spot a heart attack, after suspecting it?

While the timely intervention of a cardiologist is key here, there are a couple of tests and procedures that one needs to undergo to diagnose a heart attack.

12 Lead ECG

What may sound like a very technical term; a 12-Lead ECG is something most people have come across.

The 12-Lead ECG is a medical test which uses to record the heart’s electrical activity using a series of electrodes that self-adhere. Usually used with some type of conducting gel, these electrodes are attached to several parts of the body, primarily across the chest. These measure definitively the electrical impulses and signals of the heart, and then note these signals down on graphing paper, that then proceeds to print it out. These ECGs are then analysed by cardiac specialists, who measure and examine the causes of the patient’s discomfort. In case of additional symptoms of a heart attack, such as shortness of breath, discomfort, dizziness, nausea and more, a 12-lead ECG helps to establish the root cause and identify the risk factors for the patient.

A 12-lead ECG also identifies if the heart chamber walls are too thick, check the functioning of implanted mechanical devices like pacemakers, or understand if medicines are working fine or the patient is at risk of side effects.

Blood Studies

Today, in addition to a traditional ECG that uses electrodes placed at strategic spots on the body, blood tests can also establish any heart issues someone might have. Using what is described as a high sensitivity troponin test, cardiac specialists may help to decide whether someone’s symptoms are symptomatic of heart issues, or completely unrelated.

Additionally, blood tests can help identify if there is a higher-than-usual level of proteins in one’s bloodstream; something that may eventually lead to a heart attack. Apart from the Troponin Test, other blood studies for heart attacks include the CK or CK-MB tests and Serum Myoglobin Tests. Often, blood tests are repeated after a certain period to check if one is at risk of heart disease.

In some cases, patients with cardiac issues do not necessarily present classic symptoms on an ECG, but might still be having to deal with symptoms of a heart attack; in which case a blood test is considered useful. Those subjected to the blood test with levels of the hormone troponin elevated in their blood are considered as having cardiac issues.

Echocardiogram

An echocardiogram or ECG is the primary way of finding out if someone has either suffered a Myocardial Infarction or is in any way, at risk of one. The most standard procedure of checking for heart ailments, the primary ECG or echocardiogram uses an ultrasound that is very similar in concept to what is used for conducting scans in pregnant women.

An ECG uses sound waves to produce images of the heart, which is then studied by a cardiologist to understand the patient’s heartbeat and if the heart is pumping blood regularly. The ultrasound waves in an ECG also help in assessing the functioning of the cardiac muscles, as well as the valves of the heart.

The standard kind of ECG used to diagnose Myocardial Infarctions uses a hand-held device that is similar to the one used in sonograms as well. Known as a transducer, this device transmits waves of sound through the chest. These sound waves reflect or reverberate off the cardiac muscles and valves and record the sound wave echoes from one’s heart. These echoes are then converted into moving images on a computer to show if the structures are all normal, or if there are any structural issues.

Cardiac catheterization

A cardiac catheterization measures the effectiveness of the blood vessels in terms of supplying blood to and from the heart. It is a diagnostic procedure that involves invasive methods to gather information about the health and functioning of the heart. During a cardiac catheterization, a catheter – a long, narrow tube is placed within the leg or arm. While an ECG uses soundwaves, this procedure uses more obvious visual cues. During cardiac catheterization, a special coloured dye is injected into the patient and directed towards the heart muscle. The coloured dye thus injected is known as a contrast dye, and easily shows up on X-rays and other scans.

The technique of taking X-rays of the heart arteries is called coronary angiography or arteriography, and the images deduced are termed at coronary angiograms or arteriograms.

Management and Treatment of a Heart Attack

There are several ways to not only identify but also effectively treat heart issues. Particularly, if these issues are identified in their early stages, their efficacy is much more. In an ideal situation, preventative action is far more helpful and can be achieved by a couple of factors as listed below.

Medications

Medication, in fact, may come across as a difficult way to keep track and deal with potential heart issues. However, medication is often the most effective course of action that can be used as a preventive measure against heart attack.

There are a number of medications available to tackle each specific heart-related issue, tending to everything ranging from high blood pressure to an irregular heartbeat. There might also be issues stemming from arterial disease, where the walls of the arteries sometimes prevent effective blood flow. When taken regularly and timely, medication can not only help one deal with existing heart issues but potentially help prevent any larger ones from occurring in the future.

A common medication to prevent heart attacks can include anti-clotting medicines like Aspirin, anti-platelet medicines like Clopidogrel, anti-coagulant medicines like Warfarin, anti-anginal medicines like Nitrates and other blood-pressure and cholesterol medicines.

Door to Balloon Time

Door-to-balloon time or D2B, as known in the medical community, is described as the time from which emergency services are at the door of a patient who has suffered a Myocardial Infarction, till the time that a catheter guide wire has been inserted as part of the cardiac catheterization procedure. This means that doctors, and emergency technicians, consider the time from which the patient has been brought in or tended to, till the time that a catheter has been utilised to unblock the offending artery and minimise damage to the cardiac muscles. The longer this takes, the higher the risk of damage to the cardiac muscles. D2B is typically given as 90 minutes, in order to decrease any lasting damage from the Myocardial Infarction someone has suffered from.

Interventional Procedures

An interventional procedure is made to increase the strength of the blood flowing through the body in the event of a heart attack. Once a cardiac catheter has been placed, one of many interventional procedures can be performed on a patient.

One of the most common interventional procedures is a Balloon Angioplasty, which involves the use of a balloon to increase the width of arteries so that blood can flow into the heart more easily. The expansion of the balloon expands the arteries for this exact purpose.

Sometimes, the Balloon Angioplasty is done in combination with a stent, which is a device that is placed within the artery. A tube made of meshed metal, the stent takes on the shape and form of the artery that it is placed in, thus opening it up and expanding it. The artery then begins its healing process around the stent.

There is also a procedure known as a drug-eluting stent, when a stent has a light coating of medication that is slowly released into the coronary arteries to block cell proliferation, or reduce any other medical risks generally associated with the heart, or the post-care of a Myocardial Infarction.

Coronary Artery Bypass Surgery

The arteries that supply blood to the heart are called coronary arteries. Blockage in any blood vessel is bad news but is particularly significant if coronary arteries, which keep the heart tissue alive, are blocked. Coronary Artery Bypass Surgery, or CABG, more commonly known in India as Bypass Surgery, is ideal for patients who have obstructive heart issues, or if they have had a serious heart attack earlier.

CABG works in an interesting way, where blood vessels from healthier parts of the body are taken and reconnected to those around the blocked coronary artery, which is what the procedure is named after. The other blood vessels involve the use of arm and leg veins, and patients who have had a CABG are usually made to undergo severe lifestyle changes after their surgery.

Prevention of Heart Attacks

It is far easier and better to take preventive measures to combat a heart attack or a Myocardial Infarction than deal with the much larger, more significant consequences at a later time. While certain risk factors related to age or family history cannot be changed, there are certain conscious lifestyle choices one can adopt to help reduce the risk of heart disease.

Of course, this is not to say that everyone who suffers a heart attack is following an unhealthy lifestyle. Many people who lead healthy lifestyles exercise at regular intervals, eat healthily, still suffer heart attacks, often quite suddenly; this could be due to a number of genetic or external factors.  However, here are a couple of preventive measures against heart attacks.

Medication to combat genetic risk

People who are at risk of having a heart attack can seek medical assistance by consulting a doctor, who can put them on the relevant medication. For example, either low or high blood pressure, kept untreated for a long time, could contribute to heart issues. Preventive medication can help stem these issues before they occur, saving health, time and money as a result.

Additionally, Type 2 diabetes screening, especially for people with a family history of diabetes, are advised to get themselves retested at three-year intervals.

Lifestyle changes

Leading an active, healthy lifestyle goes a long way in preventing heart attacks. According to research, those who walked briskly for a minimum of 30 minutes a day had a 20% lowered risk of suffering from a potential heart attack.

Apart from ensuring sound physical health, mental health, goes a long way in helping prevent a heart attack. Minimising day-to-day stress in whatever way possible goes a long way in cardiac disease prevention since stress is one of the major causes of a heart attack. For example, even a few minutes of mindfulness or meditation each day can help to destress. Taking time out for oneself, family, or simply pursuing pastimes or hobbies is also helpful in dealing with stress, and preventing heart attacks in turn.

Also, a healthy diet goes a long way in ensuring a healthy heart while also keeping blood pressure, diabetes and cholesterol levels in check. It is recommended to include green vegetables, lean meat and fish, fat-free dairy, whole grains and olive oil in one’s diet. Intake of salt, processed carbohydrates, sugar, alcohol and saturated fat should be limited.

Avoiding smoking and limiting alcohol is also one of the preventive measures of heart attacks. Smokers, both active and passive, are at high risk of a heart attack as compared to a non-smoker. Also, too much alcohol consumption can lead to multiple diseases, including high blood pressure, irregular heartbeats, or sudden stroke.

Conclusion- Heart Attacks

There is no hard and fast rule as to when, or how a heart attack will strike, or whom; indeed it will strike. Of course, some people are at a higher risk either due to physical health issues, or genetic factors, or lifestyle choices. However, there are ways to deal with heart attacks when they happen, depending on the patient, the issues that have caused the heart attack, their overall health, their viability for operation – and more. Heart attacks, depending on their severity, might need stents or implants, or might need surgery; all of which are subjective to the doctor’s recommendations.

While theoretically, anyone could suffer a Myocardial Infarction, there are preventive measures; both medical and non-medical, which mostly involve switching to a more conscious and healthy lifestyle, that could prevent one. Consulting with a physician or a cardiac specialist to assess one’s heart health, ensure early detection of risk factors and take preventive measures is an excellent way to start.

Adequate knowledge about the signs and symptoms of a heart attack is always useful. Sharing knowledge amongst friends and family members about the initial or warning signs of a heart attack, common do’s, and don’ts will also help raise awareness and act as a preventive measure.

FAQs: Heart Attacks

  1. What are some of the dietary changes one can make to prevent a heart attack?

For those who are at high risk of a heart attack, or have already had one, it is generally recommended to incorporate more vegetables and fruits into their diet. Whole grains, pulses, and healthy vegetables are filling, deliver more nutrients to the body, and contribute to overall health. For meat-eaters, cutting down on red and fatty meats, and switching to leaner options like chicken, turkey and other poultry is proven to contribute to overall health.

  • Are women at a higher risk of heart attacks than men?

Males or females, anyone can suffer a Myocardial Infarction. However, the risk factors change for men and women. Men are affected by heart issues younger than women are, but women are less likely to survive a major heart attack. Women, however, are advised not to ignore the slightest symptoms of a heart attack.

  • How is smoking related to heart disease?

There is a strong correlation between smoking and heart diseases. Statistics say that 20% of all heart attacks are brought on by smoking. The nicotine present in cigarettes constricts blood flow to the heart, increases blood pressure, and even diminishes the oxygen in the blood. Smoking also leads to blood clots, which again can be a big factor in a heart attack. Second-hand smoke too can cause heart attacks – so quitting smoking can even protect your loved ones.

  • Do lifestyle habits or genetics impact the general health of the heart?

Both. There are a number of lifestyle changes that can drastically improve the quality of life, even if one has already suffered a heart attack. One might also, as a result of genetics, be at an elevated risk of suffering a heart attack. Then, it becomes even more important to prevent the other underlying causes that could spur on a heart attack.

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