A heart attack occurs when blood flow to the heart muscle is interrupted. This deprives the heart muscle of oxygen, causing tissue damage or tissue death.
Anxiety, especially feeling a sense of doom or panic without apparent reason
Unusual symptoms of heart attack (may occur more frequently in women):
Stomach pain
Back and shoulder pain
Confusion
Fainting
Diagnosis
If you think you are having a heart attack, call 911 immediately. You need emergency medical care.
Tests may include:
Blood tests—to look for certain enzymes found in the blood within hours or days after a heart attack. Blood tests will be repeated every 6-8 hours to track the enzymes’ progressive elevation that indicates heart muscle damage.
Urine tests—to look for certain substances found in the urine within hours or days after a heart attack
Electrocardiogram (EKG)
—records the heart's activity by measuring electrical currents through the heart muscle. Certain abnormalities in the EKG occur when there is significant blockage of the coronary arteries and/or damage to the heart muscle. The EKG will be repeated to track the progression of these changes.
Echocardiogram
—uses high-frequency sound waves (ultrasound) to examine the size, shape, function, and motion of the heart
Stress test
—records the heart's electrical activity under increased physical demand. A stress test can also be combined with an echocardiography. Patients who cannot exercise may be given a medication intravenously that simulates the effects of physical exertion. A stress test is done usually days or weeks after the heart attack.
Nuclear scanning—Radioactive material (such as thallium) is injected into a vein and observed as it is absorbed by the heart muscle. Areas with diminished flow, and therefore uptake of the radioactive material, show up as dark spots on the scan.
Electron-beam CT scan (coronary calcium scan, heart scan,
CT angiography
)—a type of x-ray that uses a computer to make detailed pictures of the heart, coronary arteries, and surrounding structures. This type of CT scan measures the amount of calcium deposits in the coronary arteries. Based on that and other health information, the test attempts to determine the risk of heart disease, including heart attacks. The American Heart Association (AHA) published guidelines in 2006 indicating that heart scans are not for everyone and those most likely to benefit from the procedure are patients at intermediate risk of coronary artery disease.
Coronary angiography
—X-rays are taken after a dye is injected into the arteries to look for abnormalities (narrowing, blockage) in the coronary arteries.
Treatment
Treatment may include:
Oxygen
Pain-killing medications (such as morphine)
Nitrate medications
Beta-blockers
Aspirin and other antiplatelet agents
Beta-blocking and/or ACE inhibitor medications
Anti-anxiety medications
Clot-dissolving agents (thrombolytics) —Within the first six hours after a heart attack, you may be given medications to break up blood clots in the coronary arteries.
Other medicines that may be given along with clot-busting agents include medications that block the function of platelets (called platelet IIb/IIIa receptor blockers).
Cholesterol-lowering medications
Anti-anxiety medications
ACE inhibitors (frequently given)
Depending on a patient’s specific situation, there are many different medications that may be given in combination. Your doctors will determine which ones are the best for you
Surgery
Surgeries for people with severe blockages in their coronary arteries may include:
According to a review of 23 studies, patients who received CABG had more angina relief and less need for another, similar procedure than those who received percutaneous coronary intervention (PCI). PCI involves techniques using
balloon angioplasty
or
coronary stenting
.
*
Physical or Rehabilitative Therapy
During recovery from a heart attack, you may need physical or rehabilitative therapy to help you regain your strength.
Psychotherapy or Antidepressant Medication
Some people have
depression
after suffering a heart attack. If you do, psychotherapy and/or antidepressant medications may help relieve depression.
Prevention
Preventing or treating coronary artery disease may help prevent a heart attack.
Ask your doctor about taking a small, daily dose of aspirin. It has been shown to decrease the risk of heart attack.
Ask your doctor about taking cholesterol-lowering medications.
Ask your doctor about taking medication to improve heart function or prevent future heart attacks, such as:
Beta-blockers
ACE-inhibitors
Blood thinning medications
Please remember that when you are taking aspirin, certain painkillers (eg, ibuprofen), if taken together with aspirin, may put you at high risk for gastrointestinal bleeding and also diminish the effectiveness of aspirin.
RESOURCES:
American Academy of Family Physicians http://www.aafp.org
American Heart Association http://www.americanheart.org
American Medical Association http://www.ama-assn.org
CANADIAN RESOURCES
Heart and Stroke Foundation http://ww2.heartandstroke.ca/Page.asp?PageID=24
University of Ottawa Heart Institute http://www.ottawaheart.ca/UOHI/Welcome.do
References:
American Medical Association website. Available at:
http://www.ama-assn.org/
. Accessed October 7, 2005.
Heart attack. Mayo Clinic website. Available at:
http://www.mayoclinic.com/health/heart-attack/DS00094/DSECTION=8
.
Accessed on November 15, 2006.
Meier MA, Al-Badr WH, Cooper JV, et al. The new definition of myocardial infarction: diagnostic and prognostic implications in patients with acute coronary syndromes.
Arch Intern Med
. 2002;162:1585-1589.
Mollet NR, Cademartiri F, van Mieghem CA, Runza G, McFadden EP, Baks T, et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography.
Circulation
. 2005;112:2318-2323. Epub 2005 Oct 3.
Rakel RE, Bope ET.
Conn's Current Therapy 2001
. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.
What is a heart attack? American Heart Association website. Available at:
http://www.americanheart.org/presenter.jhtml?identifier=3007482
. Accessed October 7, 2005.
Updated Outcome section on 11/7/2007 according to the following study, as cited by
DynaMed's Systematic Literature Surveillance
: Bravata DM, Gienger AL, McDonald KM, et al. Systematic Review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery.
Ann Intern Med.
2007 Nov 20. [Epub ahead of print]
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
