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Heart Attack: the Silent Killer in 21st Century

Written by
Dr. Alok Vinod Kulkarni
and medically reviewed by iCliniq medical review team.

Published on May 21, 2016 and last reviewed on Jul 10, 2019   -  4 min read



Heart diseases are extremely common in the present day given the modern lifestyle and the numerous stresses existing in the 21st century. This article enumerates the causes of heart attack, elaborates the symptoms of heart attack and deals with preventive and therapeutic strategies.

Heart Attack: the Silent Killer in 21st Century

Ischemia refers to an obstruction in blood flow. Ischemic heart disease (IHD) is a spectrum that includes angina pectoris, atherosclerosis, coronary artery disease and myocardial infarction. Acute myocardial infarction, commonly known as heart attack, is a serious problem.

Heart Attack - Typical Presentation

Angina is a medical term for the commonly experienced chest pain. The typical presentation of a heart attack includes left sided chest pain, chest discomfort and the feeling of a band being tied around the chest. This pain may radiate to the jaw, left arm or shoulder. Many perceive this discomfort as vague chest tightness, epigastric discomfort or burning sensation in the chest. This may also be accompanied by diarrhea. It is frequently misdiagnosed as acidity or gastric trouble. Suffice it to say that consulting a cardiologist is of vital importance in such a situation.

Symptoms of Heart Attack

The symptom of a heart attack includes

  • shortness of breath,
  • pain and numbness,
  • weakness or coldness in the legs and arms.
  • There is severe anxiety and a sense of impending doom.

Coronary Artery Disease

  • The cause of a heart attack is a syndrome complex called the coronary artery disease (CAD).
  • CAD is caused by the plaque, which is the build up of fatty material in the walls of the blood vessels supplying the heart. These are termed coronary arteries.
  • The components of this fatty material include cholesterol, fibrin, platelets and other such substances. These serve to narrow down the lumen (thickness) of a blood vessel. Such a narrowing down results in obstruction of blood flow to the heart and then further leads to heart attack.

Tests to Diagnose CAD

There are several cutting edge and effective tests available to diagnose CAD. These tests are to be interpreted by a well trained cardiologist as interpretation of these tests lays the foundation for further management.

Electrocardiogram (ECG):

This is an electrical recording of the heart which measures the pattern of electrical activity, rate and regularity of the heart.

Echocardiogram (Echo):

This requires specialized training in its interpretation. This detects areas of poor contractility, areas that are poorly perfused and structural heart changes. This employs sound waves to create an image of the heart that gets displayed on a screen.

Exercise Stress Test:

This is also called the treadmill test (TMT). This determines how efficiently the heart copes during periods of duress when it has to pump at a faster rate to meet the exercising body's increasing demands.

Chest X-ray:

This delineates the enlargement of the heart and gives us an idea of the state of the lungs too.

5. Coronary Angiogram:

This is the most definitive and important test in determining the blockage of arteries. Angiography is done only by an interventional cardiologist. Here, a thin, slender, flexible guide wire is passed from a major artery in the thigh (femoral) or in the arm (radial) which then reaches the heart. A dye is injected and the blocked areas or poorly perfused areas, where the dye cannot perfuse, get displayed on a monitor. This is done under fluoroscopic guidance. The cardiologist then determines the blocked areas by carefully inspecting the screen monitor. This is a safe and painless procedure.

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Heart Attack Treatments

Several effective treatments are available to treat heart attack. First and foremost is the lifestyle change including healthy food habits and regular exercise. Then it has to be followed by drugs and interventional procedures.

1. Drug Therapy:

  • Anticoagulants are blood thinners which prevent clot formation. These include Rivaroxaban, Apixaban, Dabigatran, Heparin and Warfarin.
  • Anti-platelet drugs prevent platelet adhesion which is a defining step in the pathogenesis of plaque formation. These include Aspirin, Clopidogrel, Dipyridamole, Prasugrel and Ticagrelor.
  • Angiotensin-converting enzyme inhibitors are essential in the control of high blood pressure which is another important predisposing factor in a heart attack.
  • Angiotensin ll receptor blockers include Candesartan, Eprosartan, Irbesartan, Valsartan, Telmisartan and Losartan. These are also used to treat high blood pressure.
  • Beta blockers include Atenolol, Metoprolol and Sotalol among others. These help in remodeling of the heart following a heart attack.
  • Calcium channel blockers along with beta blockers are used to treat rhythm disturbances of the heart which may accompany a heart attack. These include Diltiazem, Verapamil and Nifedipine among others.
  • Diuretics lower the blood pressure by increasing urinary excretion.
  • Vasodilators dilate the blood vessels and help in lowering the blood pressure. These include Isosorbide Dinitrate, Minoxidil, Hydralazine and Nesiritide.

2. Interventional Procedures:

Coronary Angioplasty: Here a stent is placed in the blocked blood vessel which dilates it and prevents further narrowing. This results in good perfusion to the heart with immediate symptom relief. This is the gold standard treatment for a heart attack. Stents may also elute drugs which are released in a constant and pulsed manner which prevent vessel narrowing. The latest development is the bioabsorbable vascular scaffold (BVS).

3. First Aid:

You should also remember these first aid listed for heart attach as they must help you at time.

In summary, heart attacks are an important public health problem and it is critical to increase awareness about them. It is equally critical to consult the right person in such an emergency situation.

For further doubts regarding heart attack consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist


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Last reviewed at:
10 Jul 2019  -  4 min read


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