Heart Attack: the Silent Killer in 21st Century

Introduction:

Heart diseases are extremely common in the present day, given the modern lifestyle and the numerous stresses existing in the 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. Approximately one in seven deaths in the United States is because of coronary heart disease, which includes heart attacks.

What Is a Heart Attack?

A heart attack occurs when a part of the heart muscle does not get sufficient blood or the blood flow to the heart is blocked. Angina is a medical term for 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.

What Are the Symptoms of a Heart Attack?

The symptoms of a heart attack may vary among men and women. The common symptoms include:

• Shortness of breath.

• Heart palpitations.

• Pain or discomfort in the neck, jaw, or back.

• Pain and numbness in one or both arms or shoulders.

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• Weakness or coldness in the legs and arms.

• Severe anxiety and a sense of impending doom.

What Is the Cause of a Heart Attack?

The cause of a heart attack is a syndrome complex called coronary artery disease (CAD). CAD is caused by 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 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 further leads to a heart attack.

What Are the Tests Done to Diagnose Coronary Artery Disease?

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

1. Electrocardiogram (ECG) - This is an electrical recording of the heart which measures the pattern of electrical activity, rate, and regularity of the heart.

2. 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.

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

4. Chest X-Ray - This delineates the enlargement of the heart and gives an idea of the state of the lungs.

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 arm (radial), reaching the heart. A dye is injected, and the blocked or poorly perfused areas where the dye cannot perfuse are 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.

What Are the Treatment Options for Heart Attack?

Several effective treatments are available to treat heart attacks. First and foremost is a 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 that prevent clot formation. These include Rivaroxaban, Apixaban, Dabigatran, Heparin, and Warfarin.

• Anti-platelet drugs prevent platelet adhesion, a defining step in the pathogenesis of plaque formation. These include Aspirin, Clopidogrel, Dipyridamole, Prasugrel and Ticagrelor.

• Angiotensin-converting enzyme (ACE) inhibitors are essential in controlling high blood pressure, which is another important predisposing factor in a heart attack.

• Angiotensin II 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 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 blood pressure by increasing urinary excretion.

• Vasodilators dilate the blood vessels and help in lowering blood pressure. These include Isosorbide Dinitrate, Minoxidil, Hydralazine, and Nesiritide.

• Statins lower the levels of cholesterol and prevent atherosclerotic plaque formation. These drugs are indispensable in the prevention of a heart attack.

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

One should also know the following first aid steps for a heart attack, as they must help at times.

• Do not panic; stay calm, and do not move.

• Call out for help. Do not shout; use a mobile phone if available.

• Do not walk or climb stairs to avoid exertion.

• Chew one tablet of Aspirin or Isosorbide dinitrate if available at home and keep it under the tongue, and do not swallow.

Conclusion:

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. If a person is at higher risk of heart attack, go for regular follow-ups, testing, and care to avoid any such occurrence.