What is a heart attack?
A heart attack is also known as a myocardial infarction (MI). “Infarction” means death to the tissue due to lack of blood supply, in this case, to the heart muscle. Approximately one million Americans suffer a heart attack each year. Four hundred thousand of these victims die as a result. Prompt medical attention can often repair these abnormalities, which otherwise could be fatal.

What causes a heart attack?
The heart is the body’s hardest working organ. It continuously pumps blood enriched with oxygen and vital nutrients through a network of arteries to all parts of the body. It has its own set of arteries, known as coronary arteries that carry oxygen-rich blood to the heart’s muscle wall. If blood flow to the heart is interrupted or blocked, an infarct (heart attack) occurs. The blockage that occurs is usually from the buildup of plaque (deposits of fat-like substances) due to atherosclerosis or hardening of the arteries. Smoking, high blood pressure, elevated cholesterol levels and diabetes can accelerate plaque build up. Heredity is a powerful factor that contributes to early heart disease. Being male is a risk factor, but the incidence of heart disease in women increases dramatically after menopause. A heart attack is a medical emergency, because in many cases the heart rhythm can be disturbed. If the blood supply is cut off severely or for a long time, muscle cells suffer irreversible damage and die. Disability or death can result, depending on how much heart muscle is damaged.

What are the symptoms of a heart attack?

• Chest pain (angina) is not a heart attack, but may be a warning of an impending heart attack. Angina occurs when the heart muscle is not receiving enough oxygen. Chest pain is often described as a squeezing, burning, tightness, fullness, or pressure across the chest. Angina is often mistaken for indigestion.
• Pain radiating to the shoulder, arms (especially the left), neck, jaw, teeth, earlobes, as well as the upper back between the shoulder blades.
• Numbness or tingling in the arms or hands may occur.
• Nausea and vomiting
• Shortness of breath
• Profuse sweating

How is a heart attack diagnosed?
Chest pain that lasts longer than 15 minutes should be evaluated immediately. Calling paramedics is the fastest and safest way to ask for help. Once you are in the emergency room or a doctor’s office, an electrocardiogram (EKG) will be performed. While an abnormal EKG may indicate a heart problem, the EKG is sometimes normal even when heart damage is present.

Blood tests are often performed to check the level of enzymes that may be elevated if heart injury is present. A medical history and physical exam will include related symptoms and current status.

How are heart attacks treated?
The most important part of treating a heart attack is restoring the flow of blood to the heart muscle as fast a possible. Listed below are tests and procedures that may be involved during the course of treating a heart attack as well as follow up related to preventing future heart attacks:

• Aspirin has been shown to improve survival of patients with a heart attack.
• “Clot Busting” or Fibrirolytics Therapy: Medication is given to dissolve the blood clot that may be causing the heart attack. The sooner the drug is given, the sooner the blood flow can be restored.
• Cardiac Catheterization (coronary angiography): This is a procedure performed in a special lab using local anesthesia and sterile conditions. A catheter is placed into the heart through an artery or vein in the groin or arm. Dye is injected through the catheter into the coronary arteries and heart chambers and x-rays are taken and recorded for evaluation. This allows the physician to determine blockage that may be present as well as the status of the heart muscle.
• Balloon Angioplasty / Stent Placement: Balloon angioplasty is a procedure used to dilate (widen) narrowed arteries. A doctor inserts a catheter with a deflated balloon at its tip into the narrowed part of the artery. Then the balloon is inflated, compressing the plaque and enlarging the inner diameter of the blood vessel so blood can flow more easily. Then the balloon is deflated and the catheter removed. The stent procedure uses a wire mesh coil tube (a stent) to open an artery that's recently been cleared using angioplasty. The stent is condensed to a small diameter, placed over an angioplasty balloon catheter and moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold to hold the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms (usually chest pain).
• Coronary Artery Bypass Graft Surgery: This surgical procedure involves removing a portion of a vein in your leg or the internal mammary artery from your chest and using it to “bypass” the blockages in the coronary artery to improve the supply of blood and oxygen to the heart.
• Medical Therapy including beta-blockers, ace inhibitors (when indicated), and statins (treatment that lower the cholesterol levels) can improve the patient’s chances to live longer and reduces the risk of a second heart attack.

How can a heart attack be prevented?
It is very important to change any risk factors that are currently present and maintain compliance with the regimen recommended by your physician. Listed below are ways to reduce your risk of a heart attack:

• Smoking cessation
• Lowering your cholesterol using diet and /or medications
• Exercise
• Weight reduction, if indicated
• Monitor diabetes closely