Heart Attack Causes and Prevention
A heart attack is due to part of the heart not receiving sufficient blood. The heart is made almost entirely of muscle, but it cannot obtain the necessary oxygen and other vital elements from the blood within it, because the chambers of the heart are lined with an impervious membrane and there are no fine blood vessels leading into the heart muscle from the chambers. All the blood to keep the heart alive and well passes through three small arteries that circle around the heart and send small vessels into the muscle. If one of these arteries is blocked, one part of the heart muscle cannot obtain sufficient blood, and dies. This is a heart attack or myocardial infarct. If you put a tight rubber band around your finger, you cut off the finger's blood supply. It rapidly becomes painful and would eventually wither and die. The same thing happens in the heart, but more rapidly, because the heart must keep working hard with every beat, while your finger is at rest.
The arteries of the heart can be blocked by fatty deposits that build up in the arteries because the patient is overweight or has high cholesterol levels, by clots or fat globules breaking off from damaged blood vessels elsewhere in the body and blocking an artery, or by damage to the artery from many years of high blood pressure.
Many patients feel unusual chest discomfort, a change in their angina pattern, or complain of 'indigestion' for hours, days or even weeks before a heart attack. When the heart attack occurs, the patient feels a severe crushing pain in the chest and shortness of breath. The pain builds up rapidly in waves, and then persists for some time before gradually fading. The pain may be accompanied by sweating, weakness, anxiety, dizziness, cough, nausea and vomiting. Most patients seek medical aid rapidly because of the severity of the symptoms, and this is vital, because doctors can give medications by injection that stabilize the heart and prevent it from stopping completely. Unfortunately, some heart attacks create minimal discomfort, and may be dismissed by the patient as a passing attack of severe indigestion.
If you feel that you, or someone with you, is having a heart attack, call an ambulance (use the 000 number) and your general practitioner. Once you are under the care of a doctor, your chances of survival are good, because of the many medications and treatments available to stop abnormal heartbeats, which are the normal cause of death in a heart attack. Doctors can also give injections to relieve the crushing, severe pain, and relieve the intense anxiety of the patient. Less than 20% of patients die immediately from a heart attack.
Once in hospital, the victim will be kept in a coronary care ward under the constant eye of specially trained nurses and doctors who can instantly deal with any further deterioration.
Treatment will include drugs to break up the blood clot blocking the coronary artery that supplies the heart with blood, and a complex cocktail of other medications to regulate the functioning of the heart. Most of these will be given into an intravenous drip in the arm. After a few days, you will be allowed to rest in a normal ward while the heart heals. Then after 10 to 14 days, you can go home for a further six or more weeks rest.
The heart attack is diagnosed by an electrocardiogram and by blood tests that can detect abnormal chemicals produced by the heart muscle damage. Chest X-rays will be performed, but more to check the state of the lungs and size of the heart than to diagnose the presence of a heart attack.
The secret of recovery lies in gradually increasing levels of exercise over many weeks in order to slowly strengthen the heart. Manual workers can often return to their jobs after a couple of months, and provided they look after their general health, most heart attack victims will lead a normal and full life.
After the initial recovery period, further investigations will be undertaken to determine the cause of the heart attack and to see if further surgical or medical treatment can be undertaken to prevent another heart attack. These investigations may include echocardiography, coronary angiography and nuclear scans.
Virtually every heart attack victim will be put on medication (e.g. beta-blockers and aspirin) to prevent another attack. These may need to be continued for life. It is also necessary to have regular checkups by your GP to ensure that you and your heart remain in peak condition.
If a particular artery can be found to be blocked, coronary artery bypass graft (CABG) surgery may be performed to bypass this blockage.
The long-term complications of a heart attack include angina, an irregular heartbeat (which can normally be adequately controlled by medication), heart failure and an aneurysm.
Statistically, after a heart attack, 20% of patients will die within the first hour, a further 10% will die in hospital, 5% will die within three months of leaving hospital and another 3% in every year thereafter. The death rate has been significantly lowered in recent years by the use of medication in the long term after a heart attack.
The main things that you can do to prevent a heart attack are to keep your weight within reasonable limits, have your blood pressure checked and treated if necessary, avoid excess cholesterol in your diet, exercise regularly, and stop smoking. Smokers are at a far higher risk than others in the community because nicotine can cause spasm of the arteries in the heart.
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