Heart Attacks. Compiled by- RPS YADAV, SSE/RE/Allahabad

Transcription

1 Heart Attacks Compiled by- RPS YADAV, SSE/RE/Allahabad Coronary heart disease (CHD) is the leading cause of death for both men and women in the United States. CHD is caused by a narrowing of the coronary arteries that supply blood to the heart, and often results in a heart attack. Each year, about 1.1 million Americans suffer a heart attack. About 460,000 of those heart attacks are fatal. About half of those deaths occur within 1 hour of the start of symptoms and before the person reaches the hospital. Fortunately, everyone can take steps to protect their heart and their life or that of someone else. The key is seeking medical care as soon as possible. This Web page tells you about heart attack and the steps you can take to increase your chances of survival. You ll learn why a fast response to the signs of a heart attack is crucial to save lives and limit heart damage. In This Section: What is a Heart Attack? The heart works 24 hours a day, pumping oxygen- and nutrient-rich blood to the body. Blood is supplied to the heart through its coronary arteries. In coronary heart disease (CHD), plaques or fatty substances build up inside the walls of the arteries. The plaques also attract blood components, which stick to the artery wall lining. Called

2 atherosclerosis, the process develops gradually, over many years. It often begins early in life, even in childhood. The fatty buildup or plaque can break open and lead to the formation of a blood clot that seals the break. The clot reduces blood flow. The cycle of fatty buildup, plaque rupture, and blood clot formation causes the coronary arteries to narrow, reducing blood flow. When too little blood reaches the heart, the condition is called ischemia. Chest pain, or angina, may occur. The pain can vary in occurrence and be mild and intermittent, or more pronounced and steady. It can be severe enough make difficult. to normal everyday activities The same inadequate blood supply also may cause no symptoms, a condition called silent ischemia. If a blood clot suddenly cuts off most or all blood supply to the heart, a heart attack results. Cells in the heart muscle that do not receive enough oxygencarrying blood begin to die. The more time that passes without treatment to restore blood flow, the greater the damage to the heart. Who s at Risk Heart attacks strike both men and women. However, some persons are more likely than others to have a heart attack because of their "risk factors." Risk factors are behaviors or conditions that increase the chance of a disease. Some of the risk factors for heart attack are beyond your control, but most can be modified to help you lower your risk of having a first or repeat heart attack. Factors that increase the risk of a heart attack are:

3 Factors you cannot control Pre-existing coronary heart diseases, including a previous heart attack, a prior angioplasty or bypass surgery, or angina Age-In men, the risk increases after age 45; in women, the risk increases after age 55. Family history of early heart disease-a father or brother diagnosed before age 55; or a mother or sister diagnosed before age 65. Factors you can control Smoking. High blood pressure. High blood cholesterol. Overweight and obesity. Physical inactivity. Diabetes. Risk factors do not add their effects in a simple way. Rather, they multiply each other s effects. So, it is very important to prevent or control risk factors that can be modified. If you have one or more of these factors, see your health care provider to find out how to reduce your risk of having a first or repeat heart attack. Limiting Heart Muscle Damage Treatments for a heart attack work to open the blocked artery to restore blood flow as fast as possible to prevent or limit damage to the heart muscle, and to lessen the chance of a repeat attack. The main treatments are thrombolytic ("clot-busting") therapy, other medications, and special procedures, such as angioplasty and coronary artery bypass surgery. To be most effective, these treatments must be given fast within 1 hour of the start of heart attack symptoms. Acting fast can save your life and limit damage to your heart.

4 Heart Attack Warning Signs A heart attack is a frightening event, and you probably don't want to think about it. But, if you learn the signs of a heart attack and what steps to take, you can save a life maybe your own. What are the signs of a heart attack? Many people think a heart attack is sudden and intense, like a "movie" heart attack, where a person clutches his or her chest and falls over. The truth is that many heart attacks start slowly, as a mild pain or discomfort. If you feel such a symptom, you may not be sure what's wrong. Your symptoms may even come and go. Even those who have had a heart attack may not recognize their symptoms, because the next attack can have entirely different ones. Women may not think they're at risk of having a heart attack but they are. Women and Heart Attack If you're a woman, you may not believe you're as vulnerable to a heart attack as men but you are. Women account for nearly half of all heart attack deaths. Heart disease is the number one killer of both women and men. There are differences in how women and men respond to a heart attack. Women are less likely than men to believe they're having a heart attack and more likely to delay in seeking emergency treatment. Further, women tend to be about 10 years older than men when they have a heart attack. They are more likely to have other conditions, such as diabetes, high blood pressure, and congestive heart failure making it all the more vital that they get proper treatment fast. Women should learn the heart attack warning signs. These are: Pain or discomfort in the center of the chest. Pain or discomfort in other areas of the upper body, including the arms, back, neck, jaw, or stomach.

5 Other symptoms, such as a shortness of breath, breaking out in a cold sweat, nausea, or light-headedness. As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain. It's vital that everyone learn the warning signs of a heart attack. These are: Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach. Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort. Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness. Learn the signs but also remember: Even if you're not sure it's a heart attack, you should still have it checked out. Fast action can save lives-maybe your own. Surviving a Heart Attack How do you survive a heart attack? Fast action is your best weapon against a heart attack. Why? Because clot-busting drugs and other artery-opening treatments can stop a heart attack in its tracks. They can prevent or limit damage to the heart but they need to be given immediately after symptoms begin. The sooner they are started, the more good they will do and the greater the chances are for survival and a full recovery. To be most effective, they need to be given ideally within 1 hour of the start of heart attack symptoms. Thrombolytic Therapy "Thrombolytic" or "clot-busting" therapy is used to stop a heart attack in its tracks. The drugs prevent or limit heart muscle damage by dissolving clots that block an artery. This opens up the artery and restores the blood flow. Clot-busting drugs must be given immediately after heart attack symptoms begin. The sooner they are started, the more good they do-and the greater the chances are of a full recovery. To be most effective, they need to be given within 1 hour of the start of heart attack symptoms. Special Procedures Doctors sometimes need to do a special procedure to improve blood flow to the heart muscle when the heart s artery, or arteries, are narrowed or blocked. Two

6 commonly used procedures are coronary angioplasty and coronary artery bypass graft surgery. These procedures can be done during a heart attack or later. While a Heart Attack is happening, the sooner these procedures are done, the greater the chances of saving heart muscle and of surviving a heart attack. Here's more on these special procedures: Coronary angioplasty, or balloon angioplasty. In this procedure, a fine tube, or catheter, is threaded through an artery into the narrowed heart vessel. The catheter has a tiny balloon at its tip. The balloon is repeatedly inflated and deflated to open and stretch the artery, improving blood flow. The balloon is then deflated, and the tube is removed. Doctors often insert a stent during the angioplasty. A wire mesh tube, the stent is used to keep an artery open after an angioplasty. The stent stays permanently in the artery. In up to a third of those who have an angioplasty, the blood vessel becomes narrowed or blocked again within 6 months. This is more likely to happen if you smoke, or have diabetes or unstable angina. Vessels that reclose may be reopened with another angioplasty or need a coronary artery bypass graft. Even an artery with a stent can reclose. Coronary artery bypass graft operation. Also known as "bypass surgery," the procedure uses a piece of vein taken from the leg, or of an artery taken from the chest or wrist. This is attached to the heart artery above and below the narrowed area, thus making a bypass around the blockage. Sometimes, more than one bypass is needed. Bypass surgery may be needed due to various reasons, such as an angioplasty that did not sufficiently widen the blood vessel, or blockages that cannot be reached by, or are too long or hard for, angioplasty. In certain cases, bypass surgery may be preferred. For instance, it may be used for persons who have both coronary heart disease and diabetes. A bypass also can close again. This happens in more than 10 percent of bypass surgeries, usually after 10 or more years. Testing For A Heart Attack If you think you're having a heart attack, get help at once. Don't wait to be sure. Call right away. Delay can be deadly. Once you get help, you will undergo tests to see if a heart attack has actually occurred. Some tests are done at the hospital, while emergency medical personnel who come in an ambulance can do others.

7 Key heart attack tests are: Electrocardiogram (ECG or EKG). This is a graphic record of the electrical activity of the heart as it contracts and relaxes. The ECG can detect abnormal heartbeats, some areas of damage, inadequate blood flow, and heart enlargement. Blood test. A blood test will be done routinely to check for enzymes or other substances that are released when cells begin to die. These are "markers" of the amount of damage to your heart. Nuclear scan. This test shows areas of the heart that lack blood flow and are damaged. It also can reveal problems with the heart's pumping action. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera positioned over the heart records whether the nuclear material is taken up by the heart muscle (healthy areas) or not (damaged areas). The camera also can evaluate how well the heart muscle pumps blood. This test can be done during both rest and exercise, enhancing the usefulness of its results. Coronary angiography (or arteriography). This test is used to check blockages and narrowed areas inside coronary arteries. A fine tube (catheter) is threaded through an artery of an arm or leg up into the heart. A dye that shows up on X ray is then injected into the blood vessel, and the vessels and heart are filmed as the heart pumps. The picture is called an angiogram or arteriogram. Reducing Heart Attack Risk You can reduce your risk of having a heart attack even if you already have coronary heart disease (CHD) or have had a previous heart attack. The key is to take steps to prevent or control your heart disease risk factors. Six Key Steps To Reduce Heart Attack Risk Taking these steps will reduce your risk of having a heart attack: 1. Stop Smoking Cigarettes Cigarette smoking greatly increases the risk of fatal and nonfatal heart attacks in both men and women. It also increases the risk of a second heart attack among survivors. Women who smoke and use oral contraceptives have an even greater risk than smoking alone. The good news is that quitting smoking greatly reduces the risk of heart attack. One year after quitting, the risk drop to about one-half that of current smokers and gradually returns to normal in persons without heart disease. Even among persons with heart disease, the risk also drops sharply one year after quitting smoking and it continues to decline over time but the risk does not return to normal. 2. Lower High Blood Pressure High blood pressure makes the heart work harder. It increases the risk of developing heart disease, as well as kidney disease and stroke.

8 Also called hypertension, it usually has no symptoms. Once developed, it typically lasts a lifetime. Blood pressure is recorded as two numbers the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes). For example, a measurement would be written as 120/80 mm Hg (millimeters of mercury). Normal blood pressure is less than 130 mm Hg systolic and less than 85 mm Hg diastolic. An optimal blood pressure is less than 120 mm Hg systolic and less than 80 mm Hg diastolic. A consistent blood pressure reading of 140/90 mm Hg or higher is considered high blood pressure. If the systolic and diastolic pressures fall into different categories, the higher category is used to classify blood pressure status. To help prevent or control high blood pressure, you should: lose excess weight; become physically active; follow a heart healthy eating plan, including foods lower in salt and sodium; limit alcohol intake; and, if you are prescribed a medication, take it as directed. The main types of high blood pressure medications are: diuretics, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin antagonists, calcium channel blockers, alpha blockers, alpha-beta blockers, nervous system inhibitors, and vasodilators. It's important that you take medication as prescribed and control your blood pressure to below 140/90 mm Hg. 3. Reduce High Blood Cholesterol The level of cholesterol in the bloodstream greatly affects the risk of developing heart disease. The higher the level of blood cholesterol, the greater the risk for heart disease or heart attack. Why? When there is too much cholesterol (a fat-like substance) in the blood, it builds up in the walls of arteries. Over time, this buildup causes arteries to become narrowed, and blood flow to the heart is slowed or blocked. If the blood supply to a portion of the heart is completely cut off, a heart attack results. Various factors affect cholesterol levels: diet, weight, physical activity, age and gender, and heredity. High blood cholesterol itself does not cause symptoms. You may not know your blood cholesterol level is too high. So, it's important to have your cholesterol measured. Adults' age 20 or older should have their cholesterol checked at least once every 5 years. It best to have a blood test called a lipoprotein profile. This test measures total cholesterol, "good" and "bad" cholesterol, as well as triglycerides, another form of fat in the blood. High cholesterol is treated with lifestyle changes a heart healthy eating plan, physical activity, and loss of excess weight and, if those do not lower it enough, medication. Medications include statins, bile acid sequestrants, nicontinic acid, and fibric acids. 4. Aim for a Healthy Weight A healthy weight is crucial for a long, healthy life. In 1999, almost 108 million-or 61 percent of-adults in the United States were overweight or obese. Being overweight or obese increases your risk of heart attack. And, it increases your risk of developing high blood cholesterol, high blood pressure, and diabetes-each of which also increases your chance of having a heart attack. If you are

9 overweight, even a small weight loss-just 10 percent of your current weight-will help to lower your risk of developing those diseases. Two of the measures that assess whether or not a person is overweight are body mass index (BMI) and waist circumference. BMI is a measure of weight relative to height. The risk for developing heart and other diseases increases with a waist measurement of more than 40 inches in men and more than 35 inches in women. To be at their best, adults need to avoid gaining weight and many need to lose weight. Losing weight and keeping it off depends on a change of lifestyle that combines sensible eating with regular physical activity, not a temporary effort to drop pounds quickly. If you need to lose excess weight, talk with your health care provider about developing an action plan, which includes a hearty-healthy, lowcalorie, nutritious eating plan and physical activity. 5. Be Physically Active Each Day Being physically active reduces the risk of heart-related problems, including heart attack. Physical activity can improve cholesterol levels, help control high blood pressure and diabetes, and manage weight. It also increases physical fitness, promotes psychological well-being and self-esteem, and reduces depression and anxiety. Those who have already had a heart attack also benefit greatly from being physically active. Many hospitals have a cardiac (or heart) rehabilitation program. A health care provider can offer advice about a suitable program. To protect your heart, you only need to do 30 minutes of a moderate-intensity activity on most and, preferably, all days of the week. If 30 minutes is too much at one time, you can break it up into periods of at least 10 minutes each. If you have been inactive, you should start slowly to increase your physical activity. If you have coronary heart disease, check with you health care provider before starting a physical activity program. This is especially important if you are over age 55, have been inactive, or have diabetes or another medical problem. Your health care provider can give you advice on how rigorous the exercise should be. 6. Manage Diabetes Diabetes mellitus affects more than 16 million Americans. It damages blood vessels, including the coronary arteries of the heart. Up to 75 percent of those with diabetes develop heart and blood vessel diseases. Diabetes also can lead to stroke, kidney failure, and other problems. Diabetes occurs when the body is not able to use sugar as it should for growth and energy. The body gets sugar when it changes food into glucose (a form of sugar). A hormone called insulin is needed for the glucose to be taken up and used by the body. Symptoms of diabetes include: increased thirst and urination, weight loss, and blurred vision, hunger, fatigue, frequent infections, and slow healing of wounds or sores. There are two main types of diabetes: insulin-dependent, or type 1, and noninsulin-dependent, or type 2. Type 1 usually appears suddenly and most commonly in those under age 30. Type 2 diabetes occurs gradually and most often in those over age 40. Up to 95 percent of those with diabetes have type 2.

10 You re more likely to develop type 2 if you are overweight or obese, especially with extra weight around the middle, over age 40, have high blood pressure, or have a family history of diabetes. Diabetes is particularly prevalent among African Americans, Asians, and Native Americans. Because of the link with heart disease, it s important for those with diabetes to prevent or control heart disease and its risk factors. Besides diabetes, major risk factors for heart disease include smoking, high blood pressure, high blood cholesterol, physical inactivity, and overweight and obesity. Fortunately, new research shows that the same steps that reduce the risk of heart disease also lower the chance of developing type 2 diabetes. And, for those who already have diabetes, those steps, along with taking any prescribed medication, also can delay or prevent the development of complications of diabetes, such as eye disease and nerve damage. According to the research, a 7 percent loss of body weight and 150 minutes of moderate-intensity physical activity a week can reduce the chance of developing diabetes by 58 percent in those who are at high risk. The lifestyle changes cut the risk of developing type 2 diabetes regardless of age, ethnicity, gender, or weight. To reduce the risk of developing diabetes, as well as heart disease, you should: Follow a heart healthy eating plan, which is low in saturated fat and cholesterol, and moderate in total fat. Aim for a healthy weight. Be physically active each day try to do 30 minutes of moderate-intensity physical activity such as brisk walking on most and, preferably, all days of the week. Don t smoke. Prevent or control high blood pressure. Prevent or control high blood cholesterol. If you already have diabetes, you can delay its progression, or prevent or slow the development of heart, blood vessel, and other complications by following the steps given above and these: Eat your meals and snacks at around the same times each day. Check with your doctor about physical activities that are best for you. Take your diabetes medicine at the same times each day. Check your blood sugar every day. Each time you check your blood sugar, write the number in your record book. Call your doctor if your numbers are too high or too low for 2 to 3 days. Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.

11 Brush and floss your teeth and gums every day. Take any prescribed medication for other conditions, such as coronary heart disease. Check with your doctor about taking aspirin each day if you have heart disease. Heart Disease and Medications Sometimes, medications may be needed to help prevent or control coronary heart disease (CHD) and so reduce the risk of a first or repeat heart attack. But, if medications are needed, lifestyle changes still must be undertaken. If prescribed, take medications as directed by your health care provider. Drugs used to treat CHD include: Aspirin Aspirin helps to lower the risk of a heart attack for those who have already had one. It also helps to keep arteries open in those who have had a previous heart bypass or other artery-opening procedure such as coronary angioplasty. Because of its risks, aspirin is not approved by the Food and Drug Administration for preventing heart attacks in healthy individuals. It may be harmful for some persons, especially those with no risk of heart disease. Patients must be assessed carefully to make sure the benefits of taking aspirin outweigh the risks. Talk to your doctor about whether taking aspirin is right for you. Digitalis makes the heart contract harder and is used when the heart's pumping function has been weakened; it also slows some fast heart rhythms. ACE (angiotensin converting enzyme) inhibitor stops the production of a chemical that makes blood vessels narrow and is used to help control high blood pressure and for damaged heart muscle. It may be prescribed after a heart attack to help the heart pump blood better. It is also used for persons with heart failure, a condition in which the heart is unable to pump enough blood to supply the body's needs. Beta blocker slows the heart and makes it beat with less contracting force, so blood pressure drops and the heart works less hard. It is used for high blood pressure, chest pain, and to prevent a repeat heart attack. Nitrates (including nitroglycerine) relaxes blood vessels and stops chest pain. Calcium channel blocker relaxes blood vessels and is used for high blood pressure and chest pain. Diuretic decreases fluid in the body and is used for high blood pressure. Diuretics are sometimes referred to as "water pills." Blood cholesterol-lowering agents decrease LDL cholesterol levels in the blood.

12 Thrombolytic agents also called "clot busting drugs," they are given during a heart attack to break up a blood clot in a coronary artery in order to restore blood flow. Drugs can cause side effects. If side effects occur, report them to your doctor. Often, a change in the dose or type of a medication, or the use of a combination of drugs can stop the side effect. ***********************