Myocardial Infarction Back to Basics

Heart attack or myocardial infarction is a common disease that poses a threat to human life, and according to many studies it is the main cause of death in the world. A heart attack occurs when the blood supply to the heart is suddenly cut off, as the heart receives blood through three main arteries, known as coronary arteries, and this often happens with the occurrence of a sudden blockage of one or more of these arteries or their branches due to many reasons, the most common of which is the accumulation of a clot consisting of fat and some cellular waste in these arteries, and this condition is called atherosclerosis , the inflammatory process has also been found to have a role in the emergence of a heart attack, as it facilitates the accumulation of fatty clots in the inflamed arteries . Although most cases result from coronary arteriosclerosis, some of them occur as a result of the temporary contraction of these arteries.You may have complete or partial blockage in a coronary artery. Complete embolism means that you have a myocardial infarction associated with the elevation of the ST segment. Partial embolism means you have a myocardial infarction that is not associated with ST segment elevation .Diagnosis and treatment may vary depending on the type of blockage you have. As a result the damaged cardiac tissue will develop a condition called ischemia, which occurs when oxygen is cut off from the cells. If this condition continues for a longer period of time, the cells die and the patient suffers a myocardial infarction. Angina pectoris is an early warning of a heart attack, caused by a temporary decrease in blood flow to the heart. Which occurs before the occurrence of many cases of heart attack, and may come in the form of attacks of chest pain as a result of ischemia as well, but this pain lasts for a shorter time than that associated with a heart attack, and the ischemia will soon end without causing permanent damage to heart tissue. Common signs and symptoms of a heart attack include:

1. Pressure, tightness, pain, or a squeezing or painful sensation in the chest or arms that may   spread to the neck, jaw, or back

2. Nausea, indigestion, heartburn, or abdominal pain

3. Shortness of breath

4. Cold sweat

5. Exhaustion

6. Sudden dizziness or lightheadedness Heart attack symptoms variation: Not all people with heart attacks have the same symptoms or severity. Some people have mild pain, while others have more severe pain. Some people have no symptoms. For others, the first sign may be sudden cardiac arrest.However, the more symptoms and indicators of the disease you have, the higher the chance of a heart attack. Some heart attacks occur suddenly, but many people have warning symptoms and signs of illness hours, days or weeks before a heart attack. The first warning may be a recurrence of chest pain or pressure (angina), which occurs due to exercise, and can be alleviated by rest.  Risk factors: Some factors contribute to the unwanted accumulation of fatty deposits (atherosclerosis), narrowing the arteries throughout your body. You can also improve or eliminate many of these risk factors to reduce your chances of having a heart attack: Age.  Men aged 45 or older and women aged 55 or older are more likely to have a heart attack than men and younger women. Tobacco. This includes smoking and exposure to secondhand smoke for a long time. High blood pressure. Over time, high blood pressure may damage the arteries leading to the heart. The high blood pressure associated with other problems, such as obesity, high cholesterol and diabetes, increases this risk further. High blood cholesterol levels or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol ("bad" cholesterol) most likely leads to narrowing of the arteries. A high level of triglycerides, a type of blood fat associated with your diet, also increases your risk of a heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol ("good" cholesterol) may reduce the risk of infection. Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. The incidence of these diseases may decrease with a loss of only 10% of body weight. Diabetes. Not producing enough of the hormone produced by the pancreas (insulin) or not responding properly to insulin causes your blood sugar levels to rise, increasing your risk of heart attack. Metabolic syndrome. This syndrome occurs when you have obesity, high blood pressure and high blood sugar. Having metabolic syndrome also makes you more likely to have heart disease than not. Family history of heart attack. If your siblings, parents or grandparents experience early heart attacks (at age 55 for males and 65 for females), you may be at increased risk. Lack of physical activity. The lack of physical activity contributes to high blood cholesterol levels and obesity. People who exercise regularly have better heart health, including lower blood pressure. Tension. Your stress response may increase your risk of a heart attack. Use of prohibited drugs. Taking stimulant drugs, such as cocaine and amphetamines, can result in spasm of your coronary arteries, which can put you at risk of a heart attack. History of pre-eclampsia (preeclampsia). This condition causes high blood pressure during pregnancy and  increases the lifetime risk of heart disease.. Diagnosing of a heart attack: A heart attack is diagnosed through the following tests: Electrocardiogram (ECG): this is the first test to be performed to diagnose a heart attack, where this test records the electrical activity of the heart via electrodes attached to the skin, and the pulses are recorded as waves displayed on the screen or printed on paper, and because the affected heart muscle does not give electrical impulses normally, the chart may show or predict a heart attack Blood tests: some heart proteins slowly leak into the blood after the heart has suffered a heart attack, where doctors in the emergency room will take samples of the patient's blood to test for the presence of these enzymes. Additional tests: Chest X-ray: the chest X-ray image allows the doctor to examine the size of the heart and blood vessels and look for fluid in the lungs. Echocardiogram: a laboratory sound waves to the heart and thus the waves of the heart and are processed electronically to provide photos and videos of the heart, it can help in determining whether an area of the heart has been damaged or is not pumping normally. Exercise stress test:  shows how your heart works during physical activity.Because exercise makes your heart pump harder and faster, an exercise stress test can reveal problems with blood flow within your heart.A stress test usually involves walking on a treadmill or riding a stationary bike. Your heart rhythm, blood pressure and breathing are monitored. Or you'll receive a drug that mimics the effects of exercise.Your doctor may recommend a stress test if you have signs or symptoms of coronary artery disease or an irregular heart rhythm (arrhythmia). The test may also guide treatment decisions, measure the effectiveness of treatment or determine the severity if you've already been diagnosed with a heart condition. Cardiac CT or MRI. These tests create images of your heart and chest. Cardiac CT scans use X-rays. Cardiac MRI uses a magnetic field and radio waves to create images of your heart. For both tests, you lie on a table that slides inside a long tube-like machine. Each can be used to diagnose heart problems, including the extent of damage from heart attacks Coronary catheterization (angiography): a liquid dye is injected into the arteries of the heart through a thin tube that is inserted through the artery in your wrist or groin into the arteries in the heart, where the dye makes the arteries more visible and reveals areas of blockage. Treating a heart attack: Every minute after a heart attack, more heart tissue is degraded, and rapidly restoring blood flow to the heart helps prevent heart damage Treatment of heart attack  with medications:

7. Aspirin: emergency medical paramedics may give you aspirin right away because it reduces blood clotting which helps maintain blood flow through narrow arteries.

8. Nitroglycerin: this drug is used to treat chest pain (angina), can help improve blood flow to the heart by expanding blood vessels.

9. Pain relievers: people with a heart attack may be given some pain relievers such as morphine.

10. Thrombolytics: These drugs, also called clot busters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you'll survive and have less heart damage

11. Antiplatelet agents:  platelet aggregation inhibitors are medications that help to prevent formation of new clots, maintain the size of existing clots and prevent them from becoming larger.

12. Blood thinning medications: such as heparin are likely to be given to make your blood less viscous and less prone to clots, as heparin is given intravenously or by subcutaneous injection.

13. Beta blockers: these drugs help relax the heart muscle, regulate heart rate, lower blood pressure, and prevent future heart attacks.

14. ACE inhibitors: these medications reduce blood pressure and relieve pressure on the heart.

15. Statins: these drugs help control blood cholesterol.In addition to medication, patients may undergo one of these procedures to treat a heart attack: Coronary angioplasty (stent implantation): also known as percutaneous coronary intervention (PCI), which is a procedure used to open blocked heart arteries, where a small balloon is inserted and inflated temporarily in the place where the artery is closed to help its expansion and angioplasty is often performed by placing a small, permanent wire mesh tube known as a stent to help support the opening of the artery and reduce the likelihood of narrowing and blockage again. Coronary artery bypass surgery: is a heart surgery procedure in which one or more coronary artery blockages are bypassed by diverting blood vessels to restore normal blood flow to the heart, these connections usually come from the patient's own arteries and veins located in the chest (thoracic vessels), leg (saphenous vein) or forearm (radial artery), and the vessels used in the grafting circulate around the clogged arteries to create new pathways that allow oxygen-rich blood to flow to the heart. In some cases, doctors perform emergency bypass surgery at the time of a heart attack. If possible, however, you might have bypass surgery after your heart has had time — about three to seven days — to recover from your heart attack. Cardiac rehabilitation Most hospitals offer programs that might start while you're in the hospital and continue for a few  months after you return home. Cardiac rehabilitation programs generally focus on four main areas — medications, lifestyle changes, emotional issues and a gradual return to your normal activities. It's extremely important to participate in this program. People who attend cardiac rehab after a heart attack generally live longer and are less likely to have another heart attack or complications from the heart attack. If cardiac rehab is not recommended during your hospitalization, ask your doctor about it. Lifestyle changes and home remedies:

16. Avoid smoking: One of the most important steps that you must take to improve your heart health is not to smoke. If you need to quit smoking, seek help from your doctor.

17. Control blood pressure and cholesterol levels: If one or both of them are high, your doctor can prescribe changes to your diet and medications. Ask your doctor how often you need to monitor your blood pressure and cholesterol levels.

18. Get regular medical checkups: Some of the major risk factors for a heart attack such as high cholesterol, high blood pressure and diabetes may not cause any symptoms early on, so you should consult your doctor regularly to help you discover and manage these factors.

19. Exercise: Regular exercise helps improve the function of the heart muscle after a heart attack and helps prevent a heart attack in the first place, as walking for 30 minutes a day can improve your health excellently.

20. Maintaining a healthy weight: Excess weight stresses your heart and can contribute to high cholesterol, high blood pressure and diabetes.

21. Adhere to a heart-healthy diet: Saturated fats, unsaturated fats, and high cholesterol in your diet narrow the arteries, and too much salt can raise blood pressure, so you must stick to a heart-healthy diet that includes lean proteins such as fish, beans, fruits and vegetables. And whole grains.