Heart Attack: Symptoms, Causes, Treatment and Prevention

The word “heart attack” can be a great source of panic, no matter when or where you hear it, and in recent times, the word is being heard more often than before. Something that was once considered a problem of old age is now being seen affecting people of all ages including young adults in their 20s and 30s.

In medical terms a heart attack is a myocardial infarction, in which the first word myocardial refers to the heart muscle and the term infarction literally means death or injury to a tissue due to lack of blood supply; and this is exactly what happens in a heart attack. The blood supply to the heart muscle is received from arteries known as coronary arteries, and when there is a blockage in these blood vessels due to the presence of a clot, it results in a reduction or stoppage of blood flow to the heart muscle leading to the death of the muscle tissue. A heart with damaged or dead muscle tissue is unable to pump blood efficiently to the rest of the body, and it results in the development of various symptoms and complications.

What exactly happens in a heart attack?

If you speak to the best cardiologist near you, he will explain that a heart attack is a medical emergency that results from an abrupt or sudden stoppage of blood flow and lack of oxygen to the heart muscle resulting in its death. The blockage of the blood vessels however, does not develop suddenly and it is due to the build-up of fats in the coronary arteries over a period of many years. These fatty deposits are also known as atheromatous plaques, and when a plaque breaks away from the artery wall it results in bleeding and the formation of a blood clot that has the potential to block the lumen of the artery and prevent blood flow across it.

The heart muscle is a very active muscle that does not rest for even a single minute of our lives, and it requires oxygen and nutrients so that it continues to work efficiently. When the blood supply to a part of the heart muscle is cut off, it results in a lack of oxygen and nutrient supply, resulting in tissue death in the area supplied by the blocked blood vessel. The longer the blood supply to the tissue is cut off, the greater is the amount of muscle tissue that is damaged, and therefore the more severe the complications.

What are the causes of a heart attack?

The heart receives its blood supply from the coronary arteries, which arise from the aorta, the largest blood vessel arising out of the heart. The 3 main arteries that supply blood to the heart are Right Coronary Artery (RCA), which supplies blood to the right side of the heart and the bottom of the left lower chamber, the Left Anterior Descending (LAD) which supplies blood to the front and main part of the left lower chamber, and Left Circumflex Artery (LCx) which supplies blood to the left upper chamber and the back of the left lower chamber.

Atherosclerosis which is the development of fatty deposits within the arteries is commonly seen affecting the coronary arteries. Any or all of the 3 main arteries of the heart can be affected by atherosclerosis, and when these arteries are affected, the condition is known as coronary artery disease. There are several factors that increase the risk of coronary artery disease and heart attack. These include

• Family history: A family history of heart disease increases the risk and possibility of a heart attack
• Smoking: Smoking damages the lining of the arteries and increases the build-up of plaque, and it is one of the most significant risk factors in the development of heart attacks.
• High blood pressure: Blood flowing through the arteries at a high pressure can damage the walls of the arteries and increases the risk of atherosclerosis and heart attacks.
• Bad fats and High cholesterol: High levels of LDL cholesterol or "bad" cholesterol increase the risk of plaque build-up in the arteries and the risk of heart attacks.
• Diabetes: Uncontrolled diabetes increases the risk of developing atherosclerosis and heart attacks.
• Obesity: Being overweight or obese can increase the risk of developing atherosclerosis and heart disease.
• Sedentary lifestyle and lack of physical inactivity: Contributes to weight gain, obesity, high blood pressure, and diabetes which increases the risk of heart disease and heart attacks.
• Stress: Chronic stress increases blood pressure and inflammation in the body and this can lead to the development of heart attacks.

There are other conditions and factors too that can increase the risk of a heart attack and these include

• Bad oral hygiene
• Unhealthy eating habits
• Severe anemia
• Hyperthyroidism
• Respiratory infections
• Some autoimmune diseases such as rheumatoid arthritis, lupus,
• Use of recreational drugs such as cocaine or amphetamines

Are there any triggers for a heart attack?

Although a heart attack can occur at any time or even at rest, it is seen to occur more commonly in the morning hours and some of the triggers associated with a heart attack include

• Vigorous activity,
• Anger
• Emotional stress
• Sexual activity
• Recreational drugs such as cocaine or amphetamines

What are the signs and symptoms of a heart attack?

The best cardiologists near you say that the signs and symptoms of a heart attack vary between individuals and can range from mild to severe, slowly developing or sudden and intense, and can be experienced for a short or extended duration. It is also important to note that the signs and symptoms of a heart attack are slightly different in women than in men, and women may experience symptoms that are more generalized and not those typically associated with a heart attack.

Although the primary sign and symptom of a heart attack is traditionally associated with chest pain that is felt behind the breast bone (sternum) and sometimes extends to the left arm, back, lower jaw, neck, and shoulders, it may not always be present. There are certain cases of heart attack where no symptoms are experienced and the person may not even know that they are having a heart attack, this type of heart attack is commonly known as a silent heart attack. Some of the signs and symptoms that can indicate a heart attack include

• Chest pain: Which is felt behind the sternum, and described as squeezing, pressure, heaviness, tightness, or burning pain. The pain may be felt only for a short time, or it can be continuous and last as long as 30-60 minutes or more. In some people, chest pain may be preceded a few hours or a few days before by weakness or a generalized feeling of being unwell.
• Shortness of breath: Difficulty breathing is another symptom of a heart attack that may be commonly seen and this may be seen with or without chest pain.
• Pain or discomfort: May be felt in the upper body such as in one or both the arms, the back, neck, lower jaw, or the abdomen.
• Sweating: Excessive sweating along with cold and clammy skin may be a sign of a heart attack.
• Nausea or vomiting: Nausea or vomiting may be seen in some people and it can be mistaken for indigestion or a stomach bug.
• Lightheadedness or dizziness: A heart attack can sometimes present with lightheadedness, dizziness, fainting or near fainting.
• Coughing: Sudden bouts of coughing can sometimes be seen along with breathing difficulties.
• Anxiety: A sense of doom and anxiety may be experienced by an individual having a heart attack.

How is a heart attack diagnosed?

If you or someone close to you is experiencing symptoms of a heart attack it is important to consult a heart specialist doctor immediately. A heart attack is diagnosed by the best cardiologist near you by taking a medical history of the symptoms and performing a physical examination that includes listening to the heart and lungs and checking for any other signs of medical problems. Additional tests are then performed to evaluate the problem further and these include

• ECG or Electrocardiogram – to record the electrical activity of the heart and identify abnormalities of heart rhythm.
• Blood Tests – to measure for markers of cardiac tissue death and damage such as Troponin T or I, and other tests like CK-MB, LDH.
• Echocardiogram – ultrasound of the heart to assess blood flow and functioning of the heart
• Coronary Angiogram or Cardiac Catheterization – which is a minimally invasive diagnostic procedure that is done to identify the site of the blockage in the coronary arteries
• Imaging tests – such as CT Angiogram and Myocardial Perfusion Imaging to study the blood flow to the tissues of the heart and to identify the extent of heart muscle damage.

How is a heart attack treated?

The treatment of a heart attack depends on various factors such as the severity of the heart attack, the type of heart attack, the age and overall health of the individual, as well as the timing of the medical treatment or intervention. Some heart attacks may only require medications for their management while other may require minimally invasive surgeries, while some others may require an open heart surgery.

The goal of treatment of a heart attack is to restore the blood flow to the heart muscle and prevent further tissue damage and complications. Treatment for a heart attack can include

• Medications – medications such as aspirin, nitroglycerin, statins, beta-blockers, ACE inhibitors, antiplatelet drugs, and pain relievers are usually prescribed.
• Coronary Angioplasty & Stenting – it is a minimally invasive procedure in which a  catheter is passed through a blood vessel in the arm or groin and the blockage is removed by inflating the balloon and removing the clot at the point of blockage, and putting a stent in place to prevent the artery from collapsing.
• Coronary Artery Bypass Grafting – is an open heart surgery in which the blockage in the blood vessel is bypassed using a vein or artery taken from another place in the body such as the chest or thigh.
• Cardiac Rehabilitation and Lifestyle Changes – The recovery from a heart attack and the prevention of future heart attacks is done through cardiac rehabilitation programs that focus on improving heart health, and lifestyle modifications that prevent future attacks.

What are the complications of a heart attack?

The complications that can occur after a heart attack can include the following

• Low blood pressure or hypotension
• Cardiogenic Shock
• Heart failure
• Development of abnormal heart rhythms that can be life-threatening
• Inflammation of the thin sac that surrounds the heart – a condition known as pericarditis
• Formation of blood clots that can lead to a brain stroke

How can heart attacks be prevented?

Heart attacks can be prevented by leading a healthy lifestyle, and making small modifications to our day-to-day lives. Some measures that can be taken include

• Eating a heart-healthy diet – eating a diet that is rich in vegetables, fruits, whole grains,  lean protein, low trans-fats, low saturated fats, and low salt can help reduce the risk
• Regular exercise – avoiding a sedentary lifestyle and getting regular exercise keeps the heart healthy and reduces the risk of a heart attack
• Maintaining an ideal body weight – being overweight and obese increases the risk of diabetes and heart attacks
• Keeping diabetes, hypertension, and other chronic health conditions under control – getting regular medical check-ups and monitoring of health parameters regularly is important to reduce the risk of a heart attack
• Quit Smoking – smoking is a significant risk factor for heart attacks and quitting smoking is a step towards a healthy heart
• Avoid excess alcohol consumption and using recreational drugs – as these have the potential to cause and trigger heart attacks
• Reducing and managing stress – chronic stress can severely impact heart health and it is important to take steps and measures such as relaxation techniques, breathing exercises, yoga, etc., to keep stress under check

How to recover from a heart attack?

Recovery from a heart attack can be a gradual process but it is possible to recover fully, lead a normal life, and prevent future attacks. Some measures that will help include

• Taking all medications regularly as prescribed by the attending cardiologist
• Eating a heart-healthy diet
• Getting regular exercise – as recommended by cardiac rehabilitation experts
• Quitting Smoking and avoiding excessive alcohol consumption
• Attending all follow-up appointments without fail and getting regularly tested for progress and changes.