Heart Attack - Fact File
Who suffers from heart attacks
Over 300,000 people suffer from a heart attack (or myocardial infarction) each year in the United Kingdom, approximately 40% of whom are women. It is now the commonest cause of death in women in many countries including the UK and USA. Heart attacks become more common with age but it is also possible to suffer from a heart attack in ones twenties, although this is very unusual.
What is a heart attack
A heart attack occurs when the blood supply to an area of the heart becomes suddenly cut off by a blockage in one of the arteries to the heart. This part of the heart muscle dies and therefore the heart does not work as well as it did previously. The usual cause of the blockage is the result of a gradual 'furring up' (or atheroma) of one of the coronary (heart) arteries. Finally a complete blockage is caused by a blood clot lodging inside the already narrowed artery.
Are there different types of heart attack
The basic cause of all heart attacks is the same but there are different types of heart attack depending on what part of the heart is affected and whether a large or small area of heart muscle is killed in the attack. Usually the left side of the heart is involved since this is the side that has the largest area of muscle. Heart attacks can be so small as to go almost unnoticed or large enough to cause sudden death.
What are the symptoms of a heart attack
The usual symptoms of a heart attack are a heavy crushing pain, like a band across the chest, sometimes extending up into the neck or down the left arm. These are often accompanied by a feeling of nausea and profuse sweating and sometimes faintness. However, it is possible to have what is called a 'silent' heart attack. This is where no pain is experienced but it is discovered to have taken place at a later date when an ECG (electrocardiogram or heart trace) is done either for another reason or if the doctor suspects that a small heart attack may have occurred.
What are the complications
Often a heart attack causes no complications. However, depending how large the heart attack is and which part of the heart is affected, complications can occur. The commonest complications are heart rhythm problems (where the heart rhythm becomes abnormal) or something called heart failure where the heart does not work as well as it should, causing a build up of fluid in the lungs and ankles. Obviously, if the heart rhythm becomes very abnormal this can cause the heart to stop functioning completely. This is called a 'cardiac arrest' and requires immediate action to resuscitate the individual.
What is the treatment
The treatment of a heart attack falls into immediate treatment and long term treatment.
If it is suspected that someone is suffering from a heart attack an ambulance should be called immediately. A doctor may also be called, but it is important to get assistance as quickly as possible. If the diagnosis is confirmed the individual will be taken to hospital and given an ECG test to confirm the heart attack. If one has occurred, aspirin will be given and possibly an infusion of a special drug.
Both these measures are to help dissolve the blood clot in the artery and therefore limit the amount of damage done to the heart muscle. The person will be stabilised in hospital to treat any of the complications which may occur and will then be discharged home. Long term treatment will be guided by the Gp and hospital doctors. The person will almost certainly be asked to take a small dose of aspirin every day since this has been found to reduce the risk of further heart attacks by 25%. The doctors may also prescribe other long term tablets called beta blockers or ACE inhibitors since both of these have also been shown to reduce the risk of further heart attacks.
Do people make a full recovery from a heart attack
Most survivors of a heart attack are able to return to a full and active life and in fact some, by taking certain health measures such as giving up smoking, become fitter afterwards. Gradual rehabilitation at a rate advised by a doctor means there should be a return to all normal activities including a normal sex life. If the person continues to feel unwell, suffers from breathlessness or chest pain after the heart attack the doctor will probably refer them for further investigation to see if there is a cause for their failure to fully recover.
What further investigations or treatment may be done
If someone continues to suffer from symptoms after their heart attack, particularly if they continue to suffer from chest pains, they may be advised to have further investigations. The most common tests done at this stage are an exercise ECG and/or an investigation called an angiogram. An exercise ECG involves the individual being wired up to a heart trace and then asked to run on a special treadmill which becomes gradually faster. The investigation is stopped if the patient experiences chest pain (angina) or if the heart trace becomes abnormal. This gives the doctors a very good idea of which heart arteries are furred up and by how much. This usually also helps them to decide whether or not to send the person for an angiogram. This is where dye is injected into the arteries of the heart through a special cannula (tube). The dye is then watched on an x-ray screen as it passes through the arteries. This gives a very good picture of the blood supply to the heart and is a great help in deciding whether the patient needs further treatment to open up any narrowed coronary arteries.
What further treatment may be required
Depending on the results of the tests described above, the symptoms the patient is suffering from and various other factors, the doctor may advise either something called angioplasty or coronary artery bypass grafting. Angioplasty involves passing a special wire up into the narrowed artery at which point a balloon at the end of the wire is inflated. This stretches the walls of the artery leaving the blood vessel wider than it was before, therefore allowing more blood through to the heart muscle. Coronary artery bypass grafting (CABG), on the other hand, means that the blockage(s) in the arteries to the heart are bypassed using the patients own veins taken from their legs. This is a major operation involving opening the chest and suturing new blood vessels onto the side of the heart. However, these days it is a common operation performed many times a week throughout the UK.
What can be done to prevent having a heart attack
The most important thing is not to smoke as this is the single most significant cause of furring up of the arteries. Maintaining a weight as near as possible to the ideal is helpful, as is having a regular check for blood pressure since high blood pressure can also cause narrowing of the arteries. Getting blood cholesterol level measured is also important especially if there is a family history of heart disease as a high cholesterol level can be passed down through families. Regular exercise is also advisable.
How may another attack be prevented
Firstly give up smoking since this can lead to a 50% reduction in death from a subsequent heart attack. Secondly follow the doctor's advice with respect to any medication he prescribes. He will almost certainly suggest to continue to take a small dose of aspirin daily and may also continue with other medication as described above. It is usual to have cholesterol levels checked a few months after the heart attack since it has been shown that keeping the level of this type of fat in the bloodstream below a certain level reduces further death from heart attacks by 30%. Therefore eating a low fat diet is advisable.
What do doctors mean by a low fat diet
If you have been advised to have a low fat diet this means that you should cut down on certain things such as fried food, fatty food and dairy products. Even some healthy-sounding foods such as shellfish can be very high in fat and should therefore be avoided. Most people have heard of polyunsaturated fats in certain margarines. This refers to the fact that there are some fats (the saturated fats) which are particularly prone to causing arterial blockage. These are found in butter, meat and most dairy products. The polyunsaturated fats are less harmful and some (called HDL- High Density Lipoproteins) can even help to protect the arteries against the harmful fats. These are to be found in vegetable oils and certain types of margarine.
If you have recently had a heart attack or feel that your diet or family history mean that you are especially at risk of having one, you can ask your doctor for further advice. Alternatively you can request to be referred for further dietary advice from a dietitian if one is available.
Where can I get more information
Apart from contacting your own Gp the following organisations may be of help:
British Heart Foundation
14 Fitzhardinge Street
Telephone 020 7935 0185
Infoline: 08705 200656
Coronary prevention Group
42 Store St
Telephone: 020 7580 1070
Family Heart Association
7 North Road
Tel: 01628 626638
Heartline Network Scotland
57 Ruthven Lane
Helpline: 0800 858585 (12.00-17.00 Monday to Friday)
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- GREENBAUM A B, OHMAN E M, (1997); An update on acute myocardial infarction from recent clinical trials. Current Opinions in Cardiology. 12 (4): pp 418-26.