Heart Attack (Coronary Thrombosis, Myocardial Infarction)

Some heart attacks are painless and not discovered until an electrocardiogram is taken at a later date. More often, however, a heart attack produces distinct symptoms. These may include:

• A feeling of discomfort, pressure, fullness, or squeezing in the center of the chest, lasting for two minutes or more.
• Pain that spreads throughout the chest and radiates to the shoulders, neck, jaw, arms, or back.
• Dizziness, fainting, sweating, clamminess, nausea, vomiting, and/or shortness of breath.

Not every symptom Is always present; in some cases, symptoms subside only to return later. All too often, they are ignored or attributed to indigestion. Studies show that half of heart attack victims wait more than two hours before getting help, a delay that frequently proves fatal. Each year, about 500,000 Americans die from heart attacks, 60 percent within the first hour. Most of the early deaths are from ventricular fibrillation, an ncoordinated, spasmodic twitching of heart muscle that makes pumping blood impossible.

Diagnostic Studies and Procedures

Emergency care for a patient who may be having a heart attack is a fight for time, with diagnosis and treatment taking place virtually simultaneously. Even before reaching the hospital, an emergency medical team may perform cardiopulmonary resuscitation (CPR).

Many hospital emergency rooms have a coronary-care area for people with suspected heart attacks. There, a special team first makes sure that the person is breathing and has an adequate pulse rate and blood pressure. Then they perform any necessary life-saving maneuvers; these may include defibrillation, the administering of an electric shock to the heart to stop ventricular fibrillation. They then connect the patient to a heart rhythm monitor, so that an electrocardiogram (ECG) can show the pattern of the heartbeat. The team also administers oxygen, drugs to restore normal heart rhythm, and perhaps a pain medication.

Further diagnostic measures are likely to include an angiogram, a special X-ray study of the arteries, to determine whether one or more coronary arteries is blocked. Blood tests include measurement of enzymes released by damaged muscle. A rise in these enzymes helps confirm a heart attack in cases for which symptoms and the ECG are not so clear-cut.

Medical Treatments

In recent years, the use of thrombolytic drugs to dissolve clots has greatly improved the long-term outlook for heart attack victims. These drugs include streptokinase (Streptase and Kabikinase), urokinase (Abbokinase), tissue plasminogen activator (t-PA), and anistreplase (Eminase). When given intravenously during the first hour or two of a heart attack, thrombolytic agents can literally stop the attack and prevent heart muscle death; this technique is called reperfusion therapy. Consequently, many patients can now leave the hospital having suffered little or no damage to the heart.

To prevent formation of new clots, heparin may be given intravenously. Or, aspirin may be used, often with equally good results and a lower risk of serious side effects. Other drugs that may be given early in the course of a heart attack include beta blockers, to limit the attack and prevent recurrence, and antiarrhythmia drugs, to correct or prevent abnormal heart rhythms that may accompany the attack. If drugs are not sufficient to restore blood flow and a normal heartbeat, surgery may be necessary.

Emergency coronary bypass surgery involves implanting grafts to restore blood flow to areas of heart muscle. Another procedure is balloon angioplasty, which increases blood flow through narrowed arteries. After emergency treatment, the patient is transferred to the hospital's cardiac care unit (CCU), where doctors, nurses, and technicians with special training monitor heart function.

As soon as heart function is stable, the patient may be moved to a standard hospital room. There, ongoing therapy includes continued monitoring to measure recovery rate and to guard against another heart attack. Medication may include aspirin, beta blockers, and drugs to prevent angina and heart enlargement, common complications of a heart attack. A rehabilitation program will be designed to help the patient gradually increase activity and resume a normal lifestyle. Surgery may be considered if angina continues or if an artery becomes reblocked. The average hospital stay is five to seven days but can vary, depending on the patient's overall health, the extent of damage done by the heart attack, and the development of complications. Before being discharged, the patient may undergo a modified stress test to determine a safe level of physical activity.

After the patient leaves the hospital, frequent checkups are necessary for the first few months to watch for signs of late complications, including heart failure. Continuing treatment often includes medication to lower blood pressure, reduce high cholesterol levels, and strengthen the heartbeat.

Alternative Therapies

Alternative therapies can be invaluable in recovering from a heart attack. In particular, exercise conditioning is an integral part. Many hospitals offer such programs, as do heart and cardio fitness clinics. A physical therapist can also provide guidance and supervise a therapeutic exercise regimen. The goal is to develop a life-long exercise routine that can be done safely at home or in a health club without medical supervision. Other helpful approaches include: Meditation. Stress reduction is an important aspect of cardiac recovery. Some hospitals and many rehabilitation programs offer instruction in meditation, yoga, biofeedback training, and other relaxation techniques.

Nutrition Therapy. Even before leaving the hospital, a heart-attack patient will be given specific dietary instructions. Depending upon individual factors, these may include a reduced-calorie diet to lose excess weight; reductions in fat and cholesterol to help prevent atherosclerosis; sodium restriction to help control blood pressure; and vitamin E supplements, believed to reduce the risk of a future heart attack.

Self-Treatment

Changes in lifestyle are usually central to successful recovery and prevention of subsequent heart attacks. These include giving up smoking, limiting consumption of alcohol, engaging in regular exercise, and eating healthy. Altering basic habits is often difficult. Joining a support group, such as the American Heart Associations Mended Hearts Club, can provide the motivation for permanent change.

Other Causes of Acute Chest Pain

An anxiety or panic attack can closely mimic a heart attack. Chest pain with shortness of breath, fever, and a cough can be a sign of pneumonia or pleurisy. A pulmonary embolism or a collapsed lung can also cause chest pain. Pain that is worse when bending over or lying down may come from heartburn.