Heart Attack: Cause, Symptoms, Risk Factors, Diagnosis and Treatment.
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Risk factors:
There are a few risk factors of a heart attack that are
modifiable while some are not.
Modifiable
risk factors are:
1.
Smoking (Tobacco use)
2.
High blood pressure (Hypertension)
3.
High blood cholesterol (Hyperlipidemia)
4.
High blood sugar (Hyperglycemia)
5.
Over weight (Obesity)
6.
Unhealthy diet such as food with high sugar or
high fat
7.
Lack of physical activity
8.
Excessive alcohol use
Non-modifiable risk factors are:
1.
Age: people more than 40 years’ old
2.
Family history
3.
Preeclampsia
Cause:
Heart attack or myocardial infraction occurs due to endothelial
dysfunction caused by many irritants such as smoking, high blood lipid, or
sugar content. These irritants can damage endothelial cell lining and allow the
formation of atherosclerosis which is the buildup of fat, cholesterol, protein,
calcium, and WBC. Atherosclerotic plaque can rupture suddenly and the formation
of blood clot ensues. When this blood clot becomes large enough to block blood
flow of the coronary artery, which results in ischemia, it leads to a heart
attack. The artery that most commonly gets blocked is the left anterior descending
artery (LAD), which is a branch of the left coronary artery, which supplies
front and bottom of the left ventricle. If blood supply stops for a minute
heart tissue ischemia occurs, which is reversible, and after 20 to 40 minutes’ necrosis
occurs, which is irreversible.
Symptoms:
1.
Left sided chest pain or pressure
2.
Pain radiates to the left arm or jaw
3.
Diaphoresis (excessive sweating)
4.
Nausea and vomiting
5.
Fatigue
6.
Dyspnea (difficulty breathing)
Diagnosis:
Based on the above symptoms the following diagnostic tests
can be performed:
1.
Blood test: during a heart attack, the heart
tissues get damaged and releases many cardiac enzymes such as Troponin I, Troponin
T, and CK-MB. The purpose of the blood test is to detect these cardiac enzymes
at different times to determine the severity of the damage.
2.
ECG: can detect and record-
a. the heart's electrical activities
b. the heart's rates and rhythms (regular or irregular)
c. the strength and timing of electrical signals
d.
other coronary artery diseases and signs of previous and current heart attack.
Complication:
1.
0 - 24 hours: Arrhythmias (abnormal heart rate
and rhythms) and cardiogenic shock
2.
1 - 3 days: Pericarditis (an infection of the
heart covering-pericardium)
3.
3 – 14 days: Myocardial rupture. (the heart
muscle damages and tears)
4.
After 2 weeks: Heart failure
Prevention:
1.
Lowering the risk factors discussed above
2.
Changing to a heart healthy lifestyle such as
eating balanced diet and regular physical exercise
3.
Stop smoking
4.
Manage stress
5.
Reduce weight
Treatment and management:
1.
Fibrinolytic agents: tissue plasminogen
activator (tPA), streptokinase(SK), urokinase(UK).
2.
Angioplasty: to open up the blocked arteries.
3.
Percutaneous coronary intervention (PCI): non
surgical procedure with stent to improve blood flow to the heart.
4.
Antiplatelet: Aspirin
5.
Anticoagulant: Heparin
6.
Nitrates: to relax coronary artery
7.
Beta blockers: to slow down the heart rate
8.
Statin: to decrease the amount of cholesterol
from blood
9.
ACE inhibitor: to reduce the blood pressure
10.
Pain killer.
Note: Re-perfusion injury can occur by returning blood to the
tissue. (Histology: contraction band necrosis)
By-
Maruful Bhuiyan
MD candidate, Chicago. IL, USA.
Editor-
Fariha Ahmed
Student at City University of New York
New York, USA.
(Any suggestion, comment and correction will be highly appreciated)
Reference:
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