Heart Attack

What is a heart attack?

A heart attack (also called a myocardial infarction) occurs when the flow of oxygen-rich blood to the heart is blocked. Without the oxygen it needs to function, a section of the heart muscle becomes damaged and begins to die.

The heart is surrounded by a network of vessels called arteries, which carry the oxygen-rich blood to the heart. Over time, cholesterol in the blood starts to deposit in the walls of the artery, developing into a fatty, waxy substance called plaque. The build-up of plaque is called coronary artery disease. As the plaque builds, the smooth, elastic arteries become hard and rigid and start to narrow, which becomes a condition called atherosclerosis.

If the plaque becomes unstable and breaks open, it can cause a blood clot to form at the rupture site. If the clot gets big enough, it can then block the flow of oxygen-rich blood to the heart. Unless this blockage is treated quickly, the section of the heart receiving blood from the artery starts to die.

For many people, there is no apparent reason for a heart attack to occur when it does. But for other people, heart attacks can be triggered by exercise, an emotional event, or by illegal drug use (such as cocaine).

What are the symptoms of a heart attack?

The symptoms of a heart attack can be different from person to person. For some, there may be few symptoms and they may not even realize that they’ve had a heart attack. For others, the symptoms may be severe. For those who have already experienced a heart attack, the symptoms could be different if they have another one.

Some of the most common warning symptoms of a heart attack include:

  • chest pain or discomfort (called angina), usually in the center or left side of the chest, that feels like pressure, heaviness, aching, tightness, squeezing, numbness, burning, fullness or pain; it can also feel like heartburn or indigestion. The pain usually lasts for more than a few minutes or goes away and returns.
  • upper body discomfort with pain that spreads down the left shoulder and arm to other areas, such as the back, shoulders, neck, jaw, or upper part of the stomach
    shortness of breath
  • breaking out in a cold sweat
  • nausea or vomiting
  • light-headedness or dizziness
  • feeling unusually tired for no reason, sometimes for days (particularly women)

If you experience any of these symptoms for longer than 5 minutes, call 911 immediately.

It is important to act fast at the first sign of a heart attack. In addition to saving your life, a fast response can help limit any damage to your heart. The best time to treat a heart attack is within one hour of when symptoms begin. There is a limited amount of time before major and long-lasting damage is done to the heart muscle.

How is a heart attack diagnosed?

Heart attacks are usually attended to under emergency conditions, either by paramedics in an ambulance on the way to the hospital or by a doctor in an emergency room. Initial steps usually involve assessing your heart rate, blood pressure, and breathing rate. A doctor will ask about your medical history and give you a physical examination.

Diagnostic tests that are typically performed at the time of the heart attack or within a few days after the attack include:

  • blood testing for cardiac enzymes, which are released into the blood stream when heart cells die—higher than normal levels of these proteins suggest a heart attack; commonly used tests include troponin, CK or CK–MB, and serum myoglobin
  • electrocardiogram (EKG or ECG), which records the heart’s electrical activity and checks for irregular heart rhythms (arrhythmias); the test can show signs of damage due to coronary heart disease or signs of a current or previous heart attack
  • exercise stress test, during which you walk on a trend mill or ride a stationary bike to make your heart work hard and beat fast; the doctor will look for signs of coronary artery disease, such as  shortness of breath or chest pain, abnormal changes to your heart rate or electrical activity that may indicate coronary artery disease
  • echocardiogram (ultrasound), which uses sound waves to create a moving image of the heart, so that doctors can assess overall function of the heart and to see any problems with blood flow, injuries caused by poor blood flow, or heart muscle that isn’t contracting properly
  • cardiac perfusion scan, which is used to estimate the amount of blood reaching the heart muscle during rest and exercise
  • cholesterol test, which shows the amount of cholesterol in your blood

If the doctor suspects or finds that you have clogged arteries, the following medical procedures may be performed:

  • cardiac catheterization, during which a long, thin, flexible tube called a catheter is inserted into a blood vessel in the arm, upper thigh, neck, then threaded into the heart to see if your arteries are blocked and how your heart is functioning; the procedure is typically performed in a hospital while you’re awake and with minimal pain
  • coronary angiography, which involves using an iodine dye and x-rays to show the inside of your coronary arteries so that the doctor can see the flow of blood through your heart and blood vessels; this procedure is often done with cardiac catheterization

How is a heart attack treated?

Whether you are going to the hospital in an ambulance or have gone directly to the emergency room, the first goal during a heart attack is get blood flowing again to your heart to limit further damage to the heart muscle. This involves the starting of certain treatments within 30 minutes of the first sign of symptoms.

These treatments may include:

  • aspirin to thin your blood and prevent further blood clotting—which you can chew as soon as possible after calling 911
  • oxygen therapy
  • thrombolytic therapy, also called “clot busters”, which is used to dissolve blood clots that are blocking the coronary arteries
  • antiplatelet drugs that stop the formation of blood clots by preventing the clumping of platelets in the blood
  • nitroglycerin to improve blood flow through your coronary arteries and reduce the heart’s workload
  • morphine for chest pain

During this time, you may be taken to the cardiac catheterization laboratory, or cath lab, so that doctors can evaluate your heart and arteries and assess that amount of damage done to the heart muscle. There are two main procedures that may be performed during or shortly after a heart attack. They include:

  • angioplasty (or percutaneous coronary intervention), which is ideally done as soon as possible after the heart attack. It is a nonsurgical procedure that uses a thin, flexible tube (catheter) with a balloon on the end that is threaded through a blood vessel or a narrowed or blocked artery; once there, the balloon is inflated to compress the plaque against the wall of the artery to restore blood flow. During the procedure, a small mesh tube called a stent may be inserted to keep the artery open.
  • coronary artery bypass graft (CABG), which is a type of surgery during which arteries or veins from other areas of the body are used to create a pathway around a blocked artery to restore or improve blood flow to the heart and help avoid a heart attack. Surgeons may choice to do bypass surgery over angioplasty because of the location of the blockage or due to numerous blockages.

After the heart attack

In the days after the heart attack, you will stay in the hospital so that you can be monitored closely to make sure you don't have any serious complications. Once you go home, you may continue to take daily medications and start a cardiac rehabilitation program.

The medications will help lower your risk of having another heart attack or complications and help you live longer after your heart attack. These medications may include:

  • ACE inhibitors to lower blood pressure, reduce strain on your heart, and help slow down further weakening of the heart muscle
  • antiarrhythmics to treat and prevent irregular heartbeats
  • antiplatelet drugs that stop the formation of blood clots by preventing the clumping of platelets in the blood
  • beta-blockers to slow down the heart rate and reduce blood pressure, which then reduces the heart’s demand for oxygen; they also reduce the risk of heart attacks and sudden death
  • blood thinners (aspirin, anti-coagulants) to lower the risk of blood clots in the heart or blood vessels
  • statins to lower your cholesterol and help prevent further blockage in your blood vessels and heart attacks

Your doctor may also want you to get a flu shot and pneumococcal vaccine each year.

A cardiac rehabilitation (cardiac rehab) program is designed to teach you ways to help you feel better and avoid another heart attack. The goal of the program is to help improve the health and well-being of people who have heart problems. It involves making basic lifestyle changes, including:

  • eating a healthy diet aimed at reducing high cholesterol and blood pressure levels
  • quitting smoking
  • being physically active
  • maintaining a healthy weight
  • reducing stress

Cardiac rehab is medically supervised by a team of professionals that may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists. The program can start in the hospital or soon after you return home. It’s up to you whether you want to participate. But even if you don’t, you do need to make these important lifestyle changes to lower your risk of having another heart attack.

It is also important to continue seeing your doctor on a regular basis. Be sure to keep all your appointments, and tell your doctor about any changes in your condition. Report any chest pain, shortness of breath (with or without exercise), weight gain or loss, or signs of depression.  

Advanced Cardiovascular Care at Jeanes Hospital

If you believe you are at risk or a heart attack, the highly-experienced cardiologists at the Temple Heart & Vascular Institute at Jeanes Hospital are ready to assist in assessing and treating of your symptoms. From patient consultation to a full range of diagnostic tests and surgical procedures, our Temple doctors are prepared to help you understand and manage all aspects of your condition.

The Temple cardiologists at Jeanes Hospital evaluate hundreds of patients every year, managing a wide range of serious cardiovascular conditions. After careful evaluation, they can develop and oversee a treatment plan tailored to meet your specific needs.

If surgery is required, there’s no need to travel to another institution to have it done. Since 2006, Temple cardiovascular surgeons have been performing cardiac surgery procedures at Jeanes Hospital. Our surgeons are supported by a full-time team of cardiac anesthesiologists, surgical technicians, and critical care nurses. Dedicated nurse practitioners also collaborate with surgeons to manage patient care in Jeanes Hospital and in our outpatient settings.

Procedures performed at Jeanes for the diagnosis and treatment for symptoms of a heart attack include:

  • Diagnostic coronary angiography
  • Coronary intravascular ultrasound
  • Tilt table testing
  • Complex coronary interventions
  • Heart catheterization for pressure/flow monitoring
  • Minimally invasive heart value repair and replacement
  • Balloon angioplasty
  • Coronary stenting
  • Aortic and valve repairs
  • Coronary artery bypass (CABG)
  • Surgical treatment of cardiac arrhythmia
  • Full on-site back-up capability for open heart surgery

This is the level and quality of care you would expect to find downtown or in another city. Yet, it’s available right here, in your own community.

To schedule an appointment with a cardiologist at the Temple Heart & Vascular Institute at Jeanes Hospital, click here or call 215-728-CARE (2273).

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