MHVI Owners Manual . Conditions . Coronary Artery Disease . Heart Attack

What Is It?
In a coronary artery already narrowed by the buildup of plaque (atherosclerosis), a blood clot or disruption of the plaque can cause sudden and complete blockage in the vessel, so that no blood is able to pass through it. This abrupt interruption of blood flow is called a heart attack, or myocardial infarction. When a segment of heart muscle is deprived of its blood supply, it stops working and eventually the muscle is replaced by scar tissue. A heart attack therefore weakens the heart's pumping strength. If the heart is weakened enough, congestive heart failure can result.

Symptoms
Although the symptoms of heart attack vary in number and intensity from person to person, any or all of the following may occur:

Crushing or severe chest pressure or discomfort that may travel up to your jaw or throat or down your arm(s) or into your back
Shortness of breath
Excessive sweating and clamminess
Faintness or loss of consciousness
Nausea or indigestion

DO NOT
attempt to drive yourself to the hospital.

DO NOT
have someone else take you to the hospital.

DO
call 911 and ask for an ambulance and remember, minutes count, so do not delay!

You'll notice that these symptoms are very similar to those listed for angina. The difference is that with a heart attack, the symptoms are prolonged (for example, lasting for more than 10-15 minutes). If you experience any of these symptoms whether alone or in combination, it is important to seek immediate medical care. You may have already been diagnosed as having angina and given a prescription for nitroglycerin. If chest discomfort is not relieved by your nitroglycerin, you need to go to the hospital. Do not delay. Damage to your heart can be reduced significantly with early treatment. Do not attempt to drive yourself, and don't have someone else take you to the hospital. Call 911 and ask for an ambulance. Take an aspirin on the way to the hospital.

Treatment
Initial treatment for a heart attack can take different forms, with effectiveness dependent on how soon the treatment is started and may include one or more of the following:

Special drugs sometimes called "clot busters" (thrombolytic drugs) which are used in the early stages of a heart attack to dissolve the blood clot that is causing the heart attack. This may help to limit the amount of damage to the heart muscle.
Interventions such as angioplasty, atherectomy, or stenting that open the blocked artery and help reduce damage caused by the heart attack (see Therapeutic Procedures section).
Coronary artery bypass surgery that creates new pathways for blood to reach the suffering area of your heart. This is done less often for an acute heart attack, but more often if several blockages are found in the coronary arteries (see Therapeutic Procedures section).

Suffering a heart attack can be a frightening experience, but remember that your heart muscle is durable and capable of healing. Although scar tissue forms in the damaged area, over time, your heart is usually able to compensate for the area lost to scar tissue. Your doctor will be able to monitor the recovery of your heart muscle by means of a test that measures your left ventricular ejection fraction (LVEF). A normal LVEF is 60-70 percent, meaning that each heartbeat normally pushes about two-thirds of the blood in the left ventricle out to your body with every heart beat. Knowing your ejection fraction is important in managing your follow-up treatment.

As part of your ongoing treatment after a heart attack, your doctor will most likely prescribe three or four types of medication to help restore and maintain the optimal condition of your heart. These therapies are also intended to decrease the chance of further heart trouble. These include:

Aspirin to reduce the chance of blood clot formation

No matter which treatment your doctor chooses for you, lifestyle changes will be an essential component of your "therapy package." Understanding the risk factors that contributed to your heart attack will help you take the necessary steps toward decreasing these risks and strengthening your heart.

Beta blockers to reduce your heart rate and blood pressure and "protect" your heart; both aspirin and beta blockers have been shown to reduce the chance of a second heart attack
ACE inhibitors to help reduce the work of your heart while it heals. These drugs are typically used if your ejection fraction is less than 40 percent.
Lipid lowering medicine may be prescribed if your blood cholesterol levels are elevated. Several of these types of medicines have also been shown to decrease the chance of repeat heart attacks. So, if you have had a heart attack, it is especially important to know your cholesterol numbers and follow the treatment your doctor has recommended.
If you are currently a smoker, you will need to quit as quickly as possible! Ask for help if you need it.
An aerobic exercise program that gradually increases your heart's strength and endurance will be essential. Your doctor will prescribe the right program for you. This is likely to include a cardiac rehabilitation program.
You will need to follow a diet that is high in fiber and low in fat, sugar, sodium, and cholesterol. This will help lower blood cholesterol levels and increase the level of important nutrients that improve your health.
Finding ways to better manage the stress in your life will also be very important.

More information on all of these topics is provided for you in the Lifestyle Management section of this manual. MHVI offers many helpful classes and programs as you make these critical changes in your life.

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