The heart is a vital organ in the body. It is made up of special muscles that pump blood out of the body. The blood is composed of oxygen and nutrients that are important to maintain the function of the cells, tissues and other organs in the body. Without the heart, the body would not be working in perfect harmony. The importance of the heart could not be described completely with words that are known today. One thing is important when it comes to the heart and that is CARING. Taking good care of the heart shows how important it is to us. One way to show that we care for our heart is to prevent having a heart attack. What is a heart attack and which arm hurts during a heart attack?
What exactly is a Heart Attack?
Myocardial infarction, commonly referred to as heart attack, is a medical emergency that needs immediate management. It basically means heart muscle (myocardial) death (infarct). It is primarily caused by the interruption of blood supply to the heart muscles. When heart muscles do not receive enough blood, they die and losses its function. Like the brain, heart muscles do not regenerate. If the heart muscles die, it will remain dead and useless.
Two Types of Heart Attack
There are two types of heart attack. First is the Transmural. Transmural involves the affectation of major coronary artery and can be subclassified into anterior, posterior and inferior. It can even extend to the whole thickness of the heart muscle. It is usually the result of complete occlusion of the area’s blood supply. Second is the Subendocardial. Subendocardial involves small area in the subendocardial wall of the left ventricle, ventricular septum or the papillary muscles. The subendocardial area is the farthest area of the heart from the blood’s supply thus this area is at high risk of having an infarct.
A Heart attack or myocardial infarction is the leading cause of death in the United States. It kills one in every four American citizen. It equally affects both men and women. Studies have shown that every year about 785,000 Americans have their first heart attack and about 470,000 who previously have heart attack will probably encounter another heart attack. The cost of managing heart attack is constantly increasing and so as those who will be affected by it.
What are the Causes of Heart Attacks?
The main reason for the causation of heart attack is the blockage of the blood supply. Blockage of blood’s flow is primarily caused by atherosclerotic plaque. This plaque is composed of lipids and macrophages. Atherosclerotic plaques do not build up overnight. It is the product of chronic vices, sedentary lifestyle, and consumption of inappropriate foods in inappropriate amounts. As the plaque increase in size, there would come a time that it will burst and causes the platelet to stick on it. This will then cause traffic in the blood flow. As the platelet aggregate increases in size, the pathway of the blood decreases and thus causing decrease blood flow to a certain part of the heart muscles. If the clot is not managed immediately, the affected heart muscles will eventually die.
Risk factors for atherosclerosis are as follows:
• Tobacco smoking
• Low HDL or High Density Lipoprotein
• High triglycerides level
• Drug abuse
• Chronic high blood pressure
• Obesity (body mass index of more than 30kg/m2)
• Familial history
The classical symptom of a heart attack is sudden chest pain. The pain typically radiates to the left side of the body affecting the left shoulder, arm, and neck. The pain of heart attack is described as having an elephant on the chest. Levine’s sign or when a person clenches his/her fist over the sternum is classically thought to predict cardiac chest pain but studies have shown that it has a poor predictive value.
Other symptoms that are associated with heart attack are as follows:
• Shortness of breath or dyspnea
• Nausea and vomiting
• Light headedness
• Excessive Sweating or diaphoresis
• Loss of consciousness
The above symptoms are due to the surge of catecholamines which are from the sympathetic nervous system. Sudden death can occur during a heart attack. This may be due to the development of ventricular fibrillation.
Aside from the symptoms associated with heart attack, there are also tests that can establish the diagnosis of the said pathology. The most common markers used to detect heart affectation are creatinine kinase –MB and the troponin levels. These markers are normally found inside the cells of the heart. When heart damage happens, the cells erupt and send these markers in the blood. The principle is simple. The more cells that die, the greater the value of the said markers in the blood. Other tests that can detect myocardial infarction are electrocardiogram and echocardiography.
Immediate treatment of heart attacks include administration of oxygen, aspirin and nitroglycerin. Supplemental oxygen helps the damaged heart muscles receive needed oxygen. Aspirin is used because it has an anti inflammatory, analgesic and anticoagulant property. It disintegrates the platelet aggregate on the blood vessel which is the primary cause of decreased blood flow to a certain region of the heart. Nitroglycerin is a vasodilator which helps improve blood flow to the heart.
STEMI or ST elevation MI is often treated with thrombolysis or percutaneous coronary intervention (commonly known as coronary angioplasty). For NSTEMI or non ST elevation MI, it is often managed with medications. For those with multiple blockages yet stable, bypass surgery can be an option for them.
Morphine was previously involved in the management of heart attack especially if nitroglycerine is not that effective in decreasing chest pain but today, its use is limited because of the increasing mortality rate in relation to its use (especially with NSTEMI cases).
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