About heart attacks
Heart disease is the most common cause of death in the UK. In
2006, about 113,000 people had a heart attack for the first time.
Heart attacks become more common with increasing age and are
generally more common in men than women.
You can have a heart attack at any time of the day or night, when
you're either resting or being active. Occasionally, a heart
attack can be brought on by doing energetic activity that you
aren't used to, or by intense physical or emotional stress.
You're more likely to have a heart attack if you:
smoke
have a family history of heart
disease
lead an inactive lifestyle
(doing less than 30 minutes physical activity per day, on most
days)
have diabetes
are overweight or obese
have high blood pressure
have high blood cholesterol
Symptoms of a heart attack
If you have a heart attack, you will most likely feel severe pain
in the centre of your chest. This central chest pain is often
described as heaviness, squeezing or crushing, and may come on
suddenly causing you to collapse. The pain sometimes feels like
severe indigestion. Other symptoms include:
pain spreading to the arms,
neck, jaw, back or stomach
feeling sweaty and breathless
feeling sick or vomiting
The symptoms of a heart attack
can come on suddenly, but sometimes the pain develops more slowly.
If you already have angina (narrowing of your coronary arteries
without complete blockage), you will find that the pain of a heart
attack won't completely respond to your usual medicine (eg
glyceryl trinitrate, or GTN). Heart-attack pain continues for
longer than angina and can last for hours.
Sometimes you may not have any symptoms at all, especially if
you're elderly or have diabetes.
During a heart attack, life-threatening heart rhythms may develop,
which is why a heart attack is a medical emergency.
If you suspect you're having a heart attack, call for emergency
help immediately.
Complications of a heart attack
Once the initial discomfort of a heart attack has settled (usually
within 24 to 48 hours) there are often no complications
afterwards. However, in the first few days after surviving a heart
attack, your heart may beat in irregular, unusually fast or slow
rhythms - these are known as arrhythmias.
After having a heart attack, your heart may not be able to pump
blood around your body as efficiently as before. This is called
heart failure. The larger the area of your heart muscle affected
by a heart attack, the more likely you are to have heart failure.
Other, rarer complications include blood clots in the lungs,
stroke, inflammation of the membrane covering the heart (pericarditis),
or a bulging weakness in the heart muscle (aneurysm).
Causes of a heart attack
The underlying cause of most heart attacks is atherosclerosis -
this is where the coronary arteries become narrowed over many
years by fatty deposits (plaques). These plaques are thought to
split open (rupture), releasing substances that cause the blood
flowing in the coronary artery to clot. The plaque and blood clot
(thrombus) can together completely block the coronary artery,
stopping blood flow to your heart and causing a heart attack.
Diagnosis of a heart attack
When you get to hospital, a doctor and nurse will assess your
symptoms and medical history. You will have:
a physical examination - this
involves measuring your blood pressure and monitoring your heart
rate
an ECG (electrocardiogram) -
this checks the electrical activity of your heart and helps to
diagnose any partial or complete blockages of the coronary
arteries
blood tests to check for any
damage to your heart muscle
Treatment of a heart attack
Emergency medical treatment is vital - getting to a hospital
quickly and receiving specialist care greatly improves your
chances of survival. If you can swallow, chew a single aspirin
tablet, unless you know that you're allergic to it. Aspirin thins
the blood and can help to prevent the clot that is blocking the
coronary artery from spreading.
In response to an emergency call for a suspected heart attack, the
ambulance service will send a paramedic as quickly as possible.
His/her job is to stabilise you and provide transport to a
hospital quickly and safely for further treatment. A paramedic may
have to provide oxygen and pain-relieving medicine. Some
paramedics, especially in rural areas, are also trained to give
patients clot-dissolving drugs (also known as "clot-busters" or
thrombolytics) before reaching the hospital.
During a heart attack, there may be disturbances in your heart
rhythm. The most serious form of this is called ventricular
fibrillation. This is when the electrical activity of the heart
becomes so erratic that it stops pumping and quivers or
'fibrillates' instead (known as cardiac arrest). If this happens,
the paramedic may need to use a defibrillator, which gives a large
electric shock through the wall of your chest and can restore a
regular heartbeat (resuscitation).
Hospital treatment
At hospital, you will usually be given an injection of a
thrombolytic to dissolve the clot in your coronary artery. This
increases your risk of bleeding so it won't be given if it could
cause problems, for example if you have recently had surgery. Your
chances of making a full recovery from your heart attack are much
better if the clot is dissolved.
In some hospitals you may be taken on admission for immediate
angioplasty (see Surgery), as this treatment is increasingly used.
Other medicines, such as beta-blockers (eg atenolol) or GTN, may
be given to increase the blood supply to your heart by widening
your blood vessels.
Surgery
If your arteries are narrowed, you can sometimes be treated with
angioplasty or a coronary artery bypass graft (CABG).
Angioplasty involves widening your artery by inflating a balloon
in the narrowed coronary artery. A wire mesh tube called a stent
is sometimes inserted to hold it open.
CABG surgery involves redirecting your blood around the affected
artery. This is done either using a replacement section of a blood
vessel (a graft), which is usually taken from a leg vein or by
diverting another artery in the chest wall (the internal mammary
artery).
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