Heart Attack: Causes, Signs/Symptoms and Treatment

What is Heart Attack?

Heart Attack: Causes, Signs/Symptoms and Treatment

What is Heart Attack?

Heart attack /Myocardial Infarction is seen when a certain portion of the heart muscle dies off because there is a cessation of blood flow to that area of the heart. This condition is one of the cardiovascular diseases.

Generally, this is a common cause of sudden cardiac death. In the western world, it’s a leading cause of mortality and morbidity.

In Nigeria, we have started seeing an increase in the incidence of Myocardial Infarction. This is largely explained by a process of westernization. Changes in diet, less physical activity, obesity, high cholesterol, excessive alcoholism. Cigarette smoking are amongst some of the common risk factors for the condition.

Signs/Symptoms

Usually, it presents with chest pain. This is called angina pectoris in medical terms.The classical angina is such that comes with exertion. Or anything process that makes the heart beat faster.
So emotional outbursts, excitement can also predispose to it. The chest pain is usually severe enough to stop one from any activity that’s being carried out.
The pain is usually vague. So localization cannot often be made to the nearest point on the chest. Rather it’s a wide area of discomfort usually on the left side of the chest. This pain can radiate to the neck, the left shoulder region, and possibly the inner side of the left arm. It may be associated with shortness of breath and awareness of the heart beat(palpitations).

There is usually also unnecessary sweatiness and generalized weakness of the body.
The pain will usually last more than 20 minutes. It is continuous. Will not wax and wane over days. There are other possible causes of chest pain which every doctor must rule out when a patient is seen. The common ones are pain from the lungs and it’s covering. Pain from peptic ulcer or gastritis. Pain from the covering of the heart itself called Pericarditis. Most commonly, it can come from the rib cage it self. Because the heart is deep seated, you cannot not elicit the pain from the heart by pressing the chest.

Causes

Myocardial Infarction usually occur in the setting of a plaque formed in the inner walls of the arteries that supply our heart.

This is what we call Atherosclerosis. This is usually as a result of high cholesterol. Especially the bad Cholesterol. The bad Cholesterol is called LDL. The bad Cholesterol is deposited in the walls of the arteries to the heart and as such the walls start narrowing.
Over time, the plaque can cause an occlusion. When there is a total blockage with no blood flow, the heart muscle supplied by that artery start dying. This starts within minutes. But by 6 hours if nothing is done, it’s too late.
Please!!! It’s a dire emergency!!!

There are different levels of severity depending on the artery that is involved. Data from the USA and Europe where emergency ambulance services are available, 25% of patients will die instantly. Another 25% will die in transit. Out of the 50% that makes it to the hospital 25 % will not survive. These are data available before the emergence of the ambulance services.

However, with such services manned by well trained staff and provision of defibrillators in the ambulances, these rates have tremendously improved. However, emergency services are still very poor in Nigeria, more so awareness is very poor. So the mortality rate in Nigeria is still very high.

Test Carried Out In Hospitals And Treatment

Emergency ECG. This is very key to making the diagnosis.
Next is what we call cardiac enzymes like CK-MB,troponin. These two are chemicals secreted by a damaged heart muscle, so they tend to be very high after a heart attack.

Most hospitals should be able to do these tests. Beyond this, most hospitals in Nigeria cannot do much. So pls people should endeavour to ask for quick referrals to the biggest government hospitals like National hospital and Gwagwalada. The FCDA hospitals can’t handle them. And surely the private hospital cannot either.

The next stage of investigation is what we call Coronary Angiography. At the moment, it’s only one hospital in Abuja and the neighboring 10 states that can do this. When the diagnosis is made, the treatment options are two. However, this depends on whether the patient presents at the appropriate time. There is a six hours window period of treatment after which no definitive treatment can be done.

There are conservative and definitive approach to treatment. The definitive approach also has two modalities of treatment. The first one is called Thrombolysis
This is the act of injecting a certain drug into the veins with the hope of the drug going to break down the clot that’s obstructing the artery. These are expensive drugs. At the moment, the one being used abroad is about N480,000. This is because of the exchange rate. The oldest one which we still use is about N50,000 for a dose.
Again like I said earlier, the Window period for their use is six hours. We have used them many times to save lives.
The second modality is Coronary Angiography;like I had mentioned earlier.
However, this time it’s serving as both a diagnostic as well as treatment modality. As a treatment modality, the angiography helps to determine where the obstruction is and then, either an inflatable balloon is inserted and inflated to open up the obstruction or a Stent, this is like a mesh of wire, is used to open up the obstruction.

Now the conservative method involves the use of aspirin, cholesterol lowering drugs and other drugs that open the arteries. The patient will be in the Intensive Care Unit for a period of time. After which he will be discharged to a lower level care. Sometimes, surgery might be indicated, at which time some veins are taken from the patient’s legs and used to replace the arteries.
Note: Prevention is far far better than cure. Live a healthy life.