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happens during a Heart Attack. Related Issues: Heart
Heart Attack Quiz
Year's Biggest Game Puts Men at Risk
Gender gap remains for heart attack care
Heart Health for Men, Women
What Happens During a Heart Attack?
The heart muscle requires a constant supply of oxygen-rich blood to nourish it. The coronary arteries provide the heart with this critical blood supply. If you have coronary artery disease, those arteries become narrow and blood cannot flow as well as it should. Fatty matter, calcium, proteins and inflammatory cells build up within the arteries to form plaques of different sizes. The plaque deposits are hard on the outside and soft and mushy on the inside.
When the plaque's hard, outer shell cracks (plaque rupture), platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. If a blood clot totally blocks the artery, the heart muscle becomes "starved" for oxygen. Within a short time, death of heart muscle cells occurs, causing permanent damage. This is called a myocardial infarction (MI), or heart attack.
While it is unusual, a heart attack can also be caused by a spasm of a coronary artery. During coronary spasm, the coronary arteries restrict or spasm on and off, reducing blood supply to the heart muscle (ischemia). It may occur at rest and can even occur in people without significant coronary artery disease.
Each coronary artery supplies blood to a region of heart muscle. The amount of damage to the heart muscle depends on the size of the area supplied by the blocked artery and the time between injury and treatment.
Healing of the heart muscle begins soon after a heart attack and takes about eight weeks. Just like a skin wound, the heart's wound heals and a scar will form in the damaged area. But, the new scar tissue does not contract or pump as well as healthy heart muscle tissue. So, the heart's pumping ability is lessened after a heart attack. The amount of lost pumping ability depends on the size and location of the scar.
What Are the Symptoms of a Heart Attack?
Symptoms of a heart attack include:
During a heart attack, symptoms last 30 minutes or longer and are not relieved by rest or oral medications (medications taken by mouth).
Some people have a heart attack without having any symptoms (a "silent" myocardial infarction). A silent MI can occur in any person, though it is more common among diabetics.
What Do I Do if I Have a Heart Attack?
Quick treatment to open the blocked artery is essential to lessen the amount of damage. At the first signs of a heart attack, call for emergency treatment (usually 911). The best time to treat a heart attack is within one to two hours of the first onset of symptoms. Waiting longer than that increases the damage to your heart and reduces your chance of survival.
Keep in mind that chest discomfort can be described many ways. It can occur in the chest or in the arms, back or jaw. If you have symptoms, take notice. These are your heart disease warning signs. Seek medical care immediately.
How Is a Heart Attack Diagnosed?
Once the emergency care team arrives, they will ask you about your symptoms and begin to evaluate you. The diagnosis of the heart attack is based on your symptoms, ECG and the results of your blood tests. The goal of treatment is to treat you quickly and limit heart muscle damage.
Tests You Take
How Is a Heart Attack Treated?
Once heart attack is diagnosed, treatment begins immediately -- possibly in the ambulance or emergency room. Medications and surgical procedures are used to treat a heart attack.
What Medications Are Used to Treat a Heart Attack?
The goals of medication therapy are to break up or prevent blood clots, prevent platelets from gathering and sticking to the plaque, stabilize the plaque and prevent further ischemia.
These medications must be given as soon as possible (within one to two hours from the start of your heart attack) to decrease the amount of heart damage. The longer the delay in starting these drugs, the more damage can occur and the less benefit they can provide.
Medications for this purpose may include:
Other drugs, given during or after a heart attack, lessen your heart's work, improve the functioning of the heart, widen or dilate your blood vessels, decrease your pain and guard against any life-threatening heart rhythms.
What Other Treatment Options Are There?
During or shortly after a heart attack, you may go to the cardiac catheterization laboratory for direct evaluation of the status of your heart, arteries and the amount of heart damage. In some cases, procedures (such as angioplasty or stents) are used to open up your narrowed or blocked arteries. These procedures may be combined with thrombolytic therapy (drug treatments) to open up the narrowed arteries, as well as to break up any clots that are blocking them.
If necessary, bypass surgery may be performed to restore the heart muscle's supply of blood.
Treatments (medications, open heart surgery and interventional procedures, like angioplasty) do not cure coronary artery disease. Having had a heart attack or treatment does not mean you will never have another heart attack; it can happen again. But, there are several steps you can take to prevent further attacks.
How Are Subsequent Heart Attacks Prevented?
The goal after your heart attack is to keep your heart healthy and reduce your risks of having another heart attack. Your best bet to ward off future attacks are to take your medications, change your lifestyle, and see you doctor for regular heart checkups.
Why Do I Need to Take Medicine After a Heart Attack?
Medications are prescribed after a heart attack to:
Other medications may be prescribed if needed. These include medications to treat irregular heartbeats, lower blood pressure, control angina and treat heart failure.
It is important to know the names of your medications, what they are used for and how often and at what times you need to take them. Your doctor or nurse should review your medications with you. Keep a list of your medications and bring them to each of your doctor visits. If you have questions about your medications, ask your doctor or pharmacist.
What Lifestyle Changes Will I Need to Make?
There is no cure for coronary artery disease. In order to prevent the progression of this disease, you must follow your doctor's advice and make necessary lifestyle changes. You can stop smoking, lower your blood cholesterol, control your diabetes and high blood pressure, follow an exercise plan, maintain an ideal body weight, and control stress.
When Will I See My Doctor Again After I Leave the Hospital?
Make a doctor's appointment for four to six weeks after you leave the hospital. Your doctor will want to check the progress of your recovery. Your doctor may ask you to undergo diagnostic tests (such as an exercise stress test at regular intervals. These tests can help your doctor diagnose the presence or progression of blockages in your coronary arteries and plan treatment.
Call your doctor sooner if you have symptoms such as chest pain that becomes more frequent, increases in intensity, lasts longer, or spreads to other areas; shortness of breath, especially at rest; dizziness, or irregular heartbeats.
Reviewed by the doctors at The Cleveland Clinic Heart Center.
Gender gap remains
for heart attack care
Overall, women survive heart attacks about as well as men when they are under a hospital's care. But the study found that a gender gap remains when women have the most serious type of heart attack. Women also get less of the recommended medicines and procedures than men, or it takes longer to get them.
"We're doing better but not good enough for women," said Dr. Hani Jneid, lead author of the study from Baylor College of Medicine in Houston.
The data came from 420 hospitals enrolled in an American Heart Association program to get doctors to follow guidelines for treating heart attack patients. Previous research has suggested that women's heart attacks were treated less aggressively.
The research was funded by the heart association and the findings were reported Monday in the group's medical journal, Circulation.
Dr. Nieca Goldberg, a cardiologist who specializes in women's care, said the study suggests that women's heart attack symptoms still are not being taken seriously. Some women don't have typical symptoms like chest pains, she said, but may have pain lower in their bodies or severe shortness of breath.
"This really continues to be very disappointing," said Goldberg, who is director of the Women's Heart Center at NYU Langone Medical Center in New York. "I think my colleagues need to get on the stick."
The study examined the hospital treatment for 78,254 heart attack victims to see if guidelines were followed and how many died. Hospitals in the heart association's "Get with the Guidelines" program are required to put that information in a registry.
When they looked at heart attacks overall, about the same number of men and women died in the hospital. But when they looked at the most serious kind of heart attack, there was a difference.
These heart attacks are caused by a total blockage of an artery, which deprives the heart muscle of oxygen and blood and causes part of it to die. Diagnosis is done with an electrocardiogram, which spots distinctive changes. Quick action is needed to open up the artery to restore blood flow, either with a clot-dissolving drug or an angioplasty.
About a third of the heart attacks in the study were major ones. The raw numbers showed 10 percent of the women with massive heart attacks died in the hospital, compared to about 6 percent of the men. After taking into account the women's older age and other differences, the researchers said the women in the study were 12 percent more likely to die of a major heart attack in the hospital than men.
The researchers said women were also less likely to get recommended medicines, like an aspirin within 24 hours. And they were less likely to get treatment to restore blood flow, or it wasn't given quickly enough.
Jneid said there may have been good reasons behind some of the differences; the researchers didn't know whether the treatment decisions were appropriate or not for specific patients.
But "there's no reason to see a disparity in something as simple as an aspirin," said Jneid.
Another of the researchers, Dr. Laura Wexler of the University of Cincinnati College of Medicine, noted that heart disease is usually thought of as a man's disease, but it is the leading cause of death among women.
"It's very important for the public women and the people
who love them to get over the idea that it's not a disease of
women," she said.