Myocardial infarction or MI is another name for a heart attack. The most important thing to consider is time. Your heart muscle is being damaged. A blockage in your coronary artery has rendered your heart deficient of blood supply to a section of your heart muscle. Do not waste time calling your primary care doctor. The sooner you get treatment, the better your outcome will be.
How does this really get started? There are some basic risk factors to consider. If you consider family history, primary relatives tend to carry more weight. If you are 50 years old and your brother or father had mi's in there forties enough said. You can talk about smoking which affects all blood vessels in your body. Diabetes is a huge risk factor. A person with diabetes is said to have a higher risk for mi than a person who has already had an mi but is not diabetic. High cholesterol can cause you problems as well. Some scientist and doctors have done some pretty convincing studies on this many I am sure with the backing of pharmaceutical industry. There has been a lot of evidence on reduction of ldl or bad cholesterol reducing heart attack and stroke. Lack of exercise, especially exercise which gets your heart rate up is beneficial.
So what's the problem:
well it starts with fatty plaques building up in your arteries. This gets started at a very young age.
It seems though that all plaques are not created equal. If a plaque grows large enough it can break open. Here is the real problem. when the plaque breaks open, cells in your bloodstream called platelets gather in that area to form a clot. perfect example of how your body can try to help but ends up screwing things up. That is because when the clot forms on the plaque it can completely occlude or block the artery. Now that artery has a job to do. It provides blood to part of your heart muscle. Now lacking blood, muscle becomes deprived of oxygen and nutrients. If not corrected part of muscle dies that is supplied by that artery. The bigger the artery or more important the artery the worse your outcome will be. This is why it is smartest to bypass primary care doctor and get treatment as fast as possible. CALL 911.
What are the symptoms
Usually chest pains. Is often chest pressure or squeezing pain but less frequently may feel like heartburn, indigestion. Other common symptoms include shortness of breath, nausea, break out in a sweat, irregular heart beats, dizziness, or light headed and pain may radiate to the jaw or down left arm. Left arm may also feel tingly or numb. Sometimes patients will have a lot of heartburn or burping leading them to think it is not their heart. Heart pains is not usually a short or fleeting pain. It tends to stay around longer than 10 minutes. If you have a pain that is sharp or sore and worse with movement of your chest or arms is more likely not cardiac. One example is after having respiratory infection with a lot of coughing your joints around sternum or chest bone where ribs meet chest bone can become irritated and will hurt with deep breath or a cough.
So let's say it's your lucky day and local er has the A-team on your case. First thing they will probably do is place oxygen on your nose. They very likely will be doing several things at same time. They will usually give you an aspirin to chew and maybe a nitroglycerin to dissolve under your tongue. Aspirin helps keep your body from forming clots by incapacitating your platelets. Remember the rupture plaque in your artery. Nitroglycerin is a vasodilator. It opens up your artery so blood can more easily get to your dying heart muscle. Now at some point in process they have gotten an ekg. An ekg is basically a tracing of electrical pathways in your heart. Without going into great detail on how an ekg works, just remember that doctors have discovered what a normal one should look like and can tell by patterns on it if your heart is likely to be undergoing some damage.
For the sake of reference let's say that some mi's have changes on ekg that are called ST elevation and some do not. In general if changes in ST wave is showing up on your ekg it is bad. That being said long term studies show at one year the one without ST changes can fare worse. more on this later in section on treatments. Other ways to diagnose mi is with blood tests. Most useful is a test called troponin. Troponin is very specific to heart and is a very sensitive test. With troponin most patients can be diagnosed within 2-3 hours of presentation. But if drawn early on after symptoms start it may not be elevated so usually you will have to stay in er for repeat ekg's to check for any ongoing changes and repeat blood test such as troponin. Most acute mi's can be excluded by six hours.
While troponin is very good test it might not become elevated if you are treated quickly with REPURFUSION. That is good because if your troponin does not go up then you did not get significant muscle damage.
Treatment: Again you are given oxygen because increasing oxygen levels in your general circulation has to have some chance of getting more oxygen to your heart. aspirin stops platelets from forming more clot at the damaged plaque. Nitro opens up your arteries making them wider to let more blood flow to damaged heart will often stop your chest pains. REAL treatment is reperfusion. Now here is the problem. Back to ST wave changes: mi with ST changes is called STEMI short for st elevation mi. These seem to get all the good stuff. May include medicines to bust up the clot but usual preferred method is to look at the arteries. This is done by Heart Catheterization. The cardiologist will take a long plastic catheter and run it up your artery to your heart where dye can be used to visualize your heart arteries (or coronary arteries). Is first done by making an incision most traditionally in groin over your femoral artery. The femoral artery is easily located thru the incision and catheter is put into artery and passed up to aorta (main artery in your abdomen and chest ) to heart where the cardiologist can then locate your coronary arteries using the dye. Hopefully he or she has done this before. The dye locates the narrow or completely blocked portion of the artery. Ideally BALLOON is passed thru then catheter and placed in blocked part of artery and inflated to open up that area. Then a stent may or may not be placed in that section which was opened by the balloon. A basic limitation on this procedure is how much dye has to be used to achieve these goals. You see, dye places a heavy burden on your kidneys and thus using too much can be risky for your future kidney function. So sometimes stenting has to be postponed for several days. On average your kidneys function will return to normal after 4 DAYS because it will be cleared from your body by then.
This brings me back to the less threatening mi that does not have st elevation (NSTEMI)
This next statement is beyond the scope of my practice and would be my opinion. Remember this
STEMI or mi with st wave elevation (apparently showing more damage) has a higher mortality or death rate at one month. That may be why these patients are the ones more likely to get reperfusion treatments such as balloon angioplasty or stenting. So here's the thing. At one year the patients with lesser mi or NSTEMI have been shown to have higher cardiac death or recurrence of mi. Maybe they too should have had early catheterization? not sure.
And for those with more significant disease found on cath, surgery may be recommended.
A coronary artery bypass graft surgery or CABG ("cabbage") may have to be done. This is usually the case if your main coronary artery is blocked or three or more of your major coronary arteries have significant blockages.
Now I would say this has all represented an oversimplification. If it has sparked your interest then here are a few web sites that may be useful:
American Heart Association
www.heart.org
National Heart, Lung, and Blood Institute
www.heart.org/HEARTORG/CONDITIONS/HeartAttack/Heart-attack_UCM_001092_SubHomePage.jsp
National Library of Medicine
www.nlm.nih.gov/medlineplus/heartattack.html
Another thing: Good control of high blood pressure is very important.
If you are diabetic, then get good control.
Keep your ldl or "bad cholesterol" below 100 (often requires statin). Eat a healthy diet low in saturated fats and high in fiber, fruits, and vegetables.
DON'T smoke
EXERCISE
ETC.
*"The Doctor" is a Board Certified Family Practice Physician who visits Gracie Road Monthly
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if you have concerns about your health or suspect that you might have a problem.
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