Heart Attack: Symptoms, Causes, Diagnosis, Prevention and Treatment

A heart attack, also called a myocardial infarction, is a cardiovascular event which affects millions of people worldwide. A heart attack may be a result of an increase in obesity and poor lifestyle habits. In a heart attack, there is a sudden obstruction to the blood supply to the heart muscles causing ischemia and muscle death. The arteries supplying the heart’s musculature are coronary arteries. These arteries become narrow if there is atherosclerosis and obstruction, which results in the blockage of blood flow. This blockage to a part of the heart can cause intense pain and death of heart muscle if not immediately managed. In this article, we will discuss about symptoms and causes of a heart attack, complications, diagnosis and ways to treat and prevent them.

Symptoms 

The type, as well as the extent of the symptoms, vary from person to person, some people hardly get any pain and might just experience mild heartburn or tightness but on the other hand for some people it can start from days to weeks before causing extreme pain in the chest, back, arm and neck making even the process of breathing difficult. In patients with diabetes, there are usually no to mild symptoms. Thus, heart attacks are called silent heart attacks in these individuals.

The common signs and symptoms are as mentioned below:

1. Chest pain 
2. Tightness around the chest 
3. Pressure in the chest and back 
4. Nausea 
5. Heartburn 
6. Indigestion
7. Abdominal pain
8. Shortness of breath
9. Dizziness 
10. Fatigue 
11. Cold sweat 
12. Fast or irregular heartbeat 

Causes and Risk factors

The common causes of atherosclerosis and narrowing of arteries include:

1. Age over 45-50 years increases the lipid deposits in the arteries making them narrow
2. The male gender is more prone
3. Obesity increases the chances of atherosclerosis 
4. Hypertension causes damage to the walls of arteries 
5. Alcohol/smoking/tobacco consumption 
6. Diabetes 
7. Metabolic syndrome 
8. Family history 
9. Lack of physical activity 
10. Stress
11. Medications causing spasms of the blood vessels 
12. Pregnancy and preeclampsia

Angina

Angina is the pain with a heart attack when there is a decrease in the blood supply to heart muscles suddenly causing damage to them.

There are three major types of angina:

1. Stable angina: This occurs due to partial obstruction in the blood flow to the heart muscles. The symptoms usually precipitate during the time of physical exertion and decrease in rest.
2. Unstable angina: This happens when the obstruction in the arteries is very large causing persistent pain irrespective of rest or exertion.
3. Variable angina: this is due to sudden narrowing of blood vessels due to spasms in the arteries without any known cause.

Complications 

Due to degeneration of the part of the heart where the blood supply was cut, the pumping action of the heart starts failing. And there is an irregular transmission of electrical signals along the heart muscles predisposing them for:

1. Arrhythmia: This is an abnormal and irregular beating of the heart due to improper stimulus generation and conduction
2. Heart failure: As a part of the heart muscle is inactive the efficacy of pumping decreases.
3. More heart attacks: The overburdening of the rest of the heart muscles demands more blood, and if there are any more atherosclerotic plaques present it can precipitate more heart attacks.
4. Chamber dilatation and ruptured heart muscles 
5. Aneurysm formation due to weakening and thinning of the muscles 

Diagnosis 

Heart attack causes an alteration in the electrical activity of the heart along with the release of various enzymes from the damaged heart muscle, thus screening for heart attack included scans which show the electrical activity of the heart along with blood tests detecting the levels of the enzymes released:

1. Blood tests: For detection of enzymes like troponin T, Troponin I, myoglobin etc.
2. Echocardiogram: Showing the decreased pumping of the heart muscles. 
3. Angiography: Dye is injected into the blood system showing the exact site and size of the block. 
4. ECG: This helps view the electrical activity of the heart.

Treatment 

Immediate action has to be taken to restore the blood flow to the heart muscles with the following measures:

1. Oxygen supplementation: To increase the oxygenation of the myocardial cells 
2. Nitrates: They help in dilatation of the coronary arteries and increase the blood flow.
3. Anti-platelet medications: They stop the platelet from aggregating and forming any occlusion in the arteries.
4. Anticoagulants: Helps in breaking the clot formed like aspirin.
5. Fibrinolytic drugs: Helps in clot dissolution.
6. Beta-blockers: Slows the beating of the heart to decrease the oxygen demand.
7. Antiarrhythmic drugs: If an arrhythmia is present.
8. Percutaneous coronary intervention (PCI): If the block can’t be removed by medications, then a catheter is inserted in the coronary artery to open the block and a stent is placed.
9. Bypass Grafting: If the supping artery is completely blocked and damaged, then a graft blood vessel usually from the leg is cut and put as a bypass route for the blood to reach the heart tissue.
10. Heart transplant: In very rare cases where nothing else can be done to protect the heart, this procedure is done.

Prevention 

The best preventative measure is through healthy lifestyle modifications like :

1. Healthy weight and healthy BMI maintenance 
2. Healthy food habits which are rich in proteins and less in carbohydrates and fats 
3. Avoid smoking and alcohol 
4. Regular physical activity 
5. Management of existing health conditions like hypertension, diabetes, hyperlipidemia 
6. Reduction of stress
7. Frequent checkups in case of genetic predisposition

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