Heart Attack

Few medical emergencies strike with the sudden, terrifying force of a heart attack. Often portrayed in dramatic fashion on screen, the reality is that a heart attack can be a subtle, insidious event or a crushing, unmistakable crisis. It is a moment when the very engine of our life – the heart – is under grave threat. Understanding what a heart attack is, recognising its symptoms, and knowing how to respond quickly can mean the difference between life and death, or between a full recovery and long-term disability. 

This detailed guide aims to discuss this critical health condition, offering vital information on its causes, diagnosis, treatment, and how to live well after such an event. It’s about empowering you with knowledge, ensuring you’re prepared to act for yourself or a loved one.

A heart attack, medically known as a myocardial infarction (MI), occurs when the blood flow to a part of the heart muscle is severely reduced or completely blocked. This blockage most commonly happens due to a build-up of plaque – a fatty, waxy substance – in the arteries that supply blood to the heart, known as the coronary arteries. This process is called atherosclerosis. 

When this plaque ruptures, a blood clot forms around it, quickly obstructing the artery and cutting off the vital supply of oxygen and nutrients to the heart muscle. Without this oxygen-rich blood, the affected heart muscle begins to die. The longer the blood flow is interrupted, the more damage occurs to the heart muscle. Early recognition and immediate medical attention are crucial to minimise heart damage and save lives.

While the core mechanism of a heart attack involves blocked blood flow, there are different ways this can manifest, leading to various classifications:

• STEMI (ST-Elevation Myocardial Infarction): This is the more severe type of heart attack. It occurs when a coronary artery is completely blocked, causing extensive damage to a large area of the heart muscle. It's characterised by specific changes on an electrocardiogram (ECG) called ST-elevation. STEMIs require immediate, aggressive treatment to restore blood flow.
• NSTEMI (Non-ST-Elevation Myocardial Infarction): In an NSTEMI, the coronary artery is only partially blocked, or the blockage is temporary. This still causes damage to the heart muscle but typically affects a smaller area and does not show the same pronounced ST-elevation on an ECG. While less severe than a STEMI, an NSTEMI is still a serious medical emergency requiring urgent treatment.
• Silent Myocardial Infarction: This type of heart attack occurs with few or no symptoms, or symptoms that are mild and easily dismissed (e.g., indigestion, general fatigue). Silent MIs are more common in people with diabetes or older adults, and they can still cause significant heart damage.
• Spontaneous Coronary Artery Dissection (SCAD): A rare but serious cause, where a tear occurs in the wall of a coronary artery, trapping blood and creating a bulge that blocks blood flow. SCAD often affects younger, otherwise healthy individuals, particularly women.

The primary cause of a heart attack is coronary artery disease (CAD), where the coronary arteries become narrowed and hardened due to atherosclerosis. This plaque build-up is a slow process, often starting in childhood. Over time, these plaques can rupture, leading to the formation of a blood clot that blocks the artery.

Other, less common causes include:

• Coronary Artery Spasm: A sudden tightening of the muscle in the artery wall, temporarily blocking blood flow.
• Spontaneous Coronary Artery Dissection (SCAD): As mentioned, a tear in the artery wall.
• Certain Medical Conditions: Conditions like uncontrolled high blood pressure, high cholesterol, diabetes, and obesity significantly contribute to the development of atherosclerosis.
• Drug Use: Stimulants like cocaine or amphetamines can cause coronary artery spasm.

Recognising the symptoms of a heart attack is crucial for prompt medical attention. While the classic symptom is severe chest pain, symptoms can vary greatly from person to person, and women often experience different or more subtle signs than men.

Common symptoms include:

• Chest Pain or Discomfort: Often described as a crushing, squeezing, pressure, fullness, or pain in the centre of the chest. It can last for more than a few minutes, or go away and come back.
• Pain Radiating to Other Areas: Discomfort or pain that spreads to one or both arms (often the left arm), the back, neck, jaw, or stomach.
• Shortness of Breath: This can occur with or without chest pain.
• Other Symptoms: Nausea, vomiting, lightheadedness, dizziness, cold sweat, or unusual fatigue.

It's important to remember that not everyone experiences all these symptoms, and some may have very mild or vague signs. If you suspect a heart attack, even if you are unsure, always call for emergency medical help immediately.

When a heart attack is suspected, medical professionals act quickly to confirm the diagnosis and initiate treatment. The diagnostic process typically involves:

• Electrocardiogram (ECG or EKG): This is usually the first test performed. It records the electrical activity of the heart and can detect whether a heart attack has occurred and identify its type (e.g., STEMI).
• Blood Tests: Certain proteins (cardiac enzymes or biomarkers), such as troponin, are released into the bloodstream when heart muscle is damaged. Elevated levels of these enzymes indicate a heart attack.
• Chest X-ray: While not diagnostic for a heart attack itself, it can help rule out other causes of chest pain, such as lung problems, and assess the size and shape of the heart and lungs.
• Echocardiogram: An ultrasound of the heart that shows the heart's pumping action and can identify areas of the heart muscle that have been damaged by a heart attack.
• Coronary Angiography (Cardiac Catheterisation): This is an invasive procedure where a thin, flexible tube (catheter) is threaded through a blood vessel to the heart. A dye is injected, and X-ray images are taken to visualise the coronary arteries and pinpoint any blockages. This test is often performed urgently during a heart attack to guide treatment.

Immediate treatment for a heart attack focuses on restoring blood flow to the heart muscle as quickly as possible to minimise damage.

Emergency Medications:

• Aspirin: Chewing aspirin is often the first action as it helps prevent blood clots from getting larger.
• Nitroglycerin: Helps widen blood vessels, improving blood flow and reducing chest pain. (Brands: Nitrocontin, Nitrolong)
• Clot-busting medications (Thrombolytics): These drugs (Brands: Actilyse) dissolve the blood clot blocking the artery. They are most effective when given soon after symptoms begin.
• Beta-blockers: Slow the heart rate and reduce blood pressure, decreasing the heart's workload.
• ACE Inhibitors: Help relax blood vessels and lower blood pressure.

Emergency Procedures:

• Angioplasty and Stenting (Percutaneous Coronary Intervention - PCI): This is the most common emergency procedure. During an angiogram, a balloon is inflated at the site of the blockage to open the artery, and a stent (a small mesh tube) is often inserted to keep it open. This procedure is performed urgently for STEMI heart attacks.
• Coronary Artery Bypass Graft (CABG) Surgery: In some cases, particularly if multiple arteries are severely blocked or angioplasty isn't suitable, surgery may be necessary. A healthy blood vessel from another part of the body is used to bypass the blocked coronary artery, creating a new path for blood flow.

Cardiac Rehabilitation: After the immediate crisis, cardiac rehabilitation is a crucial programme that includes supervised exercise, education on heart-healthy living, and counselling to help with recovery and reduce the risk of future heart problems.

• High blood pressure
• High cholesterol
• Diabetes
• Smoking
• Obesity
• Lack of physical activity
• Unhealthy diet
• Family history of heart disease
• Age (risk increases with age)
• Stress

• Heart failure (the heart can't pump enough blood)
• Arrhythmias (irregular heartbeats)
• Cardiogenic shock (sudden inability of the heart to pump enough blood)
• Heart rupture (a rare but fatal tearing of the heart muscle)
• Pericarditis (inflammation of the sac surrounding the heart)
• Blood clots (leading to stroke or other embolisms)
• Post-heart attack depression

• Adhere to Your Medication Regimen: Take all prescribed medications exactly as directed by your doctor, as they are crucial for preventing another heart attack and managing complications.
• Embrace Cardiac Rehabilitation: Actively participate in a cardiac rehabilitation programme; it provides structured exercise, education, and support vital for recovery.
• Prioritise a Heart-Healthy Lifestyle: Commit to dietary changes, regular physical activity (as advised), and quitting smoking to significantly reduce future risks.
• Monitor Your Symptoms: Be vigilant for any new or returning symptoms and know when to seek immediate medical attention, never hesitating to call emergency services.
• Seek Emotional Support: A heart attack can be a traumatic experience; talk to family, friends, a counsellor, or join a support group to help manage anxiety or depression.

Myth: Heart attacks always involve crushing chest pain that radiates down the left arm.

Reality: While this is a classic symptom, heart attack symptoms can be varied and subtle, especially in women and older adults, including shortness of breath, nausea, or unusual fatigue without typical chest pain.

Myth: Only older men get heart attacks.

Reality: Heart attacks can affect anyone, regardless of age or gender. While risk increases with age, younger individuals, including women, can have heart attacks, often due to specific risk factors or conditions.

Myth: If you can walk or talk, you're not having a heart attack.

Reality: Many people having a heart attack can still walk or talk, especially if their symptoms are mild or atypical. Never delay seeking emergency medical help based on whether someone seems "fine."

Any suspicion of a heart attack requires immediate emergency medical attention. Do not delay. Call your local emergency services immediately. Even if you are unsure, it's always better to be safe. Every minute counts in preserving heart muscle.

Beyond an acute emergency, you should see your doctor if you experience:

• Recurring chest pain or discomfort.
• Unexplained shortness of breath during exertion.
• Persistent fatigue.
• Swelling in your legs or ankles.
• Any new or worsening symptoms that concern you, especially if you have existing risk factors for heart disease.

• What specific type of heart attack did I have, and what caused it?
• What medications will I need to take long-term, and what are their potential side effects?
• What lifestyle changes are most important for my recovery and preventing another heart attack?
• When can I safely return to my normal activities, including work and exercise?
• What are the warning signs of another heart attack, and what should I do if they occur?
• Am I eligible for a cardiac rehabilitation programme, and how do I enrol?
• What are my cholesterol and blood pressure targets, and how will we monitor them?

• Be a Proactive Listener: Listen to their concerns and fears without judgment, offering emotional support and understanding during their recovery journey.
• Help with Lifestyle Changes: Support them in adopting heart-healthy habits by making healthy meals together, encouraging gentle walks, and joining them in stress-reducing activities.
• Assist with Medication Management: Help them stay on track with their medication schedule, perhaps by setting reminders or assisting with prescription refills.
• Encourage Medical Follow-ups: Remind them about appointments and offer to accompany them to doctor visits or cardiac rehabilitation sessions for support.

A heart attack is a life-altering event, but it does not have to be a life-ending one. With rapid diagnosis, advanced medical treatments, and a commitment to heart-healthy living, individuals can make remarkable recoveries and go on to lead full, active lives. The key messages are clear: recognise the symptoms, act immediately by calling emergency services, and then embrace the journey of recovery and prevention. By understanding this critical condition and taking proactive steps, we can collectively reduce its impact and promote healthier hearts for all.