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Surviving a Heart Attack: Timing Is Crucial
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Surviving a Heart Attack: Timing Is Crucial

Is it indigestion or chest pain? Knowing the symptoms of a heart attack can literally save your life.

John H., 46, a medical doctor, thought he had indigestion. He felt discomfort in his abdomen on and off for about a month, took antacid tablets, and went about his life. One day, his wife came home to find him lying on the floor, clutching his chest in pain. She called an ambulance and had him rushed to the emergency room. There, he learned he was having a myocardial infarction (MI), or heart attack . If Dr. H. had waited much longer to get to the hospital, doctors told him, it is quite likely he would have died.

Every year, approximately 1.1 million people in the United States suffer heart attacks, and about one third of that number die, according to the American Heart Association. In fact, MI is the leading cause of death in the United States.

The Death of Heart Cells

Most heart attacks are a result of atherosclerosis: deposits of lipids or fatty cells, which build up and cause damage to the arterial walls. The body responds by creating plaque, which forms a scar inside the artery. If the plaque ruptures, it releases its contents and can cause blood clots that block the flow of blood to the heart. Without blood, the heart does not receive the oxygen it needs, and cells of the heart muscle begin to die.

While a "heart attack" may describe several possible conditions, "myocardial infarction" refers strictly to the death of heart cells. The longer the heart muscle goes without blood, the more severe the damage, and the greater the risk of ongoing heart muscle weakness, or even death. MIs can also be caused by drug use, particularly cocaine and methamphetamine, which may lead to clotting or to spasms of the arteries and decreased blood flow to the heart.

Immediate Treatment Is Essential

Heart damage caused from myochardial infarctions can often be minimized or averted by immediate treatment. But, "too many people wait too long to go to the hospital," says Robert P. Giugliano, MD, SM, a member of the Thrombolysis in Myocardial Infarction Study Group at Brigham and Women's Hospital in Boston. According to a 1997 report by the National Institutes of Health (NIH), some studies show that as few as 3% of people suffering heart attacks receive treatment within an hour after symptoms begin; the median time delay in seeking care after the first symptoms ranges from 2 to 6.4 hours. "By then," Giugliano says, "a lot of damage may have been done."

Why People Delay

There are many reasons why people having heart attacks delay getting medical help. Some are fearful or "in denial," according to Giugliano. Others are put off by complications or costs of the medical system, have trouble reaching their doctors, run into language or cultural barriers, or don't have access to care. But many people simply don't realize that they are having a heart attack. That is because the warning signs vary widely, and the symptoms can be unclear.

The Symptoms

The classic symptom of a myocardial infarction is intense, central chest pressure. However, less than 10% of people experience typical chest pain during a heart attack. Other common symptoms include: pain or heaviness in the left arm, nausea, shortness of breath, increased perspiration, a feeling of impending doom, or pain in the jaw, teeth, arm, or abdomen. It is especially common for women to present with symptoms other than chest pain. Symptoms may come on gradually and may be intermittent or vague. A quarter of patients—particularly those with diabetes—experience no symptoms at all.

If you have symptoms that last for twenty to thirty minutes or more, or if you are having frequent shorter episodes associated with physical exertion, you should contact a doctor, Giugliano says. By asking questions about your symptoms and what precipitates them, your doctor may determine that the problem is minor; it might be indigestion or a pulled muscle. If your doctor suspects a heart attack, he or she will send you to the hospital for an electrocardiogram and blood tests to determine if your heart has been damaged. But if your symptoms come on suddenly and you think they might be due to a heart attack, don’t wait to contact your doctor. Call 911 and get help immediately. Time is precious when blood flow to the heart muscle stops, and your life may depend on how quickly help comes.

Are You at Risk?

Because heart attack symptoms can be difficult to recognize, it is important to know if you are at risk. You may be at higher risk if you:

  • Already have coronary artery disease
  • Have high blood pressure
  • Have high cholesterol
  • Have diabetes
  • Are obese or overweight
  • Are sedentary
  • Smoke
  • Have a strong family history of coronary artery disease
  • Are male (men are at greater risk than women)
  • Are older (men older than 45, and women older than 55, or younger if early menopause)
  • Have an inflammatory disease like rheumatoid arthritis or lupus
  • Take steroids, or non-steroidal anti-inflammatory medication

Help From Medical Technology

Hospitals with cardiac catheterization laboratories can quickly determine whether an artery is blocked, where, and to what extent. Drugs may be prescribed to break up clots, and doctors may use a catheter device to open blocked arteries; they may even prop open an artery with a stent, so blood can continue to flow freely. Some patients may undergo bypass surgery.

People who have had MIs need to be admitted and monitored in a hospital. Upon leaving the hospital, many will live full, rich lives. But that does not mean they are home free. "Once you have had one heart attack, you are at a higher risk for having a second one," Dr. Giugliano says. "So it is important to reduce your risks."

Life After a Heart Attack

To minimize the risk of a future MI, doctors usually prescribe drugs called beta blockers, ACE inhibitors, and aspirin to prevent future coronary blood clots. Many MI patients will receive prescriptions for a cholesterol-lowering drug to prevent the buildup of cholesterol in the blood. Doctors also recommend a low-fat diet high in fiber, a regular program of aerobic exercise, smoking cessation, diabetes control, blood pressure control, and weight management.

About six weeks after leaving the hospital, many post-MI patients undergo a stress test, which involves being monitored while walking on a treadmill or riding a stationary bike to determine readiness for more strenuous exercise. Your exercise program will depend on the extent of damage to your heart, your age, and other health issues. "If you are 40 and have suffered a first, small heart attack, you may be able to resume vigorous exercise almost immediately," Dr. Giugliano says. "But an 80-year-old who has had a third attack may be limited to slow walking." Patients should ask their doctors specific questions about what sort of activity is appropriate, he adds.

Some physicians advise reducing stress, which can help lower blood pressure. But, because stress levels are difficult to define and measure on an individual basis, according to Giugliano, scientific research on the relationship between stress and heart attacks requires further study.

RESOURCES:

American Heart Association
http://www.americanheart.org

Heart Information Network
http://www.heartinfo.org

National Heart, Lung, and Blood Institute
National Institutes of Health
http://www.nhlbi.nih.gov

References:

Greenlund KJ, Keenan NL, Giles WH, et al. Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin Islands, 2001. Am Heart J . 2004;147(6):1010-1016.

Brophy JM, Lévesque LE, Zhang B. The coronary risk of cyclo-oxygenase-2 inhibitors in patients with a previous myocardial infarction. Heart. 2007; 93(2):189-194.

Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. 1992;327:669-677.

McDonald MA, Simpson SH, Ezekowitz JA, Gyenes G, Tsuyuki RT. Angiotensin receptor blockers and risk of myocardial infarction: systematic review. BMJ . 2005;331:873.



Last reviewed February 2007 by Jill D. Landis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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