TREATMENT

How is a heart attack treated? Special treatments to open up your arteries Heart attack treatment begins immediately. Once symptoms are identified, call 9-1-1 to set in motion rapid diagnosis and treatment. Medications thrombolytic medications are used to break up clots blocking the artery The knowledge gained in the past years regarding acute coronary syndromes and what happens in the artery during a heart attack has helped guide medical treatment. 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 30 minutes from the start of heart attack symptoms) to decrease the amount of damage to the heart muscle. The longer the delay in starting these drugs, the more damage that occurs and the less benefit they can provide. Medications given right after the start of a heart attack may include: aspirin thrombolytic therapy ("clot busters") heparin other antiplatelet drugs any combination of the above 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. Your doctor will prescribe the appropriate medications for you. Door to Balloon Time The ACC/AHA practice guidelines suggest a 90-minute goal from the patient’s arrival in the Emergency Department to balloon inflation for percutaneous coronary intervention (PCI) procedures unless there is uncertainty about diagnosis or delays associated with informed choice. Interventional procedures During or shortly after a heart attack, you may go to the cardiac catheterization laboratory to directly evaluate 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 to open up the narrowed arteries, as well as to break up any clots that are blocking them. Coronary artery bypass surgery If necessary, bypass surgery may be performed to restore the heart muscle's supply of blood.

HEART ATTACK : an ACUTE CORONARY SYNDROME

Types of Acute Coronary Syndromes - or heart attacks Acute Coronary Syndrome is a name given to three types of coronary artery disease that are associated with sudden rupture of plaque inside the coronary artery: unstable angina, Non-ST segment elevation myocardial infarction or heart attack (NSTEMI), or ST segment elevation myocardial infarction or heart attack (STEMI). The location of the blockage, the length of time that blood flow is blocked and the amount of damage that occurs determines the type of acute coronary syndrome. These life-threatening conditions require emergency medical care. Unstable angina is a new symptom or a change from stable angina. The angina may occur more frequently, occur more easily at rest, feel more severe, or last longer. Although this angina can often be relieved with oral medications, it is unstable and may progress to a heart attack. Usually more intense medical treatment or a procedure is required. Unstable angina is an acute coronary syndrome and should be treated as a medical emergency. Heart attack: Non-ST segment elevation myocardial infarction (NSTEMI): This heart attack, or MI, does not cause changes on an electrocardiogram (ECG). However, chemical markers in the blood indicate that damage has occurred to the heart muscle. In NSTEMI, the blockage may be partial or temporary, and so the extent of the damage relatively minimal. Heart attack: ST segment elevation myocardial infarction (STEMI): This heart attack, or MI, is caused by a prolonged period of blocked blood supply. It affects a large area of the heart muscle, and so causes changes on the ECG as well as in blood levels of key chemical markers. Other terms associated with a heart attack: Stunned myocardium: If blood flow is returned to an area of heart muscle after a period of ischemia (lack of blood supply), the heart muscle may not pump normally for a period of days following the event. This is called "stunned" heart muscle or myocardium. Hibernating myocardium: After a heart attack, some areas of heart muscle do not pump as they should. Some areas will have permanent damage. Other areas are able to return to their normal function if blood flow is returned to that area (by medications or a procedure). Hibernating myocardium is heart muscle that is "resting" and may possibly return to normal function.

HEART ATTACK SYMPTOMS

If you are having any one of the symptoms described below that lasts for more than 5 minutes, SEEK EMERGENCY TREATMENT WITHOUT DELAY. These symptoms could be the signs of a heart attack and immediate treatment is essential. Symptoms of a heart attack include: Symptoms of a heart attack include: Angina: Chest pain or discomfort in the center of the chest; also described as a heaviness, tightness, pressure, aching, burning, numbness, fullness or squeezing feeling that lasts for more than a few minutes or goes away and comes back. It is sometimes mistakenly thought to be indigestion or heartburn. Pain or discomfort in other areas of the upper body including the arms, left shoulder, back, neck, jaw, or stomach Difficulty breathing, shortness of breath Sweating or “cold sweat” Fullness, indigestion, or choking feeling (may feel like “heartburn”) Nausea or vomiting Light-headedness, dizziness Extreme weakness or anxiety Rapid or irregular heart beats Women often have different symptoms of a heart attack than men and may report symptoms before having a heart attack, although the symptoms are not typical “heart” symptoms. In a multi-center study of 515 women who had an acute heart attack (MI), the most frequently reported symptoms were unusual fatigue, sleep disturbances, shortness of breath, indigestion and anxiety. The majority of women (78 percent) reported at least one symptom for more than one month before their heart attack. Only 30 percent reported chest discomfort, which was described as an aching, tightness, pressure, sharpness, burning, fullness or tingling. Silent MI: Some people have a heart attack without having any symptoms (a “silent” myocardial infarction). A silent MI can occur among all patients, though it is more common among people with diabetes. A silent MI may be diagnosed during a routine doctor’s exam. If you have been prescribed nitroglycerin and you experience angina, stop what you are doing and rest. Take one nitroglycerin tablet and let it dissolve under your tongue, or if using the spray form, spray it under your tongue. Wait 5 minutes. If you still have angina after 5 minutes, call 9-1-1 to get emergency help. DO NOT DELAY. Emergency personnel may tell you to chew an aspirin to break up a possible blood clot, if there is no medical reason for you to avoid aspirin. After you have called 9-1-1, continue to take your nitroglycerin as prescribed. The first symptoms start the clock At the first signs of a heart attack, call for emergency treatmen.Do not wait for your symptoms to “go away.” Early recognition and treatment of heart attack symptoms can reduce the risk of heart damage and allow treatment to be started immediately. Even if you’re not sure your symptoms are those of a heart attack, you should still be evaluated. Do not delay The best time to treat a heart attack is within one hour of the onset of the first symptoms. When a heart attack occurs, there’s a limited amount of time before significant and long-lasting damage occurs to the heart muscle. If a large area of the heart is injured during the heart attack, full recovery becomes much more difficult. Studies show that the people who have symptoms of a heart attack often delay, or wait to seek treatment, for longer than seven hours. People who delay tend to be older, female, African-American and to have a history of angina, high blood pressure or diabetes. People who delay also consult their family members or try to treat themselves first before seeking treatment. Reasons people delay: They are young and cannot believe it is happening to them Symptoms are not what they expected They may deny the symptoms are serious and wait until they go away They may ask the advice of others, especially family members They may first try to treat the symptoms themselves, using aspirin or antacids They may think the symptoms are related to other health problems (upset stomach, arthritis) They may put the care of others first (take care of children or other family members) and not want to worry them Waiting just a couple hours for medical help may limit your treatment options, increase the amount of damage to your heart muscle, and reduce your chance of survival. Call 9-1-1 – Not a friend Calling 9-1-1 or nearest hospital is almost always the fastest way to get life-saving treatment. When you call, emergency personnel may tell you to chew an aspirin to break up a possible blood clot, if there is not a medical reason for you to avoid aspirin. When they arrive, emergency personnel can promptly begin treatment, and they are trained to revive someone whose heart has stopped. Also, you’re likelier to get treated faster at the hospital if you arrive by ambulance. If you are having symptoms, do not drive yourself unless there is absolutely no other option. If you’ve had prior heart treatments Even if you’ve been treated for a prior heart attack or if you’ve had other treatments for coronary artery disease, a heart attack CAN happen again. Treatments such as medications, open heart surgery and interventional procedures DO NOT cure coronary artery disease. Know in advance: The symptoms of a heart attack. If you are at risk for a heart attack. Ask your doctor about your risk and what you should do to reduce your risk. Be sure to ask about aspirin and nitroglycerin. Who to call for emergency help. Do not call a friend or family member. Call for an ambulance to take you to the nearest emergency room. Share this information with your family members and caregivers so they learn to recognize the symptoms of a heart attack and when to help you seek emergency treatment.

WHAT HAPPENS DURING A HEART ATTACK?

A closer look inside your coronary arteries Your heart muscle needs to receive a good supply of blood at all times to function properly. Your heart muscle gets the blood it needs to do its job from the coronary arteries. What is coronary artery disease? Coronary artery disease is the narrowing or blockage of the coronary arteries caused by atherosclerosis. Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaque) on the inner walls of the arteries that restricts blood flow to the heart. Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. When one or more of the coronary arteries are completely blocked, a heart attack (injury to the heart muscle) may occur. A closer look at coronary artery disease
When fat builds up inside your arteries it causes slight injury to your blood vessel walls. In an attempt to heal the blood vessel walls, the cells release chemicals that make the blood vessel walls stickier. Other substances traveling through your blood stream, such as inflammatory cells, cellular waste products, proteins and calcium, begin to stick to the vessel walls. The fat and other substances combine to form a material called plaque.
Over time, the inside of the arteries develop plaques of different sizes. Many of the plaque deposits are soft on the inside with a hard fibrous “cap” covering the outside. If the hard surface cracks or tears, the soft, fatty inside is exposed. 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 blood supply to the heart muscle, called a coronary thrombus or coronary occlusion, the heart muscle becomes "starved" for oxygen and nutrients (called ischemia) in the region below the blockage. Within a short time, an acute coronary syndrome can occur. Acute Coronary Syndrome is a name given to three types of coronary artery disease that are associated with sudden rupture of plaque inside the coronary artery: unstable angina, Non-ST segment elevation myocardial infarction or heart attack(NSTEMI),or ST segment elevation myocardial infarction or heart attack(STEMI).
spasm A heart attack can also occur less frequently by a spasm of a coronary artery. During coronary spasm, the coronary arteries constrict or spasm on and off, causing lack of blood supply to the heart muscle (ischemia). It may occur at rest and can even occur in people without significant coronary artery disease. If coronary artery spasm occurs for a long period of time, a heart attack can occur.
Each coronary artery supplies blood to a region of the heart muscle. If an artery is occluded (blocked) there is no blood supply to that region.
dark red = artery	blue = outlines region of heart affected by blockage
Circumflex occlusion back of heart	Left anterior descending (LAD) occlusion front of heart	Right coronary artery (RCA) occlusion front of heart
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. Quick treatment to open the blocked artery is essential to lessen the amount of damage. Learn the symptoms of a heart attack and what to do if they occur. Healing of the heart muscle begins soon after a heart attack and takes about 8 weeks. Just like a skin wound, the heart’s wound heals and a scar will form in the damaged area. The new scar tissue does not contract or pump as well as healthy heart muscle tissue. So, the heart’s pumping ability is lessened. The amount of lost pumping ability depends on the size and location of the scar.

HEART ATTACK

What is heart attack

A heart attack, or myocardial infarction (MI), is permanent damage to the heart muscle. "Myo" means muscle, "cardial" refers to the heart, and "infarction" means death of tissue due to lack of blood supply.