Even so, a heart attack, known by doctors as a myocardial infarction, is still a serious event and the number one cause of death for both men and women in all parts of the world.
A heart attack occurs when blood and oxygen flow to part of the heart becomes broken up because of a blockage in one of the coronary arteries. Lack of oxygen (known as ischemia) is the reason for the chest pain or pressure, shortness of breath, nausea, palpitations (racing heart), sweating and other symptoms.
When Americans recognize these symptoms, most know they should dial 911 right away for help. Sometimes, however, symptoms are unusual or not dramatic enough to trigger quick action. Some individuals wait around, trying to deny what they are feeling. And in 25 percent of cases, the heart attack is “silent,” producing no symptoms. In such cases, the danger is great because every minute the heart muscle goes without oxygen, the greater the likelihood of permanent damage. “Time is muscle,” doctors say, and the goal of treatment is to get blood flowing quickly, if possible within 90 minutes.
First Aid Treatment
The best way of treating a heart attack, of course, is prevention. On the day of his attack, Eisenhower ate what many today might refer to as a heart attack on a plate: sausage, bacon, corn meal mush and hot cakes for breakfast; a hamburger for lunch; and roast lamb for dinner. He previously smoked four packs of cigarettes a day but quit cold turkey in 1949.
As part of his long-term treatment, doctors told the President to reduce the fat in his diet and to maintain his weight at 175 pounds. At that time there was little knowledge about the role of diet, exercise and smoking. A heart attack was commonly accepted as a sign of an aging, dying heart.
By contrast, most Americans today know what makes up a heart-healthy lifestyle, and they have medications available that can reduce their risk by lowering cholesterol and blood pressure. Heart attacks nevertheless occur at a rate of 1.2 million a year, and they occur both to those diagnosed with cardiovascular disease and those who have no idea they are at risk.
Symptoms may come on slowly, and studies show that patients wait an average of three hours before calling for medical help–a serious mistake, with as many as half of heart attack fatalities occuring in the first hour.
Do not consider driving to the hospital yourself; it is dangerous. And do not have someone else take you unless there is no other option; you will get treated more quickly and efficiently if you dial 911 and take an ambulance.
Most heart attacks are precipitated by a blood clot in a coronary artery. Unless, you are allergic to aspirin, the next thing to do is to take aspirin–162 to 325 milligrams, preferably non-coated. Chew the tablet, dissolve it or place it under the tongue for faster action. The aspirin has an anti-platelet effect that should keep further clots from forming.
Ambulance service varies according to where you live, but good pre-hospital care is crucial, not only for speedy delivery but also to start treatment and gather information that will be valuable for hospital treatment.
The acronym for early treatment is MONA–morphine or other medications for pain relief; oxygen; nitroglycerin to dilate blood vessels; and aspirin. In addition, some emergency medical staff are trained to begin administering clot-dissolving medications (thrombolytic therapy) and to perform a 12-lead electrocardiogram and transmit information that will enable timesaving decisions at the receiving hospital.
The severity of symptoms is not necessarily an indication of the severity of the heart attack, but an ECG can detect the presence or absence of ST segment elevation (typically meaning a complete blockage). In such cases, the main goal is to break up the clot and get blood flowing. Known as reperfusion, this involves either 1) injecting medications to dissolve the clot (thrombolytic therapy), 2) emergency balloon angioplasty (usually with insertion of a stent) to restore blood flow or 3) emergency coronary artery bypass graft surgery. The last option is usually chosen only if the first two options offer little chance of success.
The preferred treatment in most cases is angioplasty. When performed promptly by an experienced team, studies show that angioplasty restores blood flow in 95 percent of cases. Other studies indicate that the risk of future attacks is lower in patients getting angioplasty than in those treated with clot-dissolving medications.
The goal is to open the artery within 90 minutes of the time the patient is admitted to the emergency room. This is known as “door to balloon” time, and the 90-minute goal is admittedly a challenge for most hospitals. However, angioplasty can still be effective if carried out within the first 12 hours.
Emergency angioplasty requires that a hospital have a heart catheterization lab staffed 24 hours a day. For patients living in areas without such facilities, the emergency team must make a triage decision, determining whether the patient will be better off getting thrombolytic therapy at the nearest hospital or transported to a hospital that can perform emergency angioplasty or bypass surgery.
When blood flow can be restored promptly, the patient may suffer minimal permanent damage to the heart. The heart attack survivor today is encouraged to begin moving around as quickly as possible and is usually prescribed an outpatient rehabilitation program that includes supervised exercise. Unlike their counterparts in the 1950s, many heart attack patients today return relatively soon to a healthy, active lifestyle.
If you have questions regarding your risk of heart disease, talk with your doctor or pharmacist today.
Kerri T. Musselman, PharmD
