Heart attack

[alihashmatkhoso]

It is a disorder of circulation especially coronary circulation of the heart, in which right and left coronary arteries are unable to supply blood to the muscles of the heart.

What are the causes of a heart attack?

(1)Age - this is considered to be the largest risk factor. When a man is over 45 years, and the woman is over 55 years of age, their risk of having a heart attack starts to rise significantly.

(2)Angina - angina is an illness where not enough oxygen is reaching the patient's heart. This raises the risk of a heart attack. In some cases a diagnosis of angina was wrong - it could have been a mild heart attack instead. The main difference between a heart attack and angina is that the patient with angina will feel better about 15 to 30 minutes after taking medication, while the heart attack patient won't.
(3) Blood cholesterol levels - if a person's blood cholesterol levels are high, he/she runs a higher risk of developing blood clots in the arteries. Blood clots can block the supply of blood to the heart muscle, causing a heart attack.

(4) Diabetes - people with diabetes have a higher risk of developing several diseases and conditions, many of them contribute to a higher risk of heart attack.

(5) Diet - a person who consumes large quantities of, for example, animal fats, or saturated fats, will eventually have a higher risk of having a heart attack.

(6) Genes - you can inherit a higher risk of heart attack from your parents, and/or their parents.

(7) Heart surgery - patients who have had heart surgery have a higher risk of having a heart attack.

(8) Hypertension (high blood pressure) - this could be due to lack of physical activity, overweight/obesity, diabetes, genes, and some other factors.

(9) Obesity, overweight - as more and more people are overweight, especially children, experts believe heart attacks will become more common in future (if the overweight children become overweight adults).

(10) Physical inactivity - people who do not exercise have a much higher risk of having a heart attack, compared to people who exercise regularly.

(11) Previous heart attack - anybody who has already had a heart attack is more likely to have another one, compared to other people.

(12) Smoking - people who smoke heavily or regularly run a much higher risk of heart attack, compared to people who never smoked and those who gave up. Smoking regularly means smoking every day.


[B]Treatment after the heart attack

Most patients will need several different medications after their heart attack. The aim being to prevent future heart attacks from occurring.

@Aspirin and other Anti-platelets

Our blood has platelets. These are tiny particles that help the blood to clot. They can eventually, if they are very sticky, stick to fatty deposits, or plaques, and form a thrombosis. A thrombosis is a clot. A thrombosis in a coronary artery can cause a heart attack. Anti-platelets reduce the stickiness of the platelets.

Patients are often prescribed a daily 75mg dose of aspirin - this is called low-dose aspirin. Those who have stomach ulcers may be given medication to prevent the aspirin from damaging their stomachs. Patients who suffer from asthma may be prescribed clopidogrel, rather than aspirin.

@Beta-blockers

These drugs make the heart beat more slowly and with less force, thus easing the heart's workload. They also stabilize the heart's electrical activity. Examples include metoprolol, propranolol, timolol, and atenolol.

@ACE (Angiotensin-converting enzyme) inhibitors

These drugs help ease the workload on the heart by opening up blood vessels and lowering blood pressure. Experts say ACE inhibitors also protect the heart from further damage. Patient will have a blood test to make sure their kidneys are working properly before starting on this type of medication. Then, about ten days after starting treatment, the patient will undergo further tests to make sure his/her kidneys are still working fine. Over a period of about 3 weeks the patient's dose is gradually increased. Examples of ACE inhibitors include lisinopril, perindopril and ramipril.

@Statins

Statins make the liver produce less cholesterol, consequently lowering blood cholesterol levels. Patients with high cholesterol levels have a higher risk of developing fatty deposits in their blood vessels, especially their arteries. Statins include atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin.

@Surgery after a heart attack

If the patient's heart has been severely damaged he/she may need to be operated on. The most common surgeries performed on heart attack patients are:

@Angioplasty

This can be performed either after the heart attack, or in some specialist units during the attack. Angioplasty opens up the coronary artery. A small wire goes up the artery from the patient's groin or arm and is pushed until it reaches where the clot is in the coronary artery. There is a small balloon, shaped like a sausage, at the end of the wire. The balloon is placed at the narrowest part of the artery and is then inflated, squashing the clot away. A flexible metal mesh, called a stent, is then placed there to keep that part of the artery open.

@CABG (Coronary artery bypass graft)

The damaged blood vessel is by-passed with grafts taken from blood vessels elsewhere in the body. The bypass effectively goes around the blocked area of the artery, allowing blood to pass through into the heart muscle.