Heart Attack

CONTENTS

V The heart

1

* Blood supply to the heart

2

V What is a heart attack?

3

V The kind of person most likely to have a heart attack?

3

V Can heart attacks be prevented totally?

4

V What are the risk factors for heart attack? V

How can the risk factors be controlled?

V What are the indications of a heart attack?

V What are the changes in a blood vessel leading to a heart attack? V What steps should be taken during an attack?

V Why is it important to treat a heart attack as soon as possible? V What

is the treatment given for heart attack?

V What adjustments are required in a heart attack patient's lifestyle? V What are the -

tests to evaluate Heart Function?

-

V 6 ways to a healthy life -

--

V A little exercise does your heart good

11

12

THE HEART

The heart is one of the

most important

organs far the maintenance of one's life. Situated in the middie of the chest, it is a powerful pump, weighing about 300-350 grams, which drives blood around the body carrying vital food and oxygen (energy) to the tissues. T k job of the heart is to pump blood around two separate pathways in the body. Through one pathway the heart pumps btoud out into all the parts of the body thereby delivering foad and oxygen to them. The blood then r&urns to the heart having had all the oxygen and food absorbed by the body.

The heart also pumps the blood on its second pathway to the lungs t~ replace the oxygen. It is then returned to the heart with its oxygen renewed. Even when we sleep, the heart goes on tirelessly pumping away, never stopping for a moment, usually beating 70 times a minute and much more when we are awake and running around. During our lifetime, the heart performs a massive amount of work. In a life span of say 75 years, the heart will have beaten more than 3000 million times and pumped over 200 million litres of blood. Not surprisingly, the heart does fail eventually.

"Go t o your bosom, Knock there and ask your heart

What it doth know." - William Shakespeare,

BLOOD SUPPLY TO THE HEART

patient begins to experience the warning The muscles of the heart themselves receive signs of an impending heart attack. blood from two arteries (right and left coronary artery). This is of utmost importance because the heart works continuously and requjres large amounts of energy to sustain itself. If due to any reason, the heart muscle d ~ e s not get enough blood, then it will not be able to beat well enough to cope with the body's requirement of blood supply and the person will start getting the symptoms of a tiring heart. These symptoms of a tiring heart are a special 'Body Language' telling you that the blood supply to the heart is seriously reduced. At this stage, prompt medical attention may prevent further complications. If a person does not recognise these warning signs and seek medical attention at once, then the Mood supply to the heart soon gets further reduced and a t some time there occurs a complete shutdown of the blood supply to a part of the heart muscle. The most common cause for decreased blood supply to the heart muscle is narrowing and blockage of the coronary arteries. The process of blockage of the coronary sometimes reaches such an extent that the

WHAT IS A HEART ATTACK?

attack is known in medical terms as infarction". It is a sudden ~fe-endangeringoccurrence caused by the :omplete stoppage of the blood supply to a )art of the heart. This part of the heart nuscle then dies and is replaced by dead tissue. i heart

I "myocardial

Myocardial infarction happens mainly because of the slow. progressive, irreversible blockage of the vessels supplying blood to the heart (coronay

arteries).

THE KIND OF PERSON MOST LIKELY TO HAVE A HEART ATTACK?

"The heart never grows better by age; rather, worse, always harder." - Lord Chestefield,

c. Smoker

d. Overweight

D CHOLESTEROL

t

tY HIGH I HIGH

HEART ATTACKS BE PREVENTED TOTALLY? M Q W W I yno. But the risk can be d bgr p a q r prevention and control

of the risk factors and dutifully foilowing the advice of your Ductw.

WHAT ARE THE RISK FACTORS FOR HEART ATTACK?

CONTROLLABLEFACTORS a. Smoking - It is directly related to the number of cigarettes smoked daily. b. Overwight - Obesity puts extra strain on the heart and'also leads to high blood pressure, high blood cholesterol and

triglyceride levels and a tendency to develop diabetes. c. High blood pressure - In hypertensive people the heart must work harder to keep the blood moving from the heart to the bodv tissues. This also increases the wear and k a r of the arteries leading to arterial hardening and thickening. d. Diabetes - Due to high blood sugar levels, the process of arterial hardening and thickening is accelerated.

g. Sedentary life - People with sedentary habits are three times more susceptible to heart attack. as compared to those

who are physically active.

Uncontrollable factors a. Age - Increases with age b. Sex - More common in males c. Heridity - More common in people with strong family history of premature heart attacks (before the age of 45

years)

e. High levels of blood cholesterol and triglycerides - Excess cholesterol and triglycerides present in the blood are deposited within the walk of the arteries leading to their hardening and thickening. f. Emotional stress and tension - When a

person is under stress, the blood pressure and blood sugar levels shoot up, which then strain the heart.

-

FACTORS BEYOND OUR CONTROL

SEX

CAN THE RISK FACTORS

BE C

?

In patients who have been hospitalised far heart attack, it has been noted that the number and severitv of comolications -

masis

h k k bp@das 8-causes -

pmure level.

are markedly reduced ii accustomed to regular exercise than in patients who lead sedentary lives.

-

e.

d - kguiar check-ups of blood pressure and blood sugar levels and their proper control fdiowiog the advice of

your doctar is important to prevent damage to your heart.

WHAT ARE THE INDICATIONS OF A HEART ATTACK? The characteristic feature is sudder! pain in the centre of the chest which may come ~getherwith shortness of breath, restlessness, nausea, vomiting and loss of consciousness.

What are the different types of chest pain

1.

pressure ranging fr mild to severe causing a feeling of

A central chest

suffocation.

b. Pain radiatinq to the left arm, where it may cause a sensation of weakness in the arm muscles.

-

c. Pain radiating upto the jaw and sometimes to the back

-

-

An upper abdominal discomfort which is normally mistaken for acidity or

indigestion.

WHATARE THE CHANGES IN A BLOOD VESSEL LEADING TO A HEART ATTACK?

I

I

Blockage (atheroma)

Narrowing of the blood vessel Wall of the blood vessel

1ID 1.

WHAT STEPS SHOULD BE TMEW DURING AN ATTACK?

O not panic and do not allow others to panic.

I I 2. Call

for a Doctor immediately.

II

I

3. Stay with the patient until the Doctor arrives.

5. If the patient has di.fficuIty in breathing, he may be more comfortable in a propped up position.

7. I f pwible give the patient a tabket of nitrate to be kept belaw the tongue ta alIeviate his

6.Loosen any tight clothing on the patient and see that the room is airy and quiet. Do not allow crowds in the room and do not permit any noise.

1 8.Do not allow the mtient to smoke. it will not

I

help fo relieve hi; pain and discomfort

t

WHY IS IT IMPORTANT TO TREAT A HEART ATTACK AS SOON AS POSSIBLE? 4 heart attack can strike anyone and when t occurs there is no time for delay. Most wart: attack victims survive if they recognise the early warning signals of heart attack and seek medical attention at once. It has now been well established that most deaths associated with a heart attack occur withm the Wrst hour after its onset and that death usually is due to disturbance in the hearth electkal activity.

I

I

4

Therefore it is imperative that the patient should be transferred immediately by

ambulance to an ICCU (Intensive Coronary Care Unit) where prompt medical treatment can be

WHAT IS THE TREATMENT GIVEN FOR HEARTATTACK? The patient should be immediately transferred by ambulance to an ICCU. In the ICCU the patient is continuously monitored for changes in the blood pressure, pulse and recurrence of chest pain. During the very early stages of a heart attack intravenous drugs may be given to dissolve the clot in the coronary arteries with rernarkabke success. Facilities for DC shock and cardiac pacing are also

available in the ICCU which can help to save the patient's life.

After 'being stilbitized in the ICCU which takes 3-5 days. the patient is shifted to the wards where he is gradually mobilized and then discharged after about 2 weeks and is advised to take a months rest at home. The stages in treatment are: Medical : Drugs to control various risk factors and to prevent further blockage and narrowing of the coronary arteries.

Diagnostic : Exercise stress test The aim being to see during stress how the heart responds by building up the required amount of blood pressure and by maintaining the regularity of the heart beats. If the heart is unable to cope with this stress, it indicates that the heart is. weak due to inadequate blood supply.

WgvN This is c b e to see t o what extent are the car0m-y arteries blocked. A n a s m tube is inserted via a blood vessel in the kg and is pushed upto the heart and into the qm$ng of the coronary artery. Dye is then Injected vh the tube iirto the coronary artery and serial filrn/video recordings are takm of the flow of the dye in these arteries. Hocks in these arteries can be viwilised as areas where dye flow is thin and minimum. Surgical : Patients who do not respond to canservative medical treatment or who are young and want to pursue an active life: have a choice of surgical procedures.

Coronary angioplasty - Where a balloon is passed up to the site of obstruction and is inflated to stretch out the obstruction and thus re-establish blood flow.

a.

b Coronay artery bypass graft (CABG) In this procedure the obstructed segment of the coronary artery is bypassed with

a piece of vein graft taken from the patient's leg.

"Let my heart. be wise, I t is the God3 best giff.*' - Euripides.

WHAT ADJUSTMENTS ARE REQUIRED IN A HEART ATTACK PATIENT'S LIFE ?STYLE? The 'Road to Recovery' following a heart attack is usually about 3 months, during which there is a gradual return to normal

activity. Anyone who has suffered a heart attack has an increased r i ~ kof suffering another one in the following few years, and the second heart attack usually has serious complications which may lead to death. But the chances of another attack can be decreased and the quality of life improved, by proper control of the risk factors premt.

Controlling the risk * If the patient is overweight he is advised to reduce weight and abstain from any forms of tobacco (cigar-s, bidis, pan and snuff).

* B 1 d sugars a'nd blood fats (cholesterol and trigiyerides) s h l d be narrnalised by

g

4

diet, jular exercise and by medical treatment (drugs and/or insulin injections). * The patient is advised to take a low calorie, low salt, easily digestible diet, to be eaten in small amounts more frequently during the day.

Wcation * It is of utmost importance that the patient takes his medication on time without skipping even a single dose (It is also dangerous to take an extra dose). Irregular medication can lead to serious complications. * It is advisable to the patient to keep a boffle of nitrate Web handy at home as well as a t the place of work for use in an emergency.

Exercise programme * In the ICCU absolute bed rest is essential during the first 48 hours (to limit the extent of damage to the heart muscle).

period of 2 weeks, during which he is allowed to take short distance walks 3-4 times a day within the hospital premises. Many hospitals a t the end of this period conduct a 'limited exercise tolerance test' (modified stress test) just prior to discharge to help identi0 the high risk patient and to formulate a specialised programme for hidher physical activity. Once the patient is at home, he/she may be permitted short outdoor walks. in the early mornings or late evenings. It is n i t advisable for the patient to drive a vehicle himself or to travel by air during the first 3 months. Later, if his Doctor permits, he may do so. Most airlines make special arrangements for the transport of the patient and for handling luggage a t the airport if advance notice is given.

Sex and the heart patient

After this period the patient is allowed to sit up for short periods of time and by the 4th or 5th day he may be allowed t o sit in a bedside chair and use a bedside commode. * After his transfer to the ward from the ICCU, he is mobilised gradually over a

Sex. being one of life's survival instincts, is

one of nature's own way of alleviating tension and stress. Sex is often a taboo for a large majority of heart attack patients. About 6-8 weeks after an attack, the patient may begin his normal sex life, provided his heart holds sufficient reserves (which can be assessed by an 'Exercise Stress Test' conducted by the Doctor). Patients who have had a large portion of their heart muscle damaged due to the attack and with consequent poor heart function would necessarily have to avoid all exertion (even sex) till they get better by way of surgical treatment. The precautions for safe sex are: a. Avoid heavy meals and alcohol just before sex. b. All previous medication should have been taken on time. c. Keep a tablet of nitrate at hand. If chest

Persons employed in heavy manual work need to take a t least 3 months lay off from work On rejoining they may need to change to a lighter job.

Yoga and meditation

pain develops during or after sex. then keep the tablet below the tongue to alleviate the symptoms and immediately contact the Doctor. d. It is preferable to have sex in the mornings or at such times when one is fresh and not tired. e. The patient should continue with the routine exercise programme. This will help improve higher exercise bearing capacity.

Going back to work The timing of return to work depends on

many factors, particularly the type of employment. Those witb sedentary occupations can often return to work at the end of 2 months. In the bq~nning,they have to take things easy, like working part time for a few weeks. avoiding rush hours while travelling and not entering into any arguments.

A sincere attempt to relax the mental

attitude towards life in general and to live a more peaceful and active(not he&) life along with meditation and yoga may help tremendous~y.

Warning signs If at any time the patient feels uneasy, giddy, breathless, or gets chest pain, he should stop whatever activity he is doing. lie down immedia&ly in a comfortable

position, and if possible keep a tablet of nitrate Maw his tongue and then send for a Doctor immediately. An overall outlook of optimism, positive thinking and relaxed living would be extremely helpful in improving the quality

It has now been medically proved that in heart attack patients who take good care, the blockage and narrowing of the coronary arteries is actually reversed and slowly the coronary arteries open up! "A man 3 heart changes his countenance, eMer for good or for evil." - The Bible

of life.

WHAT ARE THE TESTS TO EVALUATE HEART FUNCTIONS? Test

What the test heips to detect

a. Physical examinatnn b. Chest X-Ray c. ECG (Electrocardiogram)

- Heart failure - Heart size and presence of heart failure - Presence of a heart attack - Strain on the heart - Disturbances of the heart rate - Position of the heart - Presence and severity of infections

d. Laboratory investigations CBC, ESR,

VDRL BUN, Creatinine FBS/PGBS/PLBS

Kidneys' excretory capacity - Blood sugar levels

Sr. Calcium, Sr.electrolytes

-

Electrolyte disturbances

-

Risk of atherosclerosis

Sr. Cholesterolflriglycerides e. Stress Test (Computerised Exercise EGG)

f. 2D-echocardiographyff Colaur Doppler ec hmrdiography g. Stress Thallium Imaging

h. Gated Blood Pool Studies i. Coronary angiography

-

Changes in the heart when put under strain - Structural and functional abnormalities of -

the heart - Which area of the hearL gets less amount of blood during exercise. The effectiveness of the pumping action of the heart. - The blockage and narrowing of the

-

coronary arteries.

SIX WAYS OF KEEPING HEALTHY By paying attention to each of the following six aspects of personal health care. you can make an important start towards improving - or rnaintainin~vour individual levels of general health and physical fitness. W

"

Eat WIWJ&

Limit alcohol

Don't smoke

Wree Regula~ly

Waght-watch

visit the doctor

A LITTLE EXERCISE

DOESYOURHEARTGOOD

Look afkr your HEART