Heart Attack

Overview

Heart attack refers to the death of a section of the heart muscles caused by a loss of blood supply. Blood is normally cut off when an artery supplying the heart muscle is blocked by a blood clot.

The blockage mostly occurs due to a buildup of cholesterol, fat, and other substances, which form a plaque in the arteries that feed the coronary arteries (the heart). The plaque eventually forms a clot.

Once the blockage occurs, blood flow is affected which may cause damage or destroy part of the heart muscle. A heart attack can be fatal but treatment has advanced extensively over the years.

According to World Health Organization, cardiovascular heart disease of which arrhythmia is one of them, causes 17.9 million deaths every year. This represents 31% of all deaths worldwide and unfortunately, 75% of these deaths occur in low-and middle-income countries such as Kenya.

At the same time, 85% of these deaths occur due to heart attacks, strokes, and unmanaged irregular heartbeats. In Kenya, it is estimated that 25% of hospital admissions and 13% of deaths are due to cardiovascular diseases.

Symptoms

Heart attack often has clear symptoms that require immediate medical attention. The common heart attack symptoms include:

  • Feeling of pressure
  • Crushing pain in the chest (often constant)
  • Tightness
  • Aching in the chest or arms that spreads to the neck
  • Squeezing
  • Coughing
  • Nausea
  • Vomiting
  • Dizziness
  • Feeling awful, generally
  • Shortness of breath – dyspnea
  • Restlessness
  • Face seeming gray in color
  • Feeling clammy and sweaty
  • A feeling of terror that life is ending

Causes

A heart attack mostly occurs when one or more of the coronary arteries is blocked. As time progresses, a coronary artery can narrow from the buildup of varied substances including atherosclerosis (cholesterol).

In other words, coronary artery disease is directly associated with or the leading cause of heart attacks. During a heart attack, one of the plaques may burst off and spill cholesterol and other substances into the bloodstream. This causes a blood clot at the site of the rapture.

If the clot is large enough, it can block the flow of blood through the coronary artery. In the process, the heart muscles are starved of nutrients (ischemia) and oxygen.

A complete blockage is called ST elevation myocardial infarction (STEMI) while a partial blockage is a non-ST elevation myocardial infarction (NSTEM).

A spasm of coronary artery is another cause of heart attack as it shuts down blood flow to sections of the heart muscle. The use of illicit drugs such as cocaine and tobacco use can lead to a life-threatening spasm.

Risk Factors

The risk factors of heart attack include:

  • Age: Women aged 55 or older and men aged 45 and older are at increased risk of a heart attack than younger people.
  • High blood pressure: Over time, hypertension may damage coronary arteries and lead to a heart attack.
  • Tobacco: Smoking and long-term exposure to second hand smoke increases the risk of heart attack.
  • Atherosclerosis or triglyceride levels: high level of low-density lipoprotein (LDL) cholesterol is likely to narrow arteries.
  • Obesity: Obesity is associated with high blood cholesterol levels.
  • Other risk factors include diabetes, metabolic syndrome, lack of physical activity, family history of heart attack, stress, illicit drug use, an autoimmune condition, and a history of preeclampsia.

Diagnosis

An emergency care team will ask you about the symptoms you are experiencing and history of heart disease. The team will then carry out a number of tests that include:

  • ECG: Also called electrocardiogram or EKG can tell the extent of damage on the heart muscle.
  • Blood tests: Blood is drawn to measure levels of cardiac enzymes that show heart muscle damage.
  • Echocardiography: It is an imaging test used during and after a heart attack to recognize how the heart is pumping and what areas are not pumping normally.
  • Cardiac Catheterization: Also called cardiac cath can be used to directly observe the blocked artery and assist the doctor to determine the ideal procedure to treat the blockage.

Treatment

Every minute you experience a heart attack, more heart tissue deteriorates or dies. Restoring blood flow helps prevent heart damage. The process of restoring blood flow is done using various medications.

These medications include:

  • Aspirin: The 911 operator might tell you to take aspiring to minimize blood clotting and help maintain blood flow through a narrowed artery.
  • Thrombolytics (Clotbursters): They help dissolve a blood clot that is blocking flow of blood to the heart.
  • Antiplatelets agents: They help prevent new clots from occurring and keep existing ones from enlarging.
  • Other drugs used to treat heart attack include ACE inhibitors, nitroglycerin, beta blockers, pain relievers, statins, and other blood-thinning medications.
  • Surgical and other procedures that are used include coronary angioplasty and stenting, and coronary artery bypass surgery.

Note that all the mentioned drugs are available in Kenya and must be used according to prescription by a doctor. Both surgical procedures are also done in the country if need be.

Prevention

Prevention of heart attack is mostly associated with lifestyle factors that include:

  • Maintaining a healthy weight
  • Eating a heart-healthy diet
  • Stop or don’t smoke
  • Managing stress and controlling conditions that may trigger heart attack
  • Exercising regularly

Taking medications can also reduce the risk of a successive heart attack and help the damaged heart function better.

For more information on diagnosis and/or treatment, speak to a doctor, or get access to a hospital near you through the Uzima Health App.