What is a heart attack?
A heart attack occurs when one or more coronary arteries that supply blood to your heart muscle become blocked off. Medically, it is referred to as a myocardial infarction or MI. If the blood supply is cut off for more that a certain period of time, usually about 20 minutes, the muscle cells in the heart which are supplied by that artery may die.What causes a heart attack?
If the plaque inside a coronary artery breaks, a blood clot occurs at this spot. This clot may block off the artery completely. This is when you might feel the symptoms of heart attack.
What are the symptoms of a heart attack?
The most common symptom of a heart attack is chest pain. This is usually a ‘crushing’ or ‘tight’ pain which may move to your jaw or to your arms particularly on the left side. This pain is not relieved by resting and is usually prolonged (over 20 minutes). You may also feel short of breath, sweaty or feel sick. Some people may feel light-headed or even lose consciousness. You may become very anxious or afraid. However, 10-15% of people who have a heart attack may not feel anything. This is more common in older people especially women and those with diabetes. Sometimes these people may just feel weak, tired, or short of breath.
How is a heart attack diagnosed?
Your doctor will make a diagnosis of a heart attack based on a number of factors. First of all the type and duration (how long the pain lasts) of chest pain is very important. The description of the pain can determine if the chest pain is indeed cardiac (from the heart). The duration of the pain will help the doctor decide the treatment options available to you. An electrocardiogram (E.C.G.) is used also in the diagnosis of a heart attack. This is a tracing of the electricity going through your heart and certain patterns on the E.C.G. can suggest a heart attack. Finally blood tests will be performed which will help confirm the diagnosis. Two out of three of these factors (chest pain, ECG changes and abnormal blood results) provide a definitive diagnosis of a heart attack.
Can a heart attack be treated?
Yes, a heart attack can be treated. Once you arrive in hospital and a heart attack is suspected, an E.C.G. is performed. You will also receive oxygen, pain relief, aspirin and a nitrate spray under your tongue. Nitrates keep the arteries relaxed as much as possible so that more blood gets to the heart muscle. Once a heart attack has been diagnosed, the doctor will then decide on the best treatment option for you. It is extremely important that you present to A&E as soon as you experience chest pain as time can save the muscle of your heart.
The most important decision is to try and open up the blocked artery. This can be achieved in two ways. Firstly you can be given drugs that break down the clot in the artery. These drugs are called “thrombolytics” (clot busting drugs). They are very powerful clot dissolving drugs and there are strict medical conditions for receiving thrombolytics. Your doctor will take great care to find out if you meet these medical conditions thus preventing any potential complications for receiving them. Secondly, patients may go directly to the Cardiac Catherisation Laboratory for “angioplasty”. Angioplasty involves inserting a wire into the arteries and passing a small balloon into the artery that is blocked. The balloon is then inflated so that the clot and plaque that blocked the artery are pushed to the side. A small metal cage called a stent is inserted to keep the artery open. This allows blood to flow back into the area of the heart muscle that had its blood supply cut off. This may prevent a\ further area of the heart muscle from dying.
What happens immediately after a heart attack?
Once a diagnosis of heart attack has been made you will be transferred from A&E or the Cardiac Cath Lab to the Coronary Care Unit (CCU) for close monitoring. This is the period of highest risk. Very fast or very slow heart rates or other complications after a heart attack may occur. During this time you will be examined carefully at least once per day to detect any complications, such as heart failure or a leaking valve.E.C.G. tests are performed regularly and if necessary Chest X-rays. Sometimes it is useful to perform an Echocardiogram (Echo) to establish how well the muscle of the heart is functioning. An Echocardiogram is an ultrasound examination of the heart.
Blood tests are carried out frequently to determine the extent of the damage that may have been caused by the heart attack and also to monitor the effects of drugs.
Why do I need to be admitted to a Coronary Care Unit (CCU)?
The Coronary care unit (CCU) is a special unit devoted to the care of cardiac (heart) patients. The nurses and doctors working in this unit are specialised to deal with patients who have had, or are threatening to have a heart attack. Equipment is available for constant monitoring of your heart rhythm, blood pressure and other factors. Patients and families are sometimes distressed by the number of monitors and drips used in CCU but this is quite normal and should not alarm you.
While in CCU, as well as daily doctors’ visits and specialised nursing care, you will be seen by the different healthcare professionals working in Cardiology. The dietician will see you and discuss your cholesterol levels, diet and requirements in detail with you. They may refer you to their outpatient department if you need follow up after you go home. You will also be seen by a member of the Cardiac Rehabilitation team who will discuss the cardiac rehabilitation programme with you and invite you to attend if applicable. There is a Medical Social Worker dedicated to Cardiology patients and is available for advice on smoking cessation, stress management, financial aid, convalescence or any other issues you would like to discuss. Physiotherapist and Heart Failure Nurse Specialists will also be involved in your care if required.
Most people who have had a heart attack spend approximately 5-7 days in hospital. After the first day of complete rest, you are allowed to sit out and do a short walk within the unit. You are usually transferred to the general ward in 2-3 days
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