Myocardial infarction

Content

Introduction

Introduction

Acute myocardial infarction is a serious disease that occurs when the flow of blood to part of the heart stops suddenly, often due to a clot, causing severe damage.

In common parlance, acute myocardial infarction is simply referred to as heart attack or heartbreaking.

The most common symptoms (symptoms) caused by acute myocardial infarction are:

  • chest pain, which can also be perceived as a feeling of tightness or heaviness in the chest. The pain can radiate to the jaw, neck, arms, back and abdomen
  • shortness of breath
  • feeling of weakness and / or dizziness
  • overwhelming feeling of anxiety

Heart attack is an emergency and requires medical intervention as soon as possible: people who suspect they are having a heart attack should call the ambulance immediately and, if they are not allergic to aspirin, they should take a 300 mg tablet. , chew it slowly and then swallow it while waiting for medical help; aspirin contributes to blood thinning.

The treatment (therapy) of the heart attack essentially depends on the severity of the episode. It can be pharmacological (anti-coagulant therapies) and surgical (interventions that help restore blood flow to the heart).

Myocardial infarction is caused by changes in the coronary arteries, the vessels that carry blood to the heart. Most often it is a reduction in the width of the lumen, or occlusion, of the internal cavity of the artery due to of deposits of lipids and cholesterol (atheromatous plaque or atheroma). These plaques, in fact, can break, forming a clot that blocks the flow of blood inside the coronary artery.

The main risk factors for heart attack are:

  • smoking habit (read the buffalo)
  • diabetes
  • high cholesterol (hypercholesterolemia)
  • high blood pressure (hypertension)
  • overweight or obesity

The timing of recovery after having a heart attack depends on the damage done to the heart. Some people manage to return to work after two weeks. Others may take several months to heal.

The very serious complications caused by heart attack are:

  • arrhythmia, the heart starts beating faster and / or irregularly until it stops (cardiac arrest)
  • cardiogenic shock, the heart muscle is severely damaged and can no longer contract properly, thus providing insufficient blood for vital functions
  • rupture of the heart, the muscle, walls, or valves of the heart separate (rupture)

These complications can occur quickly after a heart attack and lead to death.

In general, mortality from heart attack is about 1/3 of the events and occurs in most cases before the person arrives at the hospital; it has been shown that this share of events could be reduced or manifest in a less severe way with prevention actions aimed at reducing risk factors from an early age. After the first 6 months, the risk of mortality is considerably reduced and one year after the event the risk is practically the same as for people who have not had a heart attack.

Symptoms

Symptoms

Disorders (symptoms) caused by a heart attack include:

  • chest pain, feeling of pressure, tightness or heaviness in the chest
  • pain in the arms (usually the left arm, but can also affect the right), in the jaw-jaw, neck, back and abdomen
  • dizziness or vertigo
  • sweating
  • shortness of breath or wheezing
  • malaise (with nausea or vomiting)
  • overwhelming anxiety (similar to a panic attack)
  • cough or wheezing

Chest pain is usually very severe, but it can also be mild, with the sensation of indigestion. There may not even be any chest pain, especially in women, elderly people and / or people with diabetes.

It is the set of disorders (symptoms) that helps to understand if it is actually a heart attack.

If in doubt, call 118 (112 in some regions) and ask for an ambulance. It is better to make a mistake in judgment than to intervene when it is too late.

While waiting for the ambulance, it is important that the affected person is at rest, in order to minimize the strain on the heart. If you are not allergic to aspirin, and the drug is available, you may be given a 300 mg tablet to chew slowly and then swallow.

Aspirin helps keep the blood fluid and restore blood supply to the heart.

Causes

Causes

Myocardial infarction is caused by a sudden interruption of blood flow to the heart. Like all organs of the body, the heart needs a constant supply of oxygen-rich blood: if it fails, damage of varying severity can occur.

Alterations of the coronary arteries

They represent the first cause of heart attack and consist in the reduction of the width of their internal cavity (lumen of the "artery) caused by the formation of atherosclerotic plaques (atheroma), formed mainly by lipid and cholesterol deposits. If the plaque ruptures, a clot can form which further narrows the lumen of the artery and causes interruption of blood flow.

Risk factors

Myocardial infarction, like all cardiovascular diseases, is multifactorial, ie multiple risk factors contribute to its development at the same time. The risk factors for heart attack in many cases are linked to each other and largely depend on unrelated lifestyles. correct. They include:

  • smoke, nicotine and carbon monoxide strain the heart, causing tachycardia and increasing the risk of blood clots. Other chemicals in cigarettes damage the lining of the coronary arteries, occluding them
  • high blood pressure (high blood pressure) can weaken coronaries, making them more vulnerable to disease
  • diabetes and high blood glucose levels they can damage the coronary arteries
  • overweight and obesity, even if they do not directly increase the risk of coronary heart disease and heart attack, they can favor the development of other risk factors; in particular, people who are overweight or obese are more likely to suffer from high blood pressure, hypercholesterolemia and to develop type 2 diabetes
  • sedentary lifestyle, lack of exercise favors the development of risk factors such as overweight, obesity, hypertension, hypercholesterolemia and diabetes
  • supply, too much saturated fat and cholesterol, salt and sugars cause the formation of plaques inside the blood vessels
  • alcohol, excessive alcohol consumption can lead to hypertension and hypercholesterolemia and, consequently, increase the risk of coronary heart disease. In addition, alcohol abuse is often associated with other unhealthy lifestyles such as smoking, unbalanced and varied diet and sedentary lifestyle
  • age and gender, non-modifiable but important risk factors are represented by age and sex: until menopause women get heart attacks less frequently, with a delay of about 10 years compared to men; subsequently, the frequency of the disease in women progressively increases until, in old age, greater than men. It has been hypothesized that the causes of this phenomenon may be:
    • hormonal protection in women before menopause
    • higher percentage of men who smoke and consume excessive amounts of alcohol than women
    • higher percentage of overweight and obese men
  • family members affected by the disease (family history of heart attack), in the case of first degree relatives (parents, brothers or sisters, children) affected by cardiovascular disease at a young age, less than 55 years, such as heart attack or stroke, they are more likely to develop them than the general population. However, information regarding genetic inheritance must be distinguished from the transmission within the family of bad lifestyle habits
  • air pollution, recent studies on the influence of the environment on health have associated exposure to air pollution, specifically that caused by traffic, with the probability of having a heart attack

Less common causes

Possible, but less common, causes of the onset of cardiovascular disease are the consumption of drugs and the lack of adequate amounts of oxygen in the blood.

Narcotic substances

Cocaine, amphetamines and methamphetamines can cause a thinning of the coronary arteries, decrease the blood supply to the heart and cause heart attack. The heart attack caused by cocaine intake is one of the major causes of sudden death in the young population.

Lack of oxygen in the blood (hypoxia)

Coronary heart disease can result if blood oxygen levels drop due to carbon monoxide poisoning, loss of normal lung function, or severe anemia and the heart no longer receives the necessary amount of oxygen. and the heart attack.

Diagnosis

Diagnosis

The "assessment of the heart attack (diagnosis) is performed in the hospital, in a specialized department (coronary unit) or directly in the" hemodynamics unit.

Electrocardiography

The "electrocardiogram (ECG) is an important test to ascertain a heart attack and should be performed within 10 minutes of hospitalization.
It measures the electrical activity of the heart: each heartbeat produces electrical impulses that a special device (electrocardiograph) records, producing a trace, visible on paper or electronic (video), which will be interpreted by the doctor.
It does not cause discomfort and its execution lasts a few minutes: it involves the application of sensors (electrodes), small suction cups on the arms, legs and chest that capture electrical signals produced by the heart and transmit, through cables, to the device (electrocardiograph).
The ECG is important because it helps confirm the presence of a heart attack and determine the type of injury, allowing you to choose the most effective treatment.

Blood analysis

Damage to the heart caused by a heart attack causes certain specific proteins (cardiac markers) to be released into the blood. Their levels are measured during the hours / days following hospitalization to verify the extent of heart damage and determine the effectiveness of the treatments administered.

Chest X-ray

Chest X-rays can be useful to ascertain (diagnose) whether the present disorders are caused by a heart attack or other causes such as, for example, an air bubble in the lungs (pneumothorax).
Chest X-rays can also be used to check for any complications after a heart attack, such as an accumulation of fluid in the lungs (pulmonary edema).

Echocardiogram

The "echocardiogram is an examination that uses an ultrasound probe to obtain an image of the structure of the heart. It can be useful for identifying exactly which parts of the heart have been damaged and how the damage has altered heart functions.

Coronary angiography

Coronary angiography (coronary angiography) allows you to determine if there is an interruption or reduction in blood flow in the coronary arteries and to identify their exact location. It is practiced by inserting a thin tube (catheter) into the femoral artery (located at the level of the groin) or into the radial artery (located in the arm). The catheter is guided up to the coronary arteries via the radiographic image projected on video. A special liquid, visible radiographically (contrast agent), is injected through the catheter and allows, by observing its flow, to locate the exact point of the narrowing or occlusion of the coronary artery and to intervene appropriately.

Types of heart attack

To specify the type of heart attack that has occurred, an electrocardiographic characteristic, called ST segment, which allows to distinguish different situations:

ACS

It occurs in the case of major stenosis (obstruction) of the coronary artery and there are three main types: acute myocardial infarction with ST-segment elevation, acute myocardial infarction without ST-segment elevation and unstable angina:

  • myocardial infarction with ST-segment elevation
    It is the most serious type of heart attack because it causes severe damage to a large portion of the heart. It is caused by a long interruption of blood flow to the heart caused by the total occlusion of the coronary artery
  • myocardial infarction without ST-segment elevation
    Blood flow to the heart is decreased due to a partial or temporary occlusion of the coronary artery. The resulting damage concerns a smaller heart section, but it is still considered a serious medical emergency
  • unstable angina
    The blood flow to the heart is severely reduced but does not cause permanent damage, preserving the integrity of the heart muscle. Unstable angina is also a serious medical emergency
Therapy

Therapy

Treatments for heart attack are different for myocardial infarction with ST-segment elevation or for the other types of heart attack.

Acute ST-segment elevation myocardial infarction therapy

It is the most severe form of heart attack and requires evaluation and emergency care to remove blockage of the coronary arteries. Treatment varies according to the time elapsed from the onset of the symptoms (symptoms) and the time from the start of treatment:

  • if symptoms started within 12 hours, usually percutaneous coronary intervention (angioplasty) is performed
  • if symptoms started within 12 hours but angioplasty is not possiblein the immediate drugs are given that can dissolve blood clots
  • if symptoms started more than 12 hours ago another type of procedure may be used, especially if the complaints are decreasing. The most appropriate treatment is established after angiography and may include medications, angioplasty, or bypass surgery

Myocardial infarction therapy without ST-segment elevation or unstable angina

If the ECG shows a less severe type of heart attack (also known as non-ST-segment elevation myocardial infarction or unstable angina), anticoagulants, including aspirin and other medicines, are usually prescribed.
After the initial treatment with these drugs, in some cases you may be referred to angioplasty or coronary artery bypass surgery.

Percutaneous coronary intervention

This is a surgery that aims to dilate the coronary arteries (coronary angioplasty). Generally, it is preceded by a coronary angiography which, highlighting the characteristics of the obstruction and the state of the arteries, establishes its possible need.

Coronary angioplasty

Coronary angioplasty is a complex type of surgery that requires specialized personnel and equipment not found in all hospitals. This means that it may be necessary to urgently transport the person affected by a heart attack, by ambulance, to a specialized center.

Coronary angioplasty consists of introducing a thin catheter, with a "balloon" at the end, into the femoral artery or radial artery. The catheter is advanced, using radiography to direct it, to the heart and to the narrow section of the coronary artery. Once the point to be dilated is reached, the balloon is inflated inside the narrowed artery in order to widen it. One stent (flexible metal mesh) is inserted into the artery to keep it open.

Thrombolytic drugs

Drugs used to dissolve the clot, known as thrombolytics or fibrinolytics, dissolve a protein, called fibrin, which plays an important role in clotting by forming a "mesh" that hardens around blood cells.

Some examples of these drugs are:

  • reteplase
  • alteplase
  • streptokinase

Coronary bypass

Coronary artery bypass surgery involves creating new channels for blood circulation from the aorta to the coronary arteries to bypass any narrowing or obstruction. Increased blood flow reaches the heart in this way. The ducts used consist of the saphenous vein, which is taken from the leg, and one or both mammary arteries, which are taken from the inner wall of the chest. More rarely, the radial artery taken from the arm is used. These ducts are connected on one side with the aorta and on the other with a point of the coronary artery located after narrowing or occlusion. In this way the blood reaches the heart again in adequate quantity.

Prevention

Prevention

The most effective prevention against the onset or recurrence of acute myocardial infarction (AMI) is to adopt healthy lifestyles:

  • correct and balanced nutrition
  • abolition of smoking
  • blood pressure control and maintenance below 140/90 mmHg
  • moderate physical activity

Diet

A varied and balanced diet, made up of modest portions, with low consumption of saturated fats and cholesterol, low in salt and sugar, rich in vegetables and fruit, whole grains, legumes and fish decreases the risk of developing cardiovascular diseases. Fruits and vegetables are rich in vitamins, minerals and fiber, and they help keep the body healthy. The ideal is to eat at least five 80g portions of fruit and vegetables every day.

An important risk factor for the onset of cardiovascular disease is cholesterol, of which there are two types:

  • with low density lipoproteins (LDL), composed mainly of fat and a small amount of protein; this type of cholesterol is deposited in the wall of the arteries and can obstruct them, therefore it is often referred to as "atherogenic cholesterol" or "bad cholesterol"
  • with high density lipoproteins (HDL), composed mainly of proteins plus a small amount of fat; this type of cholesterol is not deposited in the arteries and is therefore often referred to as "good cholesterol"

The increase in LDL cholesterol is favored by the intake of foods containing saturated fats and cholesterol, such as:

  • sausages, red meats and fatty meats, lard and bacon
  • butter and cream
  • egg yolk (yolk)
  • cheeses
  • sweets and cookies
  • foods that contain palm or coconut oil (high in saturated fat)

On the other hand, including polyunsaturated fats in your diet lowers blood cholesterol levels and increases HDL cholesterol levels, helping to reduce atherosclerotic plaque in the arteries. Foods rich in polyunsaturated fats include:

  • blue fish
  • avocado
  • nuts and seeds
  • sunflower and rapeseed oil

Extra virgin olive oil is rich in monounsaturated fats; even monounsaturated fats have the peculiarity of lowering LDL cholesterol levels and increasing HDL cholesterol levels.

However, remember that fats are very caloric, therefore it is recommended to use them in moderate quantities

Smoke

Smoking is a major risk factor for cardiovascular disease, causing arteriosclerosis and arterial hypertension.

In Italy there is a Green Telephone against Smoking (TVF): 800 554 088, an anonymous and free national service that carries out consultancy activities on issues related to the phenomenon of smoking (for more information, consult the website of the Green Telephone against smoking of the Institute Superior of Health).

High blood pressure (arterial hypertension)

Consistently high blood pressure (high blood pressure) can place excessive strain on the heart, increasing the risk of heart attack. Arterial hypertension can be reduced by moderating the consumption of alcoholic beverages, reducing weight and keeping it within the normal range, carrying out regular and daily physical activity and following a "varied and balanced diet, with modest portions, low in salt, saturated fat, cholesterol Salt increases blood pressure and it is therefore recommended to use little, both for cooking and for seasoning, less than 5g (about a teaspoon) per day, also considering the salt contained in packaged foods.

Alcohol

Alcohol does not contain any vitamins or other nutrients, it only gives calories. Drinking wine or other alcohol regularly increases blood pressure and weight. Both men and women should not drink more than 14 alcohol units per week. not to drink more than two glasses of wine in the whole day, in women, only one glass). If you drink 14 alcohol units a week it would be better if they were spread over three or more days, and that they accompany the meal.

Weight

Being overweight forces the heart to work harder to circulate blood in the body, and this can cause blood pressure to rise.

If you are overweight or obese, losing even a few pounds can make a big difference in your blood pressure and overall health.

Exercise

Staying active and practicing physical activity regularly lowers blood pressure, keeping the heart and blood vessels in good condition. Regular physical activity also helps to lose weight, reduce blood pressure and control emotional tension.

Low-impact activities such as walking, swimming, and cycling are recommended. More demanding activities, such as soccer and tennis, may not be suitable; it is advisable to consult your doctor to make choices suitable for your state of health.

Control your stress

Avoid unnecessary stress and learn techniques for dealing with and managing everyday stress.

Complications

Complications

The complications that can occur following a heart attack are highly variable, from mild to life-threatening (Video):

Arrhythmia

Arrhythmia consists of an abnormal heartbeat: too fast (tachycardia), too slow (bradycardia) or irregular (atrial fibrillation).

Some types of arrhythmias, such as tachycardia, are mild and cause disorders such as:

  • palpitations (sensation of "racing" heartbeats in the chest, throat or neck)
  • chest pains
  • dizziness
  • dizziness
  • fatigue (tiredness)
  • breathlessness

Other types of arrhythmias can be life-threatening, such as:

  • complete heart block, a situation in which electrical signals are unable to travel from one part of the heart to the other, preventing it from beating regularly
  • ventricular arrhythmia, an event in which the heart starts beating faster before going into a spasm and then stops beating altogether; in this case we speak of cardiac arrest

These types of arrhythmias can be a leading cause of death in the 24 hours following a heart attack. Survival rates have increased significantly after the introduction of the portable defibrillator, a device that delivers electric shocks that can make the heart recover properly. rhythm.

Mild arrhythmias can usually be controlled with drugs such as beta blockers.

More dangerous arrhythmias, responsible for repeated and prolonged disorders, may require the use of a pacemaker, an electrical device surgically implanted in the chest to regulate the heartbeat.

Heart failure

Heart failure occurs when the heart is unable to effectively pump blood around the body. It can occur following a heart attack if the heart muscle has been severely damaged. It usually occurs in the left portion of the heart (the left ventricle).

Disorders (symptoms) that indicate heart failure include:

  • shortness of breath
  • exhaustion
  • swelling in the legs and arms due to an accumulation of liquids

Heart failure can be treated with a combination of drugs and, in some cases, surgery.

Cardiogenic shock

Cardiogenic shock is similar to heart failure, but more severe. It occurs when the heart muscle has been damaged so badly that it can no longer provide enough blood to maintain bodily functions.

Symptoms include:

  • mental confusion
  • cold in the feet and hands
  • decrease or absence of urine production
  • accelerated heartbeat and breathing
  • pallor

Cardiogenic shock can be treated with anti-clotting drugs that make the blood more fluid. Medicines can also be used to help contract the blood vessels, thereby slightly increasing blood pressure and improving blood circulation.

Once the initial symptoms of cardiogenic shock have stabilized, surgery may be needed to improve heart function. This may include percutaneous coronary intervention together with the insertion of a small pump, known as aortic contropulsator, which can improve the flow of blood out of the heart.

Another option is represented by aortocoronary bypass (surgery which consists in "using a blood vessel taken from another part of the body to overcome the occluded part of the artery).

Breaking of the heart

Heart rupture is a serious, and relatively common, complication of heart attack. It occurs about every 10 cases and usually leads to death within 5 days.

We talk about rupture of the heart when some of its parts (such as valves or heart walls) break due to damage caused by the heart attack. The disorders (symptoms) are the same as cardiogenic shock and, as a rule, surgery is required to open heart to repair the damage.

Living after a heart attack

Living after a heart attack

The recovery after the heart attack can take many months and it is very important not to speed up the rehabilitation times.

During the convalescence period, the support of numerous health professionals is required, including:

  • nurses
  • physiotherapists
  • dieticians
  • rehabilitation specialists

These professionals can provide physical and psychological support to ensure safe and adequate recovery starting in stages right from hospital admission. After discharge, rehabilitation can continue at home.

The main purposes of rehabilitation are:

  • gradually regain physical fitness so that you can resume normal activities (cardiac rehabilitation)
  • reduce the risk of a new heart attack

Exercise

Once at home, rest and non-strenuous activities are usually prescribed, such as short walks.

Daily momentum can be gradually increased over the weeks. The speed of recovery depends on the condition of the heart and general health. Doctors can give more detailed directions for a recovery plan that includes a gradual increase in activities.

The rehabilitation program must contain a series of exercises that also take into account age and abilities. Most of these are aerobic exercises such as stationary bikes, treadmills, and swimming, designed to strengthen the heart, improve circulation, and lower blood pressure.

Back to work

Most people after a heart attack can return to work but the time needed to resume work depends on the health of the heart and the type of work performed. If it involves light duties, such as some types of office work, two weeks may be enough; if it requires effort or if the heart has been seriously damaged, it can take up to several months before returning to work.

Medical specialists will provide you with a detailed estimate of the time needed to return to work.

Sexual intercourse

The person recovered from a heart attack may resume having sexual intercourse when he feels good again, generally this occurs 4-6 weeks after the heart attack. Sexual intercourse does not constitute an additional risk for the onset of a new episode.

Following a heart attack, about one in three men have erectile dysfunction which can make it difficult to resume intercourse.

This may be due to the anxiety and stress that are generally associated with a heart attack.

Driving of vehicles

It is advisable to avoid driving for at least 4 weeks after the heart attack and wait for the favorable opinion of the treating doctor. Particular attention should be paid to driving large means of transport or vehicles used to transport people.

Depression

Heart attack is a traumatic event and anxiety is common. In many people in the first weeks of returning home after hospital discharge, emotional stress can cause depression and crying spells.

If the feeling of depression persists, it is good to talk to your doctor to prevent it from getting worse. Furthermore, the emotional state can affect rehabilitation.

Reduce the risks of another heart attack

Reducing the risk of having another heart attack requires making changes in daily life and taking medications for prolonged periods.

In-depth link

In-depth link

Heart Project (ISS)

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