Do you also want to know about a heart attack? Let's talk about this in detail!

Today we are going to talk about a topic that is important to many people, and also a little scary. That is a heart attack, or in medical terms, a condition called `(Myocardial Infarction)`. Maybe someone in your family or a friend has had this condition. Or you may have heard about it in a newspaper or on TV. However, it is very important to have a correct understanding about this.

What is a Heart Attack?

Simply put, a heart attack is a very dangerous condition that occurs when a part of your heart muscle does not get enough blood flow. Just like a tree dies without water, that part of the heart also slowly starts to die without blood. There can be a number of reasons for this decrease in blood flow, but most often it is caused by a blockage in the blood vessels that supply blood to the heart, called the ``Coronary Arteries``.

Think of it like a clogged drain in your garden. If the blood flow is cut off in this way, the heart muscle in question will begin to die. If the blood flow is not restored quickly, a heart attack can cause permanent damage to the heart, possibly even death.

A heart attack is a life-threatening emergency. If you think you or someone you are with is having a heart attack, call 1990 (emergency medical service) immediately . Time is of the essence when treating a heart attack. Even a few minutes late can cause permanent heart damage or death.

What really happens during a heart attack?

When you have a heart attack, blood flow to a part of your heart either stops completely or is much less than normal. This causes that part of the heart muscle to be damaged or die. When a part of the heart starts to die from lack of blood, it interferes with the heart's pumping action. This can cause blood flow to other parts of the body to be reduced or stopped. If this is not treated quickly, it can be fatal.

How common is this?

Actually, heart attack is a condition that is quite common all over the world as well as in our country. Most heart attacks are caused by `(Coronary Artery Disease)`. This is also considered to be the leading cause of death in the world. Therefore, it is very important to be aware of this.

How does it feel when you're having a heart attack?

Many people experience chest pain when they are having a heart attack. This can feel like a squeezing, squeezing, or heaviness in the chest. Sometimes, the pain can be so severe that it feels like the chest is about to burst. This pain can start in the chest and spread to the left arm (sometimes both arms), shoulder, neck, jaw, back, or stomach.

The strange thing is, many people mistake this for gastritis or heartburn .

Some people may not have chest pain, but may only experience symptoms such as shortness of breath, nausea, and sweating .

What are the symptoms of a heart attack?

A heart attack can cause a variety of symptoms, some more common than others.

The most common symptoms described by many people are:

• Chest pain (`(Angina)`)
• Difficulty breathing or shortness of breath
• Insomnia (may be present before a heart attack)
• Nausea or stomach discomfort
• Feeling the heart beating fast (`(Heart Palpitations)`)
• Anxiety or a feeling that "something bad is going to happen"
• Dizziness (vertigo), fainting, or loss of consciousness

Can symptoms differ between men and women?

Yes, this is a very important point. Women may experience different symptoms of a heart attack than men. Women are less likely to experience the typical chest pain. Instead,

• Difficulty breathing
• Feeling very tired
• Insomnia before the heart attack
• Nausea and vomiting
• The most common symptoms are pain in the back, shoulders, neck, arms, or abdomen .

Therefore, women should be especially careful about this.

What causes a heart attack?

Most heart attacks are caused by a blockage in a blood vessel that supplies blood to the heart. The main cause of this is the buildup of a sticky substance called `(Plaque)` inside the arteries. It is like pouring oil down the kitchen sink and clogging the pipes. This buildup is called `(Atherosclerosis). When a lot of `(Plaque)` builds up in the blood vessels of the heart, the condition is called `(Coronary Artery Disease)`.

Sometimes, these plaque deposits inside the coronary arteries can rupture. A blood clot can then form at the site of the rupture. If the artery is completely blocked by that blood clot, the heart muscle is deprived of blood and a heart attack occurs.

Are there rare causes?

Yes, there are cases where a heart attack occurs without a `(Plaque)` bursting, but it is very rare, accounting for about 5% of all heart attacks. Some of the reasons for this are:

• A sudden contraction of the coronary arteries of the heart (`(Coronary Artery Spasm)`)
• Rare conditions that cause abnormal narrowing of blood vessels
• Rupture of coronary arteries due to accidents
• A blockage from somewhere else in the body, for example a blood clot or air bubble (`(Embolism)`) in a coronary artery
• Eating disorders can damage the heart over time and eventually lead to a heart attack.
• Congenital abnormal positions of the coronary arteries (`(Anomalous Coronary Arteries)`)
• Other conditions in which the heart does not get enough blood (e.g., very low blood pressure, low oxygen levels, prolonged high heart rate)

Risk Factors That Increase the Risk of Having a Heart Attack

There are several major factors that affect the risk of having a heart attack. Unfortunately, some of these are things we cannot change.

• Age and gender: The risk of having a heart attack increases as you get older. For men, the risk increases after age 45, and for women, the risk increases after age 50 or after menopause.
• Family history of heart disease: If one of your parents or siblings has had heart disease or a heart attack, especially at a young age, you are at higher risk because your genes are similar to theirs.
• Lifestyle: Lifestyle habits that are harmful to the heart also increase the risk of heart attack. Examples: smoking, eating a high-fat diet, not exercising, drinking too much alcohol, and using drugs.
• Certain health conditions: Some diseases put strain on the heart and increase the risk of heart attack. These include:
• Diabetes (`(Diabetes Mellitus)`)
• Obesity
• High blood pressure (`(Hypertension)`)
• High cholesterol (`(Hypercholesterolemia)`)
• Eating Disorders
• Having a history of high blood pressure during pregnancy (`(Preeclampsia)`).

Complications that may occur after a heart attack

Various complications can occur after a heart attack. These include:

• Abnormal heart rhythms (`(Arrhythmias)`)
• Heart failure
• Heart valve problems
• Stroke
• Sudden Cardiac Arrest (`(Sudden Cardiac Arrest)`)
• Depression and anxiety
• Cardiogenic Shock
• Mechanical complications that can occur if treatment for a heart attack is delayed (e.g., Ventricular Septal Defect - a hole between the chambers, a ruptured heart wall).

How do I know for sure if I'm having a heart attack? (Diagnosis)

A heart attack is usually diagnosed in a hospital emergency room. If you have symptoms of a heart attack, a doctor will do a physical exam . They will check your pulse rate, blood oxygen levels, and blood pressure, listen to your heart and lungs, and ask about any symptoms you have had.

What tests are done for this?

A doctor uses these tests to diagnose a heart attack:

• Blood tests: The most reliable way to diagnose a heart attack is to check the blood for a chemical called ``Cardiac Troponin.`` This chemical accumulates in the blood as heart muscle cells are damaged during a heart attack.
• Electrocardiogram (EKG or ECG): This is the first test done when you arrive at the emergency room. It can detect damage to the heart's electrical signals and irregular heartbeats.
• Echocardiogram: This uses ultrasound waves to take pictures of the inside and outside of the heart. It can check how well the heart is pumping and whether the valves are working properly.
• Coronary Angiogram: This uses X-rays and a special dye to look at the blood vessels in the heart and detect any blockages.
• Heart Computed Tomography (CT) scan: This takes detailed pictures of the heart and blood vessels to check for narrowing or hardening of the main coronary arteries.
• Heart MRI (Magnetic Resonance Imaging): This uses a strong magnetic field and computer technology to create a picture of the heart. It shows if there are any problems with the blood flow in the arteries that supply blood to the heart.
• Exercise Stress Test: While you exercise, you will be tested with an ECG, echocardiogram, or nuclear scan to see if your heart is getting enough blood.
• Nuclear Heart Scans: This involves injecting a radioactive substance into the blood and using computer technology (such as a CT scan) to find areas of reduced blood flow or damage to the heart. These can be either SPECT scans or PET scans.

How do you treat a heart attack?

Treating a heart attack means restoring blood flow to the affected heart muscle as quickly as possible . This can be done in a variety of ways, from giving medications to performing surgery. Often, several of these methods are used together.

Giving oxygen

People who have difficulty breathing and low blood oxygen levels are given supplemental oxygen along with other treatments. This can be given through a tube under the nose or through a mask that covers the nose and mouth. This increases the amount of oxygen in the blood and reduces the strain on the heart.

Medications

This may include the following:

• Anticoagulants: Aspirin and other blood thinners.
• Nitroglycerin: This medicine reduces chest pain and widens blood vessels, allowing blood to flow more easily.
• Thrombolytic Medications: These are only given within the first 12 hours of a heart attack.
• Antiarrhythmia Medications: A heart attack can cause irregular heartbeats (arrhythmias), which can be life-threatening. These medications can stop or prevent these irregularities.
• Painkillers: The most common painkiller given during a heart attack is `(Morphine).` This can reduce chest pain.
• Beta-blockers: These medications slow down the heart rate and help the heart recover from the damage caused by a heart attack.
• Antihypertensives: These medications lower blood pressure and help the heart recover from the damage caused by a heart attack.
• Statins: These medications stabilize plaque in the blood vessels of the heart, reducing the risk of them bursting. They also help lower cholesterol and reduce the risk of another heart attack.

Percutaneous Coronary Intervention (PCI) or Angioplasty

Doctors restore blood flow to the affected heart muscle through a procedure called Percutaneous Coronary Intervention (PCI) or Angioplasty.

Opening the artery with a catheter is essential to restoring blood flow. The sooner it is done, the better the outcome. Doctors use a measure called "door-to-balloon time" to measure their ability to treat a heart attack. This is the average time it takes to perform a PCI after you arrive at the emergency room. If you have a PCI, your doctor may place a stent, a small mesh-like structure, in the area where the blockage is. The stent helps keep the artery open so it doesn't get blocked again.

Coronary Artery Bypass Grafting (CABG)

Coronary Artery Bypass Grafting (CABG) is performed on people with severe blockages in the coronary arteries. This is commonly called open-heart surgery or bypass surgery.

This involves taking a blood vessel from another part of the body (often from the chest, arm, or leg) and creating a new route for blood to bypass the blocked artery. This transports blood to the heart muscle.

Are there any side effects of the treatment?

Side effects of treatment vary depending on the treatment method. They may include:

• Nausea and vomiting
• Weakness
• Dizziness
• Bleeding
• Infections
• Damage to a blood vessel
• Irregular heartbeat (`(Arrhythmia)`)
• Kidney problems
• Stroke

How soon will I feel better after treatment?

Typically, your heart attack symptoms should improve as you receive treatment. You may feel a little weak and tired during your hospital stay and for a few days. Your doctor will give you advice on how to rest, what medications to take, and more.

Recovery time from treatment varies depending on the treatment method. The average hospital stay for a heart attack is about four to five days.

• If you only take medication: You will usually have to stay in the hospital for about six days.
• If you have PCI: Recovery from PCI is easier than surgery because it is a less invasive procedure. You usually have to stay in the hospital for about four days.
• If you have a CABG: Heart bypass surgery takes a long time to recover from, as it is a major surgery. You will usually have to stay in the hospital for about eight to twelve days.

Can a heart attack be prevented? How can the risk be reduced?

In general, there are many things you can do to prevent a heart attack. However, there are some factors you can't change (especially your family history), so a heart attack can happen no matter how hard you try. However, reducing your risk can delay the onset of a heart attack and reduce its severity if it does occur.

You can do these things to reduce your risk:

• Get a medical check-up: See a family doctor (Primary Care Provider - PCP) for a check-up at least once a year. This can catch many early warning signs of heart disease (such as blood pressure, sugar levels, and cholesterol levels that you may not be aware of).
• Quit tobacco products: This includes smoking, smokeless tobacco, and all vaping products.
• Exercise regularly: Try to exercise at a moderate intensity for 30 minutes a day, five days a week.
• Eat a nutritious diet: For example, the Mediterranean or DASH diet. It is much better to eat plant-based foods instead of processed meats and foods high in saturated fat.
• Maintain a healthy weight for yourself: Ask your family doctor about a healthy weight and ask for help in achieving it.
• Control any medical conditions you already have: things like high cholesterol, high blood pressure, and diabetes.
• Reduce stress: Try things like yoga, deep breathing exercises, and meditation.
• Take your medication as prescribed: Don't just take your medication when you remember or when you're about to see your doctor.
• Go to every doctor's appointment: Regular visits to the doctor can help detect heart problems or other illnesses you may not have known about.

Taking charge of your health doesn't mean you have to make these lifestyle changes alone. Ask your family doctor and other healthcare teams for help. They can provide you with the information and resources you need.

If you have already had a heart attack, your doctor may recommend a cardiac rehabilitation program . The goal of this program is to reduce your risk of having a second heart attack. These programs, which are supervised by a doctor, provide counseling and focus on the healthy lifestyle habits mentioned above.

What to expect if you have a heart attack?

Your treatment for a heart attack doesn't end when you leave the hospital. You will need to continue taking your prescribed medications and make changes to your daily routine because of the risk of a second heart attack.

When will normal activities be able to resume?

Recovering from a heart attack after being discharged from the hospital depends on factors such as the severity of the heart attack, how quickly treatment was started, what treatment was received, and whether you had any medical conditions before the heart attack.

Your doctor can explain the next steps in your recovery and what you should expect. In general, most people can return to work or resume normal activities within two weeks to three months after a heart attack. Cardiac rehabilitation helps people gradually and safely return to their previous level of physical activity.

What is the health status of someone who has had a heart attack? (Outlook)

Many people today survive a heart attack. However, the situation may be a little worse for these people:

• People over 65 years of age
• People with heart failure
• People with diabetes
• People who have had a previous heart attack

These people may be at increased risk of having another heart attack or dying within the next six months. In such cases, doctors work hard to control their risk factors.

In women, premenopausal women under the age of 45 have better outcomes than men of the same age. Scientists believe this is due to the heart-protective properties of the hormone estrogen. However, after menopause, when the protection provided by estrogen is lost, women are worse off than men. Specifically:

• Women who have a heart attack between the ages of 45 and 65 are more likely to die within a year of the event than men of the same age.
• Women over the age of 65 are more likely than men of the same age to die within a few weeks of having a heart attack, so women should be especially careful about their heart health.

How do I take care of myself? (Self-care after heart attack)

After a heart attack, you may need to continue taking some of the medications you received as emergency treatment. These include:

• `(Beta-blockers)`
• `(ACE inhibitors)`
• Aspirin and other blood thinners
• `(Statins)`

When should I see a doctor? (When to see a doctor - follow-up)

After you've had a heart attack, your risk of having another one increases. Your doctor will recommend follow-up tests and treatments to help prevent future heart attacks. Some of these include:

• Heart scan: Similar to the methods used to diagnose a heart attack, these can assess the impact of your heart attack and see if there is any permanent damage to your heart. They can also check for any problems with your heart and circulatory system that could increase your risk of having a heart attack in the future.
• `(Stress Test)`: These heart tests and scans, which are done while you exercise, can detect problems that only surface when the heart is stressed.
• Cardiac Rehabilitation: These programs help improve your overall health and lifestyle, which can help prevent another heart attack.

When should I go to an Emergency Treatment Unit (ETU) ?

If you have any of the heart attack symptoms mentioned in this article and think you are having a heart attack, call your local emergency number (1990 in Sri Lanka) immediately. While waiting for help, ask if you need to take an aspirin or other medicine. Don't delay in calling. Every minute counts during a heart attack.

Why do you need to call 1990 instead of going to the hospital alone?

If you have symptoms of a heart attack, it's best to call 911 or an emergency service. There are several reasons for this:

• First responders can perform some of the initial tests and treatments for a heart attack on the way to the hospital. This speeds up the overall diagnosis and treatment process.
• If you arrive at the hospital by ambulance, you will usually be able to receive treatment immediately . Every second counts during a heart attack.
• A heart attack can cause your heart to beat irregularly or stop completely. Either of these can cause you to faint. If that happens while you're in an ambulance, first responders can immediately intervene and stabilize you. Also, you don't have to worry about fainting while driving and causing a catastrophic accident to yourself or others.

A blocked artery requires immediate treatment to prevent permanent damage to the heart. If your symptoms are not severe, you may think you are not having a heart attack. But symptoms can be mild, so it is best to get checked out by a doctor. Calling 911 or an emergency service instead of going to the hospital alone or with someone else can be more lifesaving than you think. Saving time means saving heart muscle, which means you are more likely to have a good outcome.

What questions should I ask the doctor?

Some questions you can ask your doctor are:

• What are the safe activities for me to do after a heart attack?
• What are the most important things I can do to prevent another heart attack?
• How often should I come see you?
• Should other members of my family also have heart tests?

Summary (Take-Home Message)

Although a heart attack is a very serious event, it is important to be aware of it, take action as soon as symptoms appear, and get proper treatment. Also, by identifying risk factors and living a healthy lifestyle, you can greatly reduce the risk of having a heart attack.

Remember, if you or someone you know has symptoms of a heart attack, call 1990 without delay. It could save a life!

Take care of your heart health. Because a healthy heart is the key to a healthy life!

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