Before going into a detailed discussion on relevant aspects related to heart attack, it is essential to highlight the definition, location, function, importance, and other key issues concerning the heart lying in the human body.
The heart is a single organ but acts as a double pump. It carries oxygen-poor blood to the lungs when it unloads and then it picks up oxygen. The heart is a muscular organ that circulates blood. The heart lies at the heart of the blood circulation system and is located between the lungs and just behind and slightly left of the breast bone. The base of the heart lies along the body’s midline with the apex pointing toward the left side.
This is because the heart points to the left 2/3rd of the heart’s mass lies on the left side and the rest i/3rd lies on the right. In this connection, it needs to be asserted that the chest pain on the left side does not necessarily mean a heart problem. The size of the heart for the kids is the same as the fist and the weight is 250- 300 gm. And in the case of the adults, the size of the heart is about 2 times of the fist.
So far as the heartbeat is concerned, it is about 100000 times a day and 36.5 million times a year. During the average lifetime for Asian people (71.5 years), the heartbeat is 2.5 billion times.
The main function of the heart is to pump blood in the body through the network of arteries and veins called the cardiovascular system.
The heart has 4 chambers:
2 atria and 2 ventricles. The left atrium receives oxygen-rich blood from the lungs and pumps it into the left ventricle. The right atrium receives oxygen-poor blood from the body and pumps it into the right ventricle. The right ventricle pumps the oxygen-poor blood to the lungs.
Metaphorically, heart means the ‘chief’/ the ‘central point/ the dearest. (For instance, he lives in the heart, i.e. the central point of the town / she is my sweetheart i.e. the dearest / a hearty i.e. grand reception was accorded on him/he is a hearty i.e. kind and noble person, etc). All these common usages pertaining to the heart, rightly signify the indispensability of the heart to survive for humans.
A heart attack is the death of a segment of a heart muscle caused by the loss of blood supply. In contrast, heart failure occurs when the heart muscle does not pump blood.
And stroke is the death of a brain cell due to a lack of oxygen caused by the blockage of blood flow to the brain. On the other hand, heart disease includes all the conditions affecting the function and structures of the heart, such as heart attack / coronary artery disease (narrowing of the arteries) / arrhythmia (irregular heart rhythms) / heart failure/heart valve disease / congenital heart disease (it is the most common type of heart defect which starts at birth and is a problem related to the structure of the heart) / cardiomyopathy (heart muscle disease), etc.
Conclusively, most heart attack involves discomfort in the center of the chest that lasts for more than a few minutes or it may go away and return. It can feel like uncomfortable pressure. Left chest pain is often assumed to be a heart attack which may not be true. Again pain in the right chest should not be ignored at all
Heart attack and cardiac arrest are often mistakenly used as synonyms. In fact, they are different on the following grounds.
3.1) A heart attack is a circulation problem that occurs when blood flow to the heart is blocked. On the other hand with SCA (Sudden Cardiac Arrest), the heart malfunctions. It suddenly and unexpectedly stops beating.
3.2) A heart attack can cause a cardiac arrest in which death occurs as the heart suddenly stops working in the right way. This is caused by Arrhythmias (irregular heart rhythms). The most common Arrhythmias in cardiac arrest is Ventricular fibrillation (This is a condition when the heart’s lower chamber suddenly starts beating chaotically. And the heart does not pump blood. Death arrives within a few minutes after the heart stops)
However, cardiac arrest may be reversed if CPR (Cardio-pulmonary Resuscitation) is perfumed and a defibrillator (It is a treatment procedure that delivers a dose of electric current called counter shock) is used soon to shock the heart and restore a normal heart rhythm.
ACS (Acute Coronary Syndrome): It is a situation in which the blood supplied to the heart muscle is suddenly blocked.
The most common complications following damage to the heart in the wake of a heart attack are stated below:
It refers to the abnormal heart rhythm which may be placed into 3 categories
Arrhythmias can develop after a heart attack as a result of damage to the heart muscle. The damaged muscles disrupt electrical signals used by the body to control the heart. Some arrhythmias, such as tachycardia are mild and cause symptoms that include: palpitation (the sensation of heart racing in the chest or throat) / chest pain /dizziness (it is the momentary drop in blood pressure and blood flow to the head that occurs when one gets up from bed too quickly from a seated or a lying position) or lightheadedness (It is a common and typically an unpleasant sensation of dizziness and/or feeling that one may faint.
It can be short-lived, prolonged, or rarely occur. In addition to dizziness, the individual may feel as though the head is weightless) /fatigue(it is extreme tiredness resulting from mental or physical (exertion) /breathlessness (It may appear in different forms, such as difficulty in catching the breath, noisy breathing, very fast and shallow breathing, increase in pulse rate, wheezing, chest pain, skin that looks pale and slightly blue, especially around the mouth and cold clammy skin)
Other arrhythmias may be life-threatening
(These are: complete heart block- which is a condition where electrical signals are unable to travel from one side of the heart to the other so that the heart can’t pump blood properly / ventricular arrhythmias- which is a condition where the heart begins beating faster before going into spasm when it totally stops pumping known as sudden cardiac arrest)
Conclusively, all these life-threatening conditions relating to arrhythmias can be a major cause of death 24- 48 hours after a heart attack.
It is similar to heart failure but is more serious. It crops up when the heart muscle is damaged so extensively that it can no longer pump the blood needed to maintain most of the body's functions. Symptoms include mental confusion /cold hands and feet / reduced or nil urine output/rapid heartbeat /rapid breathing with difficulty/ pale skin.
Conclusively, once the initial symptoms of cardiogenic shock have strengthened the foothold, surgery may be needed to restore the functioning of the heart.
The patient will feel difficulty in catching breath/weakness/chest discomfort /palpitation/swelling of ankles, feet, and abdomen/ rapid weight gain.
It is a laceration of the ventricles of the heart.
Signs are mostly objective phenomena detected by the doctor through suitable test results, while symptoms are subjective phenomena observed and experienced by the patients. The diagnosis is identifying the root problem through applying various tests, observing symptoms as well as interrogating the patient about his feelings, lifestyle, notably food habits, and finally recording the genetic and personal history pertaining to the disease.
Some heart attacks are intense and arrive all of a sudden. But mostly, it comes slowly and with mild pain and discomfort. The major symptoms are stated as follows:
Other symptoms: Other possible symptoms include cold sweat (a state of sweating triggered by fear, anxiety, stress, or illness)/ lightheadedness /nausea (it is a feeling of sickness with an inclination to vomit).
The diagnostic tests may be broadly classified into :
Caution: The Holter Monitor must be taken off during bath or swimming, lest it should be wet and damaged.
In fact, causes are the agents directly responsible for the occurrence of the disease. In most cases, it is not clear what mainly causes the disease. Again, a risk factor is not necessarily a cause. A risk factor may be anything that increases the likelihood for a patient to develop the disease. (For instance, aging is a vital risk factor for any malignancy, but it cannot be a cause).
Veritably, the heart muscle needs oxygen to survive. A heart attack occurs when the blood flow (that brings oxygen to the heart muscle) is severely reduced or completely cut off. This happens because the coronary arteries (that maintain the uninterrupted blood flow to the heart muscle) get narrowed due to the build-up of fat and cholesterol (it is a waxy fat-like substance that is found in the cells within the body. The body needs cholesterol to make some hormones, vitamin- D, and other substances that help digest food. But excess of anything is bad. A high cholesterol level can trigger a heart attack) which together are called plaque. This blood clot blocks the blood flow running through the arteries to the heart muscle. In consequence, it leads to ischemia (It is an inadequate blood supply to an organ or a part of the body, especially in the heart muscle). The heart muscle is starved of oxygen and nutrients when a part of the heart becomes numb and damaged. The ultimate result is a heart attack.
Sometimes a coronary artery contracts or goes into spasm. When this happens the artery narrows and as a result, the blood flow to that part of the heart muscle declines or stops.
Another cause of heart attack is spasm (it is the sudden involuntary muscular contraction) which occurs in normally appearing blood vessels as well as in the vessels partly blocked by atherosclerosis (It is a disease of the arteries characterized by deposition of fatty materials on their inner walls). A severe spasm can cause a heart attack.
Another cause of heart attack is spontaneous coronary artery dissection due to spontaneous tearing of the coronary artery wall.
The risk factors that invite heart attack may be categorized under 2 broad heads:
Aging: As people move on the age path without any break, the more they become aged, the more likely they are to develop all malignant diseases including heart attack. As one ages, so do the blood vessels which become flexible and make it harder for blood to flow easily.
Advice: It is essential for the aged people to watch: when/where/what amount/ what foods and drinks they take on a regular basis. Because, if aging is paired with an unhealthy sedentary lifestyle (such as unhealthy and junk foods and drinks loaded with excessive amounts of sugar, salt, and unhealthy fats, in addition to physical inactivity as well as smoking and alcohol), then the risk of a heart attack becomes too high.
Gender: Males, in general, have a higher risk of heart attack, and additionally, they develop heart attack much earlier in life (as compared to females)
Heredity including race: Children of parents (having heart disease) are more likely to develop heart disease themselves in the course of time. Additionally, Africans/Americans/Hispanics (as compared to Caucasians) have a higher risk of heart attack (partly due to high blood pressure and partly due to obesity.
Advice: Since aging/gender/heredity can neither be changed nor controlled, it is well-advised to be cautious and exert control over only the modifiable risk factors.
22.214.171.124) High blood pressure: The normal blood pressure for a healthy person is 120/80 mm Hg (the top number indicates systolic and the bottom number indicates diastolic blood pressure). The higher the blood pressure, the higher the risk of a heart attack. High blood pressure raises the heart’s workload causing the heart muscle to thicken and get stiffer. The stiffening of the heart muscle ultimately causes the heart to function abnormally which increases the risk of heart attack (in addition to stroke and kidney failure)
126.96.36.199) High blood cholesterol: As blood cholesterol rises, so does the risk of a heart attack.
A high level of triglycerides combined with a high level of LDL and a low level of HDL cholesterol can trigger atherosclerosis which causes the build-up of fatty deposits inside the artery wall inviting the risk of a heart attack in addition to stroke.
188.8.131.52) Diabetes: It is a life-threatening disease that increases the risk of developing cardiovascular diseases including heart attack.
The normal blood glucose for a non-diabetic adult is 3.33- 6.11 mm ol/L (fasting). The glucose level for a non-diabetic adult (not fasting) is below 8.8 mm ol/L.
Blood glucose is the body’s main source of energy. But blood glucose can only enter cells provided there is insulin in the bloodstream. Without insulin, the cells would starve, After we eat, blood sugar concentration rises
Before discussing the harmful effects of obesity in inviting the risk of heart attack, it seems essential to highlight the relevant concept of ideal and healthy weight (in contrast to unhealthy weight which includes: obesity/ overweight /underweight).
Ideally, weight is measured by BMI (Body Mass Index = W/H2. Where: W = weight in kg and H2 = squire of height in meters). Taking an instance of height (1.7 meters), the related BMI for different body weights is:
In the case of the obese, people have excessive body fat – especially, at the waist. They are more likely to develop heart disease including heart attack and stroke. Even if other risk factors are totally absent, a single risk factor like obesity is strong enough to invite a traumatic heart attack
A healthy diet means a healthy life. Similarly, an unhealthy diet (in utter disregard of aging and other health problems) if taken regularly and indiscriminately, will simply invite other controllable risk factors (such as High blood pressure/ bad cholesterol of high amount/diabetes/ obesity, etc).
A sedentary inactive life will seriously activate the risk factors for heart attack. Regular moderate physical activity helps to reduce the risks of cardiovascular diseases including heart attack.
Stress is a major risk factor for heart attack. People under stress, are normally found addicted to smoking and alcohol. (or they may smoke and drink more than before when they were free from stress and anxiety).
Addiction to alcohol is a great risk factor for any malignancy and for any age. Additionally, this expensive bad habit has no social and religious recognition.
Therefore smoking is the gateway for most of the malignancies to enter mightily. Smoking invites early death At least 1 person dies every 10 seconds somewhere in the world only due to smoking-related diseases including heart attack (source: the World Health Organization, 2010).
The following treatment procedures are applied to bring heart attacks under control.
Heart attack treatment includes a variety of drugs. The doctor will recommend the best combination of heart attack medicines depending on age/specific health problems and other conditions.
Conclusively, high blood pressure is injurious to heart health.
Heart attack/ patients treated with stents in their coronary arteries/patients who undergo CABG (Coronary Artery Bypass Graft) surgery are treated at the same time with 2 types of antiplatelet agents to prevent blood clotting.
One antiplatelet agent is aspirin. Almost everyone with coronary artery disease (including those who have had a heart attack/ stent/CABG) is treated with this aspirin throughout the rest of their lives. In addition to aspirin, the 2nd type of anti-platelet agent (P2Y12 inhibitor) is usually prescribed for months or years.
There are 3 P2Y12 inhibitors that doctors prescribe. These are: Clopidogrel /Presugrel /Ticagrelor. Studies show that the 2 drugs (Prasugrel /Ticagrelor) are stronger than Clopidogrel and are considered a bit better in reducing the complication of blood clots.
The patient who has been hit by the 1st heart attack should always remain alert to prevent the 2nd attack. As such, of the 2 Hs (Home and Hospital), the home should always be well equipped with emergency treatment facilities, notably, with emergency medicine under the advice of a specialist. Research studies show that most heart attacks in general hit in the morning hours (4 AM- 10 AM). And the sufferer is most likely to stay at home during this time. The emergency need at home during the time will be to chew or swallow an aspirin (unless one has an allergy, or has been advised by the doctor never to take it)
Conclusively, aspirin reduces blood clotting and helps monitor blood flow through the narrowed arteries.
10.1) Heart attack is a frightening and terrible experience for those who have survived the 1st attack and it should be 1st priority for them not to wait for the 2nd. After treatment, the patient is likely to receive advice and instructions from the doctor pertaining to lifestyle in general and food habits in particular. All the “DO’s and Don’ts” as prescribed by the specialist should be meticulously followed in order to escape the 2nd attack which might be more dangerous and life-threatening.
10.2.) Although aging is a great risk factor for heart attack, it may arrive at any time without warning signs (common symptoms). Research studies show that multiple risk factors arrive after age 40. In some cases, it may arrive much earlier. Veritably, a young age with a young mind and youthful happy moments, cannot be a guarantee against a heart attack which sometimes arrives suddenly and mightily. Therefore, people having major risk factors (notably, heredity paired with obesity), should regularly consult physicians along with diagnostic test results (even if no symptom is apparently experienced by them).
Conclusively, the “Wait and see approach” invites only time killing that may kill the waiter.
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