NIH - Heart Attack "A heart attack occurs when the supply of blood and oxygen to an area of heart muscle is blocked, usually by a clot in a coronary artery. ...Prompt treatment of a heart attack can help prevent or limit lasting damage to the heart and can prevent sudden death. ...The sooner treatment begins, the better your chances of recovering."

NIH - Heart attack (Medical Encyclopedia) “Causes: Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. If the blood flow is blocked, the heart starves for oxygen and heart cells die. A clot most often forms in a coronary artery that has become narrow because of the build-up of a substance called plaque along the artery walls. (See: atherosclerosis) Sometimes, the plaque cracks and triggers a blood clot to form. Occasionally, sudden overwhelming stress can trigger a heart attack. ... Risk factors for heart attack and coronary artery disease include: • Bad genes (hereditary factors) • Being male • Diabetes • Getting older • High blood pressure • Smoking • Too much fat in your diet • Unhealthy cholesterol levels, especially high LDL ("bad") cholesterol and low HDL ("good") cholesterol Higher-than-normal levels of homocysteine, C-reactive protein, and fibrinogen may also increase your risk for a heart attack. Homocysteine is an amino acid. C-reactive protein and fibrinogen are linked to inflammation. Fibrinogen is also involved in blood clotting. Symptoms: Chest pain is a major symptom of heart attack. However, some people may have little or no chest pain, especially the elderly and those with diabetes. This is called a silent heart attack. The pain may be felt in only one part of the body or move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or back. The pain can be severe or mild. It can feel like: • Squeezing or heavy pressure • A tight band around the chest • Something heavy sitting on your chest • Bad indigestion Pain usually lasts longer than 20 minutes. Rest and a medicine called nitroglycerine do not completely relieve the pain of a heart attack. Other symptoms of a heart attack include: • Shortness of breath • Nausea or vomiting • Anxiety • Cough • Fainting • Lightheadedness - dizziness • Palpitations (feeling like your heart is beating too fast) • Sweating, which may be extreme “

NIH - Heart Attack

NIH - Heart Attack InteractiveTutorial(Patient Education Institute)

NHS – Heart attack (includes video) “Some people do not feel any pain during a heart attack. This is known as a 'silent' heart attack and tends to affect people with diabetes, or those who are over 75 years of age. Some evidence suggests that up to 20% of mild heart attacks go undiagnosed. This means that some people, because of previous undiagnosed attacks, may be suffering progressive damage to the heart muscle. ... Diagnosing a heart attack: If you are having a suspected heart attack, you will usually be taken to hospital so that tests can be carried out to confirm the diagnosis. Some of these tests are outlined below. Electrocardiograph (ECG) An electrocardiograph (ECG) helps to trace the electrical activity of the heart. Every time your heart beats, it produces tiny electrical signals. An ECG machine records these signals on to paper, allowing your doctor to see how well your heart is functioning. An ECG can detect damage to your heart muscle, or problems with your heart rhythm. It can also show if you have had a heart attack, either recently, or some time ago. The test takes about five minutes and is painless. During the test, electrodes (flat metal discs) are attached to your arms, legs, and chest. Wires from the electrodes are connected to the ECG machine, which records the electrical impulses. Cardiac enzyme tests When your heart has been damaged by a heart attack, it causes certain enzymes to slowly leak into your blood. Enzymes are special proteins which help regulate the chemical reactions that take place in your body. If you have had a suspected heart attack, a sample of your blood will be taken so that it can be tested for these heart enzymes. Your enzyme levels will be measured through a series of blood samples taken over a few days. A chest X-ray may also be taken to look for any enlargement (swelling) of your heart.”

Highlighted Articles

More compressions, fewer interruptions lead to higher cardiac arrest survival (2009) “Study highlights: • Survival rates for sudden cardiac arrest patients increased when professional rescuers focused on minimizing interruptions to chest compressions during CPR. • Compression rate was increased to 50 compressions followed by two breaths. • Rescuers delayed other interventions, such as intubation and IVs, until enough compressions had been given."

Hospitals Slow in Heart Cases, Research Finds (2008)"Delays were more likely in patients whose hearts stopped at night or on the weekend, who were admitted for noncardiac illnesses, in hospitals with fewer than 250 beds and in units without heart monitors."

Hospitals slow to defibrillate heart patients (2008) "Just because you're in the hospital doesn't mean you'll quickly get treated if your heart stops beating. About one-third of patients don't get a potentially live-saving shock within the recommended two minutes, a new study found. Those who don't get prompt defibrillation are more likely to die or end up brain damaged or disabled, the study showed. For every minute of delay, the chances of survival worsens, researchers reported in Thursday's New England Journal of Medicine. "It is probably fair to say that most patients assume - unfortunately, incorrectly - that a hospital would be the best place to survive a cardiac arrest ." "

What initial dose of aspirin is right for STEMI patients? (2008)"An initial dose of 162-mg aspirin may be as effective as and perhaps safer than 325 mg for the acute treatment of ST-elevation MI (STEMI), a new study suggests [1]."

Brief, High Doses Of Folate -- B Vitamin -- Blunt Damage From Heart Attack

High-Dose Folic Acid Pretreatment Blunts Cardiac Dysfunction During Ischemia Coupled to Maintenance of High-Energy Phosphates and Reduces Postreperfusion Injury (Circulation 2008) "Background-The B vitamin folic acid (FA) is important to mitochondrial protein and nucleic acid synthesis, is an antioxidant, and enhances nitric oxide synthase activity. Here, we tested whether FA reduces myocardial ischemic dysfunction and postreperfusion injury. . Conclusions-FA pretreatment blunts myocardial dysfunction during ischemia and ameliorates postreperfusion injury. This is coupled to preservation of high-energy phosphates, reducing subsequent reactive oxygen species generation, eNOS-uncoupling, and postreperfusion cell death."

Eating your greens could prove life-saving if a heart attack strikes (2007) "A diet rich in leafy vegetables may minimize the tissue damage caused by heart attacks, according to researchers at the Albert Einstein College of Medicine of Yeshiva University. Their findings, published in the November 12 Proceedings of the National Academy of Sciences, suggest that the chemical nitrite, found in many vegetables, could be the secret ingredient in the heart-healthy Mediterranean diet. … Researchers now have good evidence that hearts undergoing heart attacks have a “backup” pathway for making nitric oxide. Triggered by falling oxygen levels, enzymes in heart muscle convert nitrite stored there into nitric acid that can then help minimize tissue damage. Nitrite in the diet comes mainly from vegetables—celery, beets, and spinach, lettuce and other leafy types. Once consumed, nitrite exits the bloodstream and then accumulates and become stored in organs such as the heart, kidney and brain. … Dr. Lefer says that the nitrite levels found cardioprotective in his study can easily be achieved by consuming more vegetables containing the chemical. That dietary change, he says, might be especially helpful for people at increased heart-attack risk—those who’ve already suffered a heart attack, have been diagnosed with cardiovascular disease or have a family history of it."

[Complications of an unrecognized myocardial infarction] (Ned Tijdschr Geneeskd. 2005)"Around one-third of patients who have a myocardial infarction do not have chest pain but experience shortness of breath, autonomic nervous symptoms (sweating, nausea, vomiting), extreme and inexplicable tiredness and fainting. These atypical symptoms should suggest myocardial infarction. In order to avoid high morbidity and death from complications such as arrhythmias, heart failure, rupture and aneurysm formation it is important that a patient who has had a myocardial infarction should be treated as soon as possible ... "