Myocardial Infarction (Heart Attack)
- Diagnosis, Imaging, Screening
- General Information
- Guidelines
- Heart Attack Warning Signs
- Internet Sites
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- Risk Factors
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Heart Attack
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 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 ArticlesMore 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 ... "
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Myocardial Infarction (Heart Attack)
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Defibrillator Implantation Early after Myocardial Infarction. (N Engl J Med. 2009)
Late stenting not better days after heart attack "A new international study found that when doctors try to use stents to prop open a closed artery days after an untreated heart attack, patients do no better long-term than patients who simply received drugs and other nonsurgical treatment. In at least one out of three heart attacks, surgeons fail to reopen the blocked artery responsible right away, in part because many heart attack victims do not seek treatment for many hours or days, when heart muscle may already be damaged. "Our study specifically addresses the question of whether, with a complete blockage, there is any benefit, now that the dust has settled after the acute heart attack, to opening the artery anyhow," said Dr. Daniel Mark of the Duke University Medical Center in North Carolina, who led the study. "I think our comprehensive answer to that is the benefit is very small and it's not worth the extra cost of doing the procedure. . The findings show that "the heart muscle where that artery is blocked is pretty much dead, and it's not going to help it out by opening the artery," Mark said in a telephone interview. "The patients studied in OAT did not experience the full benefit of angioplasty and stenting because they received treatment after the heart was irreversibly damaged and no longer able to significantly benefit from the oxygenated blood flow that angioplasty provides," the Society for Cardiovascular Angiography and Interventions said in a statement. "This is a dangerous situation that can lead to heart failure." "
Drug Side-Effects and Interactions
Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data (The Lancet 2009) “The yearly incidence of bleeding was 2•6% for the aspirin group, 4•6% for clopidogrel, 4•3% for vitamin K antagonist, 3•7% for aspirin plus clopidogrel, 5•1% for aspirin plus vitamin K antagonist, 12•3% for clopidogrel plus vitamin K antagonist, and 12•0% for triple therapy. … Interpretation In patients with myocardial infarction, risk of hospital admission for bleeding increased with the number of antithrombotic drugs used. Treatment with triple therapy or dual therapy with clopidogrel plus vitamin K antagonist should be prescribed only after thorough individual risk assessment.”
Drugs
Exercise
General Information
Compress the Chest: Better CPR Improves Survival from Out-of-Hospital Cardiac Arrest ”Comment: The promising results of this large study suggest the AHA was on the right track with its renewed focus on basic CPR, including the importance of providing uninterrupted chest compressions.”
Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission (Circulation: Cardiovascular Quality and Outcomes 2009)
The role of potassium and magnesium in the treatment of acute myocardial infarction (Herz 2009) “In contrast, potassium substitution should be performed in the setting of acute myocardial infarction with documented hypokalemia (K+ <3.5 mmol/l) because of increased risk of ventricular arrhythmias. According to the documented results of the trials reviewed in this article no recommendations for the routine use of magnesium in myocardial infarction can be given.”
Chewable Aspirin Is Best for the Heart “Measurements of blood showed clearly that aspirin was absorbed fastest when administered in chewable form and swallowed. "This supports the recommendation to use chewable [aspirin] formulation in the treatment of ACS," the researchers say. ACS refers to "acute coronary syndrome," the general medical term meaning heart attack or sudden onset of angina. Current guidelines call for giving heart attack patients one aspirin tablet and for them to chew it to speed up its anti-blood-clotting properties. Aspirin works within 15 minutes to prevent the formation of blood clots in people with known coronary artery disease. One adult-strength aspirin contains 325 milligrams. The current study suggests that 325 milligrams of chewable aspirin would be preferred in the setting of a heart attack or sudden onset of angina (chest pain). However, aspirin should still be taken under these circumstances if the chewable form is unavailable. Aspirin use in patients with heart disease is common. People with known coronary disease often are told to take a "baby" aspirin (81 milligrams) daily to reduce their risk of heart attack of stroke.”
More compressions, fewer interruptions lead to higher cardiac arrest survival “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."
Coffee consumption and mortality after acute myocardial infarction: the Stockholm Heart Epidemiology Program. (Am Heart J. 2009)
Changes in management of elderly patients with myocardial infarction. (Eur Heart J. 2009)
Guidelines
Immunotherapy
Internet Sites
Treatment Information
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Mediterranean diet and inflammatory response in myocardial infarction survivors. (Int J Epidemiol. 2009) "CONCLUSIONS: Adherence to the traditional Mediterranean diet was associated with a reduction of the concentrations of inflammatory markers in MI survivors. This may, in part, explain the beneficial effects of this diet on various chronic diseases such as atherosclerosis and cancer, and expands its role to secondary prevention level."
Other
Other Treatments
Cooling Therapy For Cardiac Arrest Survivors Is As Cost-effective As Accepted Treatments
Experimental
Chocolate consumption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program. (J Intern Med. 2009) “CONCLUSIONS: Chocolate consumption was associated with lower cardiac mortality in a dose dependent manner in patients free of diabetes surviving their first AMI. Although our findings support increasing evidence that chocolate is a rich source of beneficial bioactive compounds, confirmation of this strong inverse relationship from other observational studies or large-scale, long-term, controlled randomized trials is needed.”
Radiotherapy
Supplements-Vitamins-CAM
n-3 polyunsaturated fatty acids are still underappreciated and underused post myocardial infarction. (Heart. 2009)
Surgery
Help for High-Risk Heart Attacks: Study Shows Angioplasty After Treatment With Clot-Busting Drugs Reduces Complications “Patients who have a heart attack and receive clot-busting drugs do better if they are transferred as soon as possible to a hospital that can perform angioplasty, a procedure to open blocked arteries, according to a new study. That treatment approach works better than giving clot-busting drugs and then waiting to see if the medications work, transferring them only if the clot-busting drugs fail, says Shaun Goodman, MD, study co-author and co-chair of the Canadian Heart Research Center, Toronto. Performing angioplasty right after a heart attack "is a great procedure, if it can be done," he says. But in the U.S. and Canada, as well as other locales, angioplasty capabilities aren't available on site at many hospitals. "In the U.S., less than 25% of acute care hospitals have on-site angioplasty," Goodman says. So Goodman's team wanted to see if the timing of angioplasty after clot-busting drugs might improve outcomes. The study is published in The New England Journal of Medicine. “
Why Females Do Not Fare As Well As Men In Undergoing Angioplasty For Heart Attacks “The studies found, when compared with their male counterparts, women undergoing angioplasty for heart attack are often older (by an average of nine years), in poorer condition (such as suffering from diabetes) and have a longer onset due to delayed recognition of symptoms by both patients and their caregivers. In addition, women are less likely to develop brisk blood flow through the treated artery after percutaneous coronary intervention (PCI). As a result, women face twice the likelihood of procedural failure and an increased risk of death, according to the studies.”
Patients Who Get Coronary Angiography After MI Are Twice as Likely to Survive
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