R Ecognition Of Heart Attack Dr.Shahi

Heart Attack ! What you need to know Madhukar Shahi MD DM DNB Consultant Invasive & Interventional Cardiology Artemis Health Institute , Gurgaon

Basics

Heart : The most hard-working muscle of our body – pumps 4-5 litres of blood every minute during rest

Supplies nutrients and oxygen rich blood to all body parts, including itself

Coronary arteries surrounding the heart keep it nourished with blood

What Causes a Heart Attack?

“ Plaque” build up under the vessel lining

“ Vessel lining” prevents blood from clotting and allows blood to keep flowing

Usually, a heart attack is caused when a plaque abruptly cracks or ruptures and erodes/denudes the “ vessel lining”.

A blood clot may then rapidly form over the disrupted plaque. This clot can completely clog the coronary artery

What happens when the artery blocks off?

When a blood clot suddenly cuts off most or all blood supply to the heart, a heart attack results.

The portion of the heart's muscle (myocardium) that is deprived of oxygen will be permanently destroyed.

The more time that passes without treatment to restore blood flow, the greater the damage to the heart.

What happens to the heart muscle?

The heart muscle affected doesn't die all at once; rather a heart attack is a continuous process that may last from four to six hours or even 12 hrs

As time passes, without an intervention to improve blood flow, more heart muscle is deprived of oxygen and dies.

Although a part of your heart has died, the rest of your heart continues to work and pump blood throughout your body

THE ROAD TO A HEART ATTACK Artery Lining Muscle Layer Blood Vessel Interior Increased Plaque Beginning Plaque Blood Clot Complete Blockage

Why do Heart Attacks occur suddenly ?

A heart attack occurs suddenly without much warning.

But the coronary artery disease, the underlying cause for the heart attack, had been brewing for many years.

So, what happened to cause the sudden heart attack?

We don’t need tightly narrowed arteries to cause heart attacks!

Research has shown that most heart attacks are caused by rupture of the plaque, and that small plaques are often responsible.

It is not important how big the plaque is. What matters, at least for proneness to precipitate heart attacks, is how the plaque is built (“vulnerable plaque”)

What do we mean by vulnerable plaques?

If the top covering on the plaque is thick and the core is small, dry, and hard, the plaque is "stable" and is unlikely to rupture. Big plaques are often stable.

If the top covering of the plaque is thin and if the core is filled with soft, fatty material, the plaque is "unstable" and can rupture or break. Moderate sized plaques are often “vulnerable”

Most Heart Attacks Are Caused by non-critical blockages

Pooled data from 4 studies: Ambrose et al, 1988; Little et al, 1988; Nobuyoshi et al, 1991; and Giroud et al, 1992. (Adapted from Falk et al.)

Falk E et al, Circulation , 1995.

Symptoms of a heart attack!

Primary symptom is a consistent deep, often severe, pain in the chest that can spread to the left arm, neck, jaw, or the area between the shoulder blades.

The pain may be present from 15-20 mins up to twelve hours.

Many people describe it as a heavy, substernal pressure that makes it feel as if the chest is being squeezed.

Heart Attack Discomfort Areas

Crushing pain in your chest that may spread to your left shoulder

Chest pain that may spread to your neck, jaws, and/or down your back

Deep, dull pain or a tight, heavy, or squeezing sensation beneath your breastbone

The pain may be just in your arms

It may be in your jaw It may be in your back

Other associated symptoms

Dizziness, fainting, sweating, nausea, shortness of breath, or weakness

None of these symptoms assures that a heart attack is in progress, but the more symptoms you have, the more likely it is a heart attack.

“ Silent” Heart Attack

Heart attacks can occur without any “classical” warning symptoms.

“ Atypical' symptoms = heartburn, nausea/ vomiting and / or loose motions, or sudden light-headedness / weakness/ loss of consciousness, sudden shortness of breath, intense cold sweating, intense headache etc

These are more common in women, diabetics, and people older than 65.

What would you do?

Recite the Hanuman chalisa?

Try Baba Ramdev’s yogic exercises?

Phone a friend?

Take an antacid and hope like hell it goes away?

Call 6767000?

Typical Scenario for Response to Heart Attack Symptoms Friend Family Health Care Provider Stranger Coworker Patient Experiences Symptoms of Heart Attack Does Not Know Cause of Symptoms Calls ER Drives to Hospital Ignores Symptoms Self- Medicates Consults Others Knows cause of symptoms

Heart Attack – The Problem

Each year, more than a million Indians suffer a heart attack.

About 40% of those heart attacks are fatal

About half of those deaths occur within 1 hour of the start of symptoms and before the person reaches the hospital.

Why the need to recognise heart attack symptoms early

The first hour of a heart attack is known as the "golden hour.”

If you get help during that first hour, your chances of recovery are greatly improved.

TIME IS MUSCLE

MUSCLE IS HEART FUNCTION

HEART FUNCTION IS LIFE

What to do?

Stop whatever you're doing and sit down or lie down

If you have chest pain that lasts longer than 2 mins and is not relieved by rest , take a tablet of nitroglycerine.

If after 5 mins of nitroglycerine, discomfort persists , get immediate medical attention – CALL 6767000.

Immediately after you call for medical help, chew and swallow an aspirin and drink a glass of water. (Don't take aspirin if you are allergic to aspirin.)

What Should You Do If You Suspect You Are Having A Heart Attack

If you suffer from stable angina, you can take upto 3 tablets of nitroglycerine at 5 min intervals, only if symptoms are markedly improved with first dose. If residual symptoms persist, call 6767000

If you do not have nitroglycerine and have had symptoms for two minutes or more, call 6767000 immediately. Then take an aspirin unless you are allergic to aspirin.