(Acute Myocardial Infarction [AMI]; Myocardial Infarction [MI]; ST-Segment-Elevation MI [STEMI]; Transmural Myocardial infarction)
A heart attack occurs when blood flow to the heart muscle is interrupted. Oxygen can't get to the heart muscle, causing tissue damage or tissue death.
A heart attack may be caused by:
- Thickening of the walls of the arteries feeding the heart muscle (coronary arteries)
- Accumulation of fatty plaques in the coronary arteries
- Narrowing of the coronary arteries
- Spasm of the coronary arteries
- Development of a blood clot in the coronary arteries
These factors increase your chance of developing heart attack. Tell your doctor if you have any of these:
Squeezing, heavy chest pain, especially with:
- Exercise or exertion
- Emotional stress
- Cold weather
- A large meal
- Pain in the left shoulder, left arm, or jaw
- Shortness of breath
- Sweating, clammy skin
- Loss of consciousness
- Anxiety]]> , especially feeling a sense of doom or panic without apparent reason
Unusual symptoms of heart attack (may occur more frequently in women):
- Stomach pain
- Back and shoulder pain
If you think you are having a heart attack, call 911 right away.
Tests may include:
- Blood tests—to look for certain enzymes found in the blood within hours or days after a heart attack
- Urine tests—to look for certain substances found in the urine within hours or days after a heart attack
- Electrocardiogram (EKG)]]> —records the heart's activity by measuring electrical currents through the heart muscle, changes can show if there is blockage or damage
- ]]>Echocardiogram]]> —uses high-frequency sound waves (ultrasound) to examine the size, shape, function, and motion of the heart
- ]]>Stress test]]> —records the heart's electrical activity under increased physical stress, usually done days or weeks after the heart attack
- Nuclear scanning—uses radioactive material to show areas of the heart muscle where there is diminished blood flow
- Electron-beam computed tomography (EBCT) —a type of x-ray that uses a computer to make detailed pictures of the heart, coronary arteries, and surrounding structures; may be helpful if you are at immediate risk of ]]>coronary artery disease]]>
- ]]>Coronary angiography]]> —uses dye and x-rays to look for narrowing or blockage in the coronary arteries
- Pain-relief medications (such as morphine)
- Nitrate medications
- Aspirin]]> and other antiplatelet agents
- ]]>Beta-blocking]]> and/or ACE inhibitor medications (frequently given)
- Anti-anxiety medications
Clot-dissolving agents (thrombolytics)—Within the first six hours after a heart attack, you may be given medications to break up blood clots in the coronary arteries.
- Other medicines that may be given include those that block the function of platelets (called platelet IIb/IIIa receptor blockers).
- ]]>Cholesterol-lowering medications]]> (eg, statin drugs)
If you have severe blockages, you may need surgery. Surgery includes:
- ]]>Coronary artery bypass grafting (CABG)]]>
- ]]>Balloon angioplasty]]> with or without stenting
According to a review, patients who received CABG had more ]]>angina]]> relief and less need for another, similar procedure. This is compared to those who received percutaneous coronary intervention (PCI). PCI involves techniques using balloon angioplasty or ]]>coronary stenting]]> .
Physical or Rehabilitative Therapy
During recovery , you may need physical or rehabilitative therapy to help you regain your strength.
Preventing or treating coronary artery disease may help prevent a heart attack.
- Maintain a healthy weight]]> .
- Begin a safe ]]>exercise program]]> . Follow your doctor's advice.
- If you smoke, ]]>quit]]> .
- Eat a ]]>healthful diet]]> . Your diet should be low in saturated fat and rich in whole grains, fruits, and vegetables.
- Treat ]]>high blood pressure]]> , ]]>diabetes and high cholestrol]]> .
- ]]>Manage stress]]> .
Ask your doctor about taking a small, daily dose of
- Although most people are able to tolerate such a low dose of aspirin, even this small amount can rarely lead to serious bleeding, particuarly from the gastrointestinal (GI) tract .
- Aspirin may not work as well when combined with other pain medications.
American Heart Association
Heart and Stroke Foundation
Heart Healthy Kit: Public Health Agency of Canada
Heart and Stroke Foundation
Heart attack. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/heart-attack/DS00094/DSECTION=8 . Updated 2007. Accessed June 29, 2008.
Meier MA, Al-Badr WH, Cooper JV, et al. The new definition of myocardial infarction: diagnostic and prognostic implications in patients with acute coronary syndromes. Arch Intern Med . 2002;162:1585-1589.
Mollet NR, Cademartiri F, van Mieghem CA, et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation . 2005;112:2318-2323. Epub 2005 Oct 3.
Rakel RE, Bope ET. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.
What is a heart attack? American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3007482 . Accessed June 29, 2008.
Women Physicians Congress. What you need to know about heart disease. American Medical Association website. Available at: http://www.ama-assn.org/ama/pub/category/11021.html . Updated 2008. Accessed June 29, 2008.
11/7/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Bravata DM, Gienger AL, McDonald KM, et al. Systematic Review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med. 2007 Nov 20. [Epub ahead of print]
7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Antithrombotic Trialists' (ATT) Collaboration, Baigent C, Blackwell L, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373:1849-1860.
Last reviewed September 2009 by ]]>David N. Smith, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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