A heart attack, or myocardial infarction, occurs when a portion of the heart muscle is damaged or dies due to insufficient blood flow. This serious condition typically arises when a blood clot blocks an artery supplying the heart. The heart muscle requires a constant supply of oxygen-rich blood, and a prolonged interruption can lead to permanent injury. A heart attack is an urgent medical emergency requiring immediate intervention.
Recognizing a Heart Attack and Immediate Steps
Recognizing heart attack symptoms and acting swiftly is crucial. Classic symptoms include chest pain (pressure, squeezing, or heaviness) that can radiate to the left arm, jaw, neck, back, or abdomen. Shortness of breath, sweating, nausea, and lightheadedness are also common indicators. Women may experience less obvious symptoms like unusual fatigue, nausea, or pain in the back, shoulder, neck, or jaw, sometimes without significant chest pain.
If a heart attack is suspected, calling emergency services (e.g., 911) is the most important action. This ensures rapid access to professional medical help, as ambulances provide immediate care and transport to a cardiac-specialized hospital. Prompt medical attention significantly reduces heart muscle damage.
Aspirin can help if the person is conscious, not allergic, and has no severe bleeding risk. Chewing a 300 mg aspirin tablet (or 81 mg baby aspirin) prevents further blood clotting, potentially reducing heart damage. Always call emergency services before administering aspirin. While waiting, remain calm, sit or lie down, and avoid physical exertion to minimize the heart’s workload.
Emergency Medical Interventions
Emergency medical technicians (EMTs) and paramedics initiate critical interventions before reaching the hospital. They conduct an initial assessment, checking vital signs and performing an electrocardiogram (ECG) to evaluate the heart’s electrical activity. This rapid assessment helps confirm a heart attack and guides immediate treatment.
Oxygen therapy may be administered to ensure the heart muscle receives adequate oxygen. Medications like nitroglycerin can widen coronary vessels and alleviate chest pain. Morphine may be used for severe pain relief and to reduce anxiety. These medications decrease the heart’s workload and improve blood flow.
Continuous ECG monitoring is maintained during transport to detect abnormal heart rhythms. If cardiac arrest occurs, paramedics perform CPR and use an automated external defibrillator (AED) to restore a normal heart rhythm. Swift transport to a hospital with cardiac facilities is paramount, as every minute saved can significantly impact recovery and the amount of heart muscle preserved.
Hospital-Based Treatments
Upon arrival at the hospital, confirming the heart attack diagnosis involves several tests. Blood tests are conducted to measure cardiac enzymes, particularly troponin, which is released into the bloodstream when heart muscle is damaged. Elevated troponin levels indicate heart injury, and repeated tests can show the extent of damage. An angiogram, a procedure where a thin tube (catheter) is guided to the heart and a contrast dye is injected, allows doctors to visualize the coronary arteries and pinpoint the exact location and severity of any blockages.
Primary Percutaneous Coronary Intervention (PCI), also known as angioplasty with stenting, is the preferred and most effective treatment for opening blocked coronary arteries during a heart attack. This minimally invasive procedure involves inserting a catheter, usually through an artery in the wrist or groin, and guiding it to the blocked vessel. A tiny balloon at the catheter’s tip is then inflated to compress the plaque and widen the artery, restoring blood flow.
Following angioplasty, a mesh tube called a stent is typically deployed to keep the artery open and prevent it from narrowing again. The time from a patient’s arrival at the emergency department to the opening of the blocked artery with a balloon, known as “door-to-balloon” time, is a critical factor, with guidelines recommending it be no more than 90 minutes for optimal outcomes.
If PCI is not immediately available, thrombolytic therapy, involving clot-busting medications, can be administered to dissolve the blood clot blocking the artery. These medications, often given intravenously, target fibrin, a protein that forms the structure of blood clots, thereby restoring blood flow. While effective, thrombolytics are generally less precise than PCI and carry a higher risk of bleeding complications.
Coronary Artery Bypass Graft (CABG) surgery is an alternative for more complex or severe blockages, particularly when multiple arteries are affected or PCI has not been successful. During CABG, a healthy blood vessel, often taken from the patient’s leg or chest, is surgically attached to create a new pathway (bypass) around the blocked section of the coronary artery. This reroutes blood flow, ensuring the heart muscle receives the necessary oxygen. This open-heart surgery is typically performed under general anesthesia, sometimes utilizing a heart-lung machine to maintain circulation while the heart is temporarily stopped.
Several medications are administered in the hospital after a heart attack to prevent further complications and support heart function. Antiplatelet drugs, such as aspirin and clopidogrel, are routinely prescribed to prevent new blood clots from forming. Beta-blockers help reduce heart rate and blood pressure, decreasing the heart’s workload.
ACE inhibitors or Angiotensin Receptor Blockers (ARBs) are often given to protect the heart muscle and improve its pumping ability. Statins are prescribed to lower cholesterol levels and stabilize plaque in the arteries, reducing the risk of future events. Following these intensive treatments, patients are closely monitored in specialized units like the intensive care unit (ICU) or cardiac care unit (CCU) for initial recovery and stabilization.