Heart Attack

Heart attack is one of the leading causes of death in many parts of the world. In Singapore, heart attack is the number 2 killer after cancer.

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Heart attack occurs when blood flow to part of the heart is blocked causing poor supply of oxygen to the heart muscles.

Some people have chest pains when heart attack happens but some people have no symptoms at all. It is important to be aware of the risks of heart attack because most of them are preventable.

Heart attack occurs when the blood flow to the heart is critically reduced or completely blocked, causing the person to feel varying degrees of chest pain. If not treated promptly, the affected heart tissue dies.

Chest pain does not always mean a person is suffering from a heart attack. It can be a sign that there is a problem in another body system such as in the lungs or gastrointestinal tract.

Prior to a heart attack, most victims experience episodes of angina (chest pain) that, like a heart attack, is provoked by blockage of blood flow to the heart (ischemia). With angina, blood flow is quickly restored, pain recedes within minutes, and the heart is not permanently damaged.

However, a third of all heart attacks occur without warning signs. The victims suffer from sporadic interruptions of blood flow to the heart that, for unknown reasons, are pain free, although they gradually damage the heart tissue. This condition is known as silent ischemia and can be detected by an ECG (electrocardiogram).

​​​Related: Chest Pains​

Causes and risk factors

The most common cause of heart attack is atherosclerosis (narrowing of the artery due to build-up of cholesterol) of one or more arteries that supply the heart. The heart needs a steady supply of oxygen to function well. When there is disruption of the blood flow due to blockage or narrowing of the artery, oxygen supply to the heart is compromised. If the blood flow is not restored, the heart cells are injured and eventually die.

Risk factors of heart attacks include the following:

  • High blood pressure
  • High blood lipids especially LDL (Low Density Lipoprotein) cholesterol
  • Obesity
  • Diabetes
  • Too much stress
  • Inactive lifestyle
  • Tobacco smoking
  • Excessive alcohol consumption
  • Family history of heart attack
  • High levels of certain proteins in the body like C-reactive protein, fibrinogen and homocysteine.

In general, men have higher risk than women of heart attacks. However, women increase their risk of heart attack after menopause.

Related: Cartoid Artery Disease

​​​​

Signs and symptoms


  • Prolonged crushing, squeezing or burning pain in the center of the chest
  • Pain that radiates from the chest area to the neck, arms, shoulders or the jaw
  • Shortness of breath
  • Dizziness
  • Nausea
  • Chills and sweating
  • Weak pulse
  • Cold and clammy skin, gray pallor, a severe appearance of illness

Related: Heart Arrhythmias


Complications

Damage to the heart caused by heart attack leads to serious consequences like:

  • Heart failure
  • Abnormal heart beats which can be fatal
  • Weakening of heart muscles with the potential risk of heart rupture
  • Damage to the heart valves

Treatment

Nitroglycerin, Thrombolytic agents and Anticoagulants are used to treat heart attacks.

Nitroglycerin dilates the blood vessels to the heart. It is administered sublingually (under the tongue), and quickly reduces or relieves the chest pain.

Thrombolytics are given intravenously to dissolve the blood clot that is causing the heart attack.
Aspirin is an anticoagulant. If you feel chest pain and suspect that you are suffering a heart attack, take an aspirin even before you get to the hospital. The aspirin will "thin" the blood and reduce further clot formation. Heparin, another type of anticoagulant, is administered intravenously for a few days after a heart attack has occurred.

In addition to the medications, you may undergo surgery like ballooning or bypass to manage blockage of the arteries.

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