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Cardiovascular Diseases



A myocardial infarction, commonly referred to as a heart attack, occurs when blood vessels or arteries that supply blood to the heart become blocked, usually due to a build up of plaque or a blood clot. The decrease in blood supply and oxygen reaching the heart leads to death or permanent damage of heart muscle. If reduced blood supply to the heart is not restored within approximately 30 minutes after onset, death of heart muscle begins. If not treated immediately, the heart muscle will continue to die over approximately eight hours, at which time scar tissue forms. Heart attacks, more prevalent among men than women, are the leading cause of death worldwide.

The symptoms of a heart attack vary among individuals, but usually begin with sudden, severe crushing chest pain often described as a sensation of tightness or pressure. Chest pain or discomfort can radiate into the left arm, left neck and lower jaw. Symptoms, depending on severity, may include difficulty breathing or shortness of breath, nausea and vomiting, excessive sweating, general weakness and fatigue. Heart palpitations, or rapid heartbeats, may also be symptoms of an impending heart attack, especially when combined with chest pain, dizziness or anxiety. While the onset of a heart attack is usually gradual with symptoms manifesting over several minutes, it is essential that medical treatment be sought immediately, as loss of consciousness and death may occur. Approximately 90 percent of heart attacks are reported to be caused by atherosclerosis, a gradual process in which plaque or cholesterol deposits line the walls of major arteries leading to the heart. The narrowing of the inner channel of the arteries restricts blood flow to the heart. As the plaque continues to build and harden, the arterial walls become weak and eventually rupture, leading to blood clot formation.

Several risk factors have been linked to heart attacks, including family history and advancing age, neither of which can be avoided. Lifestyle risk factors include smoking, excessive alcohol use, drug abuse and obesity. Medical risk factors include diabetes mellitus, high blood pressure, chronic kidney or liver disease, acute infections such as pneumonia and prior cardiovascular events. Heart attack rates are reported to be more prevalent after intense physical exertion or exercise, and have been related to extreme psychological or emotional stress situations.

Upon admission to a hospital emergency department after a suspected heart attack, the first priority is stabilization of the patient, including the immediate restoration of oxygen supply to the heart. Intravenous lines will be placed for the administration of pain medications, heparin and anti-coagulant medications. Chest imaging studies will be performed to rule out other causes of the symptoms. Therapy rendered in critical care units is focused on limiting of the extent of the heart attack and preventing additional heart damage. Following an extensive physical examination, various diagnostic tools are utilized to confirm the diagnosis of myocardial infarction. An electrocardiogram (ECG) will be performed, usually followed by chest radiographic studies and routine laboratory blood studies. In determining the severity and extent of the myocardial infarction, an echocardiogram (ultrasound), CT and MRI scans and an angiogram may also be performed. An angiogram is a procedure during which a catheter is threaded into the ventricles of the heart to determine the origin and extent of the suspected blockage.

After a heart attack, long-term medication regimens have proven effective in preventing future occurrences. Anti-platelet therapy with aspirin or clopidogrel reduces the risk of arterial rupture due to plaque formation. Beta blocker therapy with atenolol, metapropol and propanol is beneficial to high risk patients. ACE inhibitor therapy, which should be commenced within approximately 48 hours following a heart attack, reduces the risk of heart failure. ACE inhibitor medications are manufactured under the generic names lisinopril, enalapril, ramipril, and include other combinations. Statin therapy medications, including lovastatin, simvastatin and rosuvastatin are proven effective in stabilizing the development of plaque and are safe for long term usage. Eplerenone and spironolactone can reduce the risk of cardiovascular death when used in conjunction with standard beta blocker and anti-platelet medication therapy.

Some types of heart attacks are treated with angioplasty, a minimally invasive surgical procedure performed to open blocked arteries or blood vessels that supply blood to the heart. The procedure involves the placement of a stent, which is a small mesh-type tube used to expand a coronary artery and prevents the artery from collapsing. Coronary artery bypass surgery, often referred to as open heart surgery, is performed if a diagnostic angiography reveals severe coronary artery disease in many blood vessels or a severe narrowing of the left main coronary artery. This procedure involves the removal of a vein or artery from another part of the body with good blood flow, usually the leg areas. The new, healthy vein or artery is then surgically placed in the heart to bypass the blocked or damaged coronary artery, creating a new outlet for blood flow into the heart. Coronary artery bypass surgery is usually indicated in patients when angioplasty procedures have failed.

Following a heart attack, lifestyle changes can help prevent future heart attacks. Smoking cessation, reduction in alcohol consumption, dietary changes and regular exercise are all crucial in rebuilding a healthy heart. In addition, long term medication therapy, including beta blockers, anti-platelet medication and ACE inhibitors are all effective in minimizing potential plaque build up, maintaining consistent blood pressure levels and reducing the development of future heart failure.

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