Heart Attack

The medical term is Myocardial Infarction (M.I.).  Heart muscle dies if its circulation (the coronary arteries) is cut off for too long (“myocardium” = heart muscle; “infarction” = muscle death, in medical-speak).  If a lot of muscle dies, so do you.  Death can also occur in a small heart attack with electrical short circuit (“ventricular fibrillation”), which stops the heart from pumping (cardiac arrest); in this case, defibrillation (shocking) saves lives without a doubt. 

We suspect a heart attack by a combination of symptoms and risks:

1. Symptoms of heart attack

  • Heavy chest pain (or pressure, ache, discomfort, etc.), not “sharp,” and not one that gets worse with each breath.  It’s felt in mid- or left-chest, rarely on the right, and sometimes in confusing places (see right below **)
  • Pain gets worse with exertion, eases with rest.
  • May be accompanied by shortness of breath, nausea or vomiting, cold sweats on the forehead, and/or lightheadedness

**  If the pain from a heart attack is felt in the left shoulder or upper arm, patients may think they pulled a muscle.  If felt in the left jaw, they may think it’s a toothache, & a dentist may make the diagnosis.  In the early 1980s, when all we had for ulcers were liquid antacids, a brilliant young internist friend confided his greatest fear — a patient returns to the ER “DOA [‘dead on arrival’], with Maalox on his mouth.”  He explained, “It happened to others in my class, but never to me.”  So pain was felt in the stomach, doctors diagnosed “indigestion” & missed “heart attack.”

2. Risk Factors for Coronary Artery Disease (major ones)

  • Age: Men >35-40; Women after menopause
  • High Blood Pressure (Hypertension)
  • Smoking (or less than 3 years since quitting)
  • Diabetes
  • High Cholesterol (Hyperlipidemia)
  • Family History of Heart Attack (at near the same age as patient)
  • Same-day Stimulant Use (cocaine, meth, etc.)

Diagnosisย  —ย  An electrocardiogram (EKG) can identify a heart attack.ย  But sometimes the EKG is uncertain, and sometimes even normal!ย  [The “K” in the abbreviation is from the German word; sometimes it’s called “ECG” in English, but not often].ย  The EKG can often identify an old M.I.ย  Frequent EKGs during a heart attack can show typical changes and progression.ย 

Definite diagnosis is made by blood tests.ย  Troponin is an enzyme in cardiac muscle.ย  If levels rise, it means heart muscle has been damaged (there are other cardiac enzymes also).

Treatment can restore circulation and save heart muscle, if performed with 2-3 hours.ย  The best treatment is done at specialized hospitals, by cardiac catheterization (“Cath” for short), threading a tiny catheter (tube) into the coronary artery to relieve the obstruction (angioplasty, with stents).ย  At regular ERs, they can inject I.V. medicine (“clot-busters”) to try to do the same thing.

Once it’s been too long to bring back circulation, treatment consists of preventing another heart attack.  This means not smoking, and a combination of medicine, diet, and exercise to control blood pressure, cholesterol, and diabetes.

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