What is a heart attack (Myocardial infarction) ?
Heart attack is the death of a portion of the heart muscle by interruption of its blood supply through the coronary arteries. In the Netherlands in 2012, an estimated 39,000 people deceased from cardiovascular disease, of whom 10,000 in "ischemic heart disease". These are heart complaints caused by insufficient blood supply to the heart muscle, caused by a narrowing or occlusion of one or more coronary arteries. As a collective name of myocardial infarction and unstable angina is sometimes referred to as acute coronary syndrome. A heart attack can cause heart failure, mortality or life-threatening arrhythmias. A heart attack occurs almost always due to the formation at the site of an atherosclerotic plaque in a coronary artery a blood clot or a blood clot so that the supply of blood, which had been previously lower, now suddenly is cut off completely. Rare causes a closure of a coronary artery and thus be a myocardial infarction: a dissection of the wall of the coronary artery, embolization of a clot (thrombus) or from the left ventricle of a coronary artery vasculitis. Research from the University of Groningen found that heart attacks 30% more common in the morning than on the basis of accidents can be expected. However, this study showed that heart attack in the morning is often smaller than when it 'occurs at night. The patient feels in typical cases a heavy, crushing pain middle behind the breastbone, sometimes radiating to the jaw or shoulders and arms, especially the left shoulder. This is often accompanied by sweating and pallor, and with nausea and vomiting.
Treatment of an acute heart attack
It is in an acute attack of interest as soon as possible to professional help so that the patient is transported to a hospital which can be eliminated by means of balloon angioplasty closure of the coronary artery. The faster is lifted, the closing of the coronary artery, the more the irreparable damage of the heart muscle can be limited. Opening of the coronary artery within 6 hours, still provides approximately 20-30% reduction in the size of the scar, within 2 hours the reduction is approximately 60%. Formerly a heart attack was handled by giving medication that could cause clots "solve"; This is called thrombolysis. Examples of these agents are streptokinase, reteplase, alteplase, urokinase. Several large international studies, however, have shown that a balloon angioplasty procedure is almost always more effective and safer, at least as long as a patient within one and a half hours of transport of a hospital is where dotter procedures are carried out. In some sparsely populated areas, for instance in America, thrombolysis can thus still be the best treatment. A bypass operation is carried out in severe cases of blockages in coronary arteries that can not be dealt with in a different way.
Possible complications of a heart attack
- Ventricular Fibrillation: A person with an acute heart attack that hit unconscious by a failure of the pumping function of the heart caused by an arrhythmia (ventricular fibrillation), when the bystanders respond quickly and appropriately give chest compressions and artificial respiration, several tens of minutes longer alive be held to the heart through defibrillation can be restarted. Defibrillators are present in every ambulance, and increasingly in places where many people gather, such as shopping centers, sports clubs, stations and of course in hospitals. More and more police cars have a defibrillator (also known as AED), which often can be faster than an ambulance present. If the circulation is not restored than death occurs after about 10 minutes, before (after ca 5 min), there is irreversible brain damage has occurred. From a Japanese study (2006) indicates that in the event of cardiac arrest after heart attack doubled survival if applied solely CPR. Ventilation would be a waste of time. Cardiac arrest by heart attack the person automatically receives extra oxygen through the hyperventilation which began the attack, but achieved by the stalled circulation this oxygen the brains anymore. If quick action is taken and only CPR is used, the breathing itself would again have to get going. Chest compression is in itself a minor, indirect form of ventilator because the chest cavity is alternately larger and smaller, according to Japanese scientists. When combined with choking or breathing would be more appropriate. The Dutch and European Resuscitation Council considers it likely that their conclusions would have been different if the guidelines after 2005 were involved in the investigation. Therefore continues breathing part of the directive.
- Heart failure - if the damage to the heart muscle is large, heart failure develops. This can lead to acute death in very serious damage, but also to chronic heart failure
- Valve disease - a rear wall infarction may lead to mitraliskleplekkage. The papillary avoid inverting or by blows' of the mitral or tricuspid valve respectively in the left atrium and right atrium. The posterior papillary muscle is attached to the rear wall of the heart. If those back no more contracts, the valve may partly by clapping in the bosom of leakage. In addition, widening of a poorly functioning left ventricle can also provide dilation of the mitral valve annulus, thereby also result in leaks.
- Dressler's syndrome - a great heart attack can lead to an inflammation of the pericardium surrounding the heart or pericardium, a (sterile) pericarditis. Besides pain and fever may also lead to fluid around the heart with the onset of a cardiac tamponade. It is often self-limiting, but may also be persistent, in which moisture and over again around the heart which is created by means of a puncture with a needle or by means of surgery must be removed. Proper treatment is not available, but anti-inflammatory drugs such as NSAIDs and prednisone are usually granted with any results.
Risk factors for a heart attack
Risk factors for accelerated development of arteriosclerosis or the occurrence of a heart attack are: male gender, advanced age, the incidence of ischemic heart disease and / or vascular disease in the immediate family (family, primary care), diabetes, high blood pressure, high cholesterol , smoking, alcohol abuse, insufficient physical activity / inactivity, unhealthy diet, overweight / obesity and physical or psychological stress.
Heart attack symptoms
A patient with a heart attack often suffers from an oppressive, suffocating or crushing chest pain, which may radiate to the jaw, arms or back. The pain is intense but fairly constant. In sharp stabbing is little chance that it is a heart attack. In a heart attack, keeps the pain usually long on at least five minutes or longer. Often there are so-called vegetative symptoms such as nausea and sweating. The symptoms may differ from person to person. In women and older patients, the symptoms may not be easy to recognize because they do not complain so much about the pain but about trouble, possibly with a light headedness. If you suspect a heart attack, 112 must be dialed to get an ambulance. In a heart attack, after all, every minute counts. The faster one is in the hospital in order to open the closed artery, the better. That opening is done nowadays mainly by angioplasty or a stent, but may in some cases also with powerful anti clotting medications. The sometimes deadly ritmestoornisssen which an infarct may be associated, mainly occur in the beginning of the infarction on. Also therefore the patient must as soon as possible to a monitor to be monitored.