HEART ATTACK THREAT: TYPES, CAUSES, SYMPTOMS AND TREATMENTS - MEDICINE - 2024

A suspected heart attack is a tightness in the chest and sudden pain in the heart area. It is a paroxysmal pain that occurs behind the breastbone, which is considered a symptom and not a disease. Symptoms usually start suddenly and usually last seconds to minutes.

When the heart muscle does not have a sufficient supply of oxygenated blood or the heart demands more oxygen due to an increase in work or intense physical activity, an imbalance occurs which can lead to a suspected heart attack. The reason for this is mainly a hardening of the arteries (atherosclerosis).

It is estimated that approximately 9.8 million Americans suffer from this condition annually, with 500,000 new cases occurring each year.

Types of suspected heart attack

There are three types of suspected heart attack or angina pectoris: stable, unstable and variant (Prinzmetal).

Stable

It lasts a few minutes and is triggered by physical or emotional stress. Sometimes even for a very cold or very large meal. The pain can radiate to the neck, jaw, teeth, shoulders, and arms. After resting a little, the pain usually disappears.

Unstable

This does not disappear with rest, indeed, it can occur even if you are calm or at rest. This attack is stronger and lasts longer. The risk of heart attack in patients with unstable angina is 20 percent, so an emergency doctor should be called immediately.

Princemetal or variant angina

He is a rare type. The pain occurs at rest as well as during sleep. The spasm occurs in the coronary artery, which is why doctors speak of a coronary vasospasm.

Causes and influencing factors

Coronary heart disease is the most common cause of reduced blood flow to the heart. This disease is the accumulation of fatty deposits inside the coronary arteries, causing them to narrow and restrict the amount of blood that flows to the heart muscle.

Certain risk factors make it more likely that you will develop coronary heart disease and have a heart attack. Some of these risk factors can be controlled.

Risk factors that can be controlled

The main risk factors that can be controlled are:

• Smoke
• High blood pressure
• High cholesterol in the blood
• An unhealthy diet (high in trans fat, saturated fat, cholesterol, and sodium)
• Overweight and obesity
• Lack of physical activity in the daily routine
• High blood sugar due to insulin resistance or diabetes

Some of these risk factors, such as hypertension, obesity, and high blood sugar, tend to occur together, which is known as metabolic syndrome. Generally, a person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes.

Risk factors that cannot be controlled

Risk factors that cannot be controlled include:

• Family history: if the father or a brother was diagnosed with this heart disease before turning 55 years of age the risk increases. Also if the mother or sister was diagnosed before 65 years of age with heart disease.

• Age: The risk of heart disease increases for men after age 45 and for women after age 55 (or after menopause).

• Preeclampsia: This condition can develop during pregnancy. The two main signs of pre-eclampsia are increased blood pressure and excess protein in the urine. Preeclampsia is linked to an increased risk of heart disease throughout life, including coronary heart disease, heart attack, heart failure, and high blood pressure.

Symptoms

Symptoms basically manifest as pain, burning, and a feeling of pressure or tightness behind the breastbone.

The pain often radiates to other areas of the body, such as the neck, throat, jaw, teeth, arms, or the upper abdomen. Also, pain between the shoulder blades can occur.

A feeling of heaviness and numbness is often described in the arm, shoulder, elbow or hand, and especially the left part of the body is affected.

In addition, symptoms such as sudden shortness of breath, nausea, vomiting, sweating, and a feeling of choking may appear.

In women, symptoms such as fatigue, shortness of breath, and an upset stomach are more common. The pain in the chest on the other hand is uncharacteristic.

The threat of heart attack or angina pectoris has a special characteristic in diabetics, because due to nerve damage related to diabetes (diabetic neuropathy), they often do not feel any pain. Therefore, it can occur silently, with almost no pain, or with little pain.

Diagnosis

Diagnostic studies that can be used are:

• Chest X-ray: Usually normal in angina pectoris, but certain precautions should be taken based on the patient's history.
• Graduated stress test: it is the most used test for the evaluation of patients with chest pain and can be performed alone or in combination with an echocardiography or a myocardial perfusion scan.
• Other tests that may be helpful include: ECG (including exercise with ECG monitoring and ambulatory ECG monitoring), selective coronary angiography (a definitive diagnostic test to assess the anatomical extent and severity of CAD), among others.

Treatment

General measures include smoking cessation as well as treatment of risk factors (eg, hypertension, high cholesterol, diabetes mellitus, obesity, hyperlipidemia).

Other drug therapies that may be considered include: aspirin, clopidogrel, hormone replacement therapy, sublingual nitroglycerin, beta blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, autologous cell injections, revascularization, among others.

Other procedures that may be considered are: intra-aortic balloon counterpulsation, enhanced external counterpulsation (in patients whose angina is refractory to medical therapy and who are not suitable candidates for percutaneous or surgical revascularization), transmyocardial laser revascularization (experimental), among others.

References

1. O'Toole (2013). Angina - causes, symptoms, treatment. Medical Library. Recovered from: southerncross.co.nz.
2. Gary H. Gibbons (2013). Risk for a Heart Attack. Department of Health and Human Services. Recovered from: nhlbi.nih.gov.
3. Jamshid Alaeddini (2016). Angina Pectoris. MedScape. Recovered from: emedicine.medscape.com.
4. Look at Seidel (2016). Angina pectoris Symptome. NetDoktor. Recovered from: netdoktor.de.
5. Heart Foundation (2013). Managing your angina. Heart Foundation of New Zealand. Recovered from: southerncross.co.nz.