Why people get Heart Attack?

1. Heart attack is caused by sudden blockage in one of the arteries supplying blood to the heart muscles. The sudden blockage could be caused by one of the following mechanism:
1. In most patients, there is a deposition of fats /cholesterol and other substances (known as plaque formation) in the walls of the arteries causing and during acute heart attack part of the deposited material (plaque) is ruptured and cause acute blockage of the artery
2. In some cases, there is sudden formation of clots in the arteries by the Platelets and other material of your blood. This usually happens without any warning or prior angina. Common in female and smokers.

Risks for Heart Attack

1. Smokers
2. Diabetes
3. High blood pressure
4. High blood cholesterol or triglyceride levels
5. Unhealthy diet and Lack of exercise
6. Increasing age
7. Family history of heart problems
8. Stressful Life
9. Recreational Drugs like Cocaine (Rare)

Types of Heart Attack

There are two main types of heart attacks, depends on the types of blockages of your heart arteries:

1. ST-Elevation Myocardial infarction (STEMI):
1. In this type, you would have a complete blockage of your heart artery. (Usually one of the three major arteries).
2. The pain is usually severe and continues until treated
2. Non-ST Elevation Myocardial infarction (NSTEMI):
1. In this type, you would have a partial blockage of your heart artery. (Usually one of the three major arteries).
2. The pain is usually less severe and may start to ease without or without treatment.

How to Diagnosis & Treat Heart Attack (Emergency)

1. The Diagnostic steps and treatment might be different depending on the type of heart attack you are having (see types of heart attack)
2. It is important to diagnose heart attack as soon as possible as it may put your life at risk.
3. What to Do if You see someone might be having heart attack- Click Here

The Steps to Follow are:

1. Step 1: Call for ambulance or Go to the nearest Hospital

2. If you have the following symptoms:

1. Chest pain or chest discomfort may be mild or severe. ( usually on the left side of upper chest/left arm or neck/jaw)
2. May have Nausea, Shortness of breath, cold clammy and Sweating or Dizziness
3. Some people may describe it as the “ The worst pain of my life”.
4. Some people may have their heart stop immediately (sudden cardiac arrest)
3. Step 2: Doctor in hospital will do:
1. The doctor will take a detailed history of the symptoms of chest pains and do physical examination.
2. Do and Urgent ECG/EKG
3. Additional tests may be required (Bloods, Chest X-ray and/or Urgent Heart SCAN - Echocardiogram)
4. Step 3: Doctor Will Make diagnosis and decide for treatment

5. Once the doctor confirms the Heart attack, the aim is to:
   “Quickly restore the blood flow of the blocked artery in order to save the heart muscle from damage”
   
   The steps are as follows:

1. Will be attached heart monitor/ Blood pressure monitor and ECG/EKG.
2. You may be started on oxygen (Mask)
3. Aspirin will be given ( usually given by ambulance- team)
4. Pain relievers with morphine or other medications
5. Blood-thinning medications called heparin.
1. Heparin make your blood less "sticky" and stops clots formation.
2. Heparin is given intravenously or by an injection under your skin
6. Clot-preventing drugs: (Anti-platelet medications)
1. Medications such as clopidogrel (Plavix) OR prasugrel (Effient) OR ticagrelor (Brilinta), will be used in addition to Aspirin. (The type of medications depends on your hospital availability)

During Hospital Admission

The duration of total stay in hospital varies from 3 days to 1 week. This usually depends on the amount of damage your heart has sustained and your adjustments to various medications.

1. After the initial emergency treatment (as above), you will be admitted to coronary care unit or cardiology ward, where will you will be monitored closely and looked after specialized trained team of doctors and other medical staff.
2. You will undergo various investigations in hospital including:
1. Electrocardiogram (ECG or EKG)
2. Blood tests; including heart chemicals ( Troponin)
3. Echocardiogram

Medications

Your doctor will prescribe various medications based on your individual needs and your underlying other conditions and risk factors. These are as follows:

1. Aspirin
1. Prescribed as soon as your doctor diagnose you with angina.
2. Aspirin increases the blood flow through the narrowed heart arteries. In addition, reduces the ability of your blood to clot and reduce your risk of a heart attack.
2. Beta-blockers
1. Beta-blockers reduces the heartbeats and reduces blood pressure
2. Beta-blockers also help blood vessels relax and improve blood flow to heart muscle, thus reducing or preventing angina.
3. Nitrates
1. Nitrates relax and widen your blood vessels, which leads to increase blood to flow to your heart muscle
2. The doctor may prescribe for long-term and available in various doses
3. This can be used under your tongue in the form of spray or tablet.
4. Statins
1. Statins are drugs used to lower blood cholesterol, which helps in reabsorbing cholesterol that has accumulated in plaques in your artery walls.
5. Clot-preventing drugs
1. In addition to Aspirin you would be given, ONE of the additional blood thinning medications such as clopidogrel (Plavix) OR prasugrel (Effient) OR ticagrelor (Brilinta)
2. The duration of this additional medication varies from 6 months to 18 months ( depends on each patient)
6. Heart strengthening medications
1. Your doctor may prescribe angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in order to help relax your arteries and lowers the blood pressure
2. Other Medications: you may be need to be treated with medications if you suffers from diabetes, heart failure or chronic kidney disease

Life after Heart Attack

1. Diet and Life Style Changes:
1. If you had a heart attack, you must work on your lifestyle changes: these changes include:
1. Stop smoking and avoid exposure to passive smoking.
2. Regular Exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack. Walking 30 minutes a day, five days a week can improve your health. (discuss with your doctor about a safe exercise plan).
3. Eat a healthy diet with limited amounts of saturated fat; eat whole grains, and many fruits and vegetables.
4. Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol and stress.
5. Get regular medical check-ups.
6. Limit alcohol consumption to one to two drinks or fewer a day
7. Get an annual flu shot to avoid heart complications from the virus
2. Cardiac Rehabilitation
1. Very important program run by doctors and medical team to help you recover from your heart attack.
2. Cardiac rehabilitation programs generally focus on four main areas — medications, lifestyle changes, emotional issues and a gradual return to your normal activities.
3. The above changes will be tailored according to your individual needs and the amount of heart damage following your heart attack.
3. Heart Attack and Driving
1. You can drive after 4 weeks following heart attack.
2. You must inform your licensing authority and get advice if you drive large goods vehicles (LGV) or passenger-carrying vehicles (PCV).
4. Heart Attack and Work
1. After about 4-6 weeks you can usually go back to your work.
2. You should keep your GTN tablets/spray with you just in case you have an angina
3. If your job involves heavy lifting or manual labour, discuss with your employer.
5. Heart Attack and Sexual Life
1. Most people can safely return to sexual activity after recovery but usually depends on your physical comfort, psychological readiness and previous sexual activity.
2. Some heart medications can affect sexual function. Your doctor can then prescribe alternative medications.
3. You should NOT use Viagra if you are on regular nitrates tablets.

Upcoming soon....

Getting support

1. Heart Attack and support services
1. Having a heart attack is one of the scariest experience of your life.
2. People may experience Fear, anger, guilt and depression after a heart attack
3. Discussing them with your doctor, a family member or a friend might help. Or consider talking to a mental health provider or joining a support group.
4. Please refer to online support groups such as:
1. British Heart Foundation (BHF)