When the heart is not beating or cannot beat
effectively, oxygen does not get to the body’s tis-
sues. Within seconds the body begins to shut
down nonessential functions. The BRAINand the
heart itself are the most vulnerable to damage
resulting from lack of oxygen; their cells begin to
die within three minutes. Immediate CARDIOPUL-
MONARY RESUSCITATION(CPR) can restore OXYGENA-
TION and prevent permanent damage or death.
However, the likelihood of survival diminishes by
about 10 percent for each minute that passes fol-
lowing the heart’s stoppage.
Symptoms and Diagnostic PathSymptoms vary far more widely than most people
realize. The classic symptoms of heart attack are
- intense chest pressure, often crushing
- rapid BREATHING
- profuse sweating (diaphoresis)
- PAINthat radiates from the chest up the left arm
- difficulty breathing or shortness of breath
Many people, and especially women, do not
experience classic heart attack symptoms. Instead,
their symptoms are more generalized. The danger
is that they delay seeking treatment because they
are unsure whether they are having a heart
attack. Such a delay can be the difference between
surviving and dying from a heart attack. Nonclas-
sic heart attack signs include
- NAUSEA and occasionally VOMITING associated
with a sense of queasiness - persistent indigestion (DYSPEPSIA)
- unexplainable anxiety
- vague discomfort in the chest, neck, jaw, or
back - lightheadedness
Warning signs that persist for five minutes
require immediate medical assessment. More peo-
ple survive heart attacks than do not, and more
people could survive heart attacks if they received
prompt medical treatment. Cardiologists recom-
mend chewing an aspirin tablet at the first signs of
possible heart attack, which helps slow the clot-
ting process.
The diagnostic path begins with ELECTROCARDIO-
GRAM(ECG), which shows the heart’s electrical pat-
terns and can usually identify the location of the
disrupted function. Regardless of cause, heart
attack produces arrhythmias (irregularities of the
HEART RATE). Blood tests to measure electrolyte lev-
els and certain proteins that a damaged heart MUS-
CLE releases also help point to the diagnosis.
ECHOCARDIOGRAM can show areas of structural
damage to the heart, and CARDIAC CATHETERIZATION
with ANGIOGRAMcan identify the precise sites of
occlusions in the coronary arteries.Treatment Options and Outlook
Treatment begins with stabilizing the heart’s func-
tion, which may require various medications
including antiarrhythmia medications and drugs
that strengthen the heart while reducing the force
of its contractions. DEFIBRILLATIONmay be necessary
to restore a functional rhythm to the heart. When
doctors can determine within three hours that the
cause of the heart attack is a blood clot, they may
choose to administer thrombolytic medications
(“clot busters”) to dissolve the clot as well as antico-
agulant medications to prevent further clots.
Beyond three hours, thrombolytic medications are
not effective. Supportive measures include OXYGEN
THERAPYto increase the amount of oxygen in the
blood and intravenous fluids to maintain HYDRATION
and restore electrolyte balance.
Once the heart recovers, the cardiologist may
recommend interventions such as ANGIOPLASTYor
CORONARY ARTERY BYPASS GRAFT(CABG) to restore ade-
quate circulation to the heart. Other treatments
typically include medications to help regulate the
heartbeat and strengthen the heart, and lifestyle
modifications for improved cardiovascular health.
Treatment also targets any identified underlying
causes of the heart attack such as HYPERTENSION
(high BLOOD PRESSURE) and ATHEROSCLEROSIS. Current
treatment protocols recommend nearly everyone
who has a heart attack take statin medications
afterward. Statins are lipid-lowering medications
that can reduce CHOLESTEROL BLOOD LEVELS, notably
low-density lipoprotein cholesterol (LDL-C) by 30
to 40 percent within three months. Statins also
help strengthen the heart. Other medications may
include beta blockers or calcium channel blockers
to lower blood pressure and regulate rhythm.heart attack 57