More than a million Americans have heart attacks each year. A heart attack, or myocardial infarction (MI), is permanent damage to the heart muscle. "Myo" means muscle, "cardial" refers to the heart, and "infarction" means death of tissue due to lack of blood supply.
What Happens During a Heart Attack?
The heart muscle requires a constant supply of oxygen-rich blood to nourish it. The coronary arteries provide the heart with this critical blood supply. If you have coronary artery disease, those arteries become narrow and blood cannot flow as well as they should. Fatty matter, calcium, proteins, and inflammatory cells build up within the arteries to form plaques of different sizes. The plaque deposits are hard on the outside and soft and mushy on the inside.
When the plaque is hard, the outer shell cracks (plaque rupture), platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. If a blood clot totally blocks the artery, the heart muscle becomes "starved" for oxygen. Within a short time, death of heart muscle cells occurs, causing permanent damage. This is a heart attack.
While it is unusual, a heart attack can also be caused by a spasm of a coronary artery. During a coronary spasm, the coronary arteries restrict or spasm on and off, reducing blood supply to the heart muscle (ischemia). It may occur at rest, and can even occur in people without significant coronary artery disease.
Each coronary artery supplies blood to a region of heart muscle. The amount of damage to the heart muscle depends on the size of the area supplied by the blocked artery and the time between injury and treatment.
Healing of the heart muscle begins soon after a heart attack and takes about eight weeks. Just like a skin wound, the heart's wound heals and a scar will form in the damaged area. But, the new scar tissue does not contract. So, the heart's pumping ability is lessened after a heart attack. The amount of lost pumping ability depends on the size and location of the scar.
Heart Attack Symptoms
Symptoms of a heart attack include:
Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone
Discomfort radiating to the back, jaw, throat, or arm
Fullness, indigestion, or choking feeling (may feel like heartburn)
Sweating, nausea, vomiting, or dizziness
Extreme weakness, anxiety, or shortness of breath
Rapid or irregular heartbeats
During a heart attack, symptoms last 30 minutes or longer and are not relieved by rest or nitroglycerin under the tongue.
Some people have a heart attack without having any symptoms (a "silent" myocardial infarction). A silent MI can occur in anyone, but it is more common among people with diabetes.
What Is the Treatment for a Heart Attack?
Once heart attack is diagnosed, treatment begins immediately -- possibly in the ambulance or emergency room. Drugs and surgical procedures are used to treat a heart attack.
What Drugs Are Used to Treat a Heart Attack?
The goals of drug therapy are to break up or prevent blood clots, prevent platelets from gathering and sticking to the plaque, stabilize the plaque, and prevent further ischemia.
These medications must be given as soon as possible (within one to two hours from the start of your heart attack) to decrease the amount of heart damage. The longer the delay in starting these drugs, the more damage can occur and the less benefit they can provide.
Drugs used during a heart attack may include:
Aspirin to prevent blood clotting that may worsen the heart attack
Other antiplatelets, such as Brilinta, Effient, or Plavix, to prevent blood clotting
Thrombolytic therapy ("clot busters") to dissolve any blood clots in the heart's arteries
Any combination of the above
Other drugs, given during or after a heart attack, lessen your heart's work, improve the functioning of the heart, widen or dilate your blood vessels, decrease your pain, and guard against any life-threatening heart rhythms.
What Lifestyle Changes Are Needed After a Heart Attack?
There is no cure for coronary artery disease. In order to prevent the progression of heart disease and another heart attack, you must follow your doctor's advice and make necessary lifestyle changes -- quitting smoking, lowering your blood cholesterol, controlling your diabetes and high blood pressure, following an exercise plan, maintaining an ideal body weight, and controlling stress.