Heart attack

It is the clinical picture that occurs as a result of the sudden occlusion of the vessels feeding the heart by the blood clot and the inability of the heart muscle to receive enough oxygen. 95% of the heart attacks occur as a result of the cracking of the atherosclerotic plaque and the formation of a clot over it. The remaining 5% of the heart attacks are coronary embolism, dissection, spasm, etc. is responsible.

Symptoms:

Common symptoms:

-Chest pain, feeling of pressure in the chest; the pain may radiate to the neck, jaw, back and arms

-Nausea, indigestion, burning in the chest, abdominal pain

-Shortness of breath

-Cold sweating

-Dizziness

Rare symptoms:

– Not all patients who have had a heart attack have the same symptoms. While some patients have very severe pain, some patients may have mild pain. While some patients have no symptoms, some patients may have sudden death. Usually, the symptoms are very faint in elderly patients. If you have several of these symptoms, heart attack There’s a chance you’re going through.

– While the heart attack starts suddenly in some patients, most patients complain of chest pain that occurs hours, days, weeks before with effort and disappears during rest.

Risk factors:Certain factors cause fat accumulation (atherosclerosis) and narrowing in your veins. You can reduce the risk of a first heart attack or a secondary heart attack by completely eliminating or reducing some risk factors.

Age: Men older than 45 and women older than 55 have a higher risk of heart attack than younger people.

Smoking or being a passive smoker for a long time increases the risk of heart attack.

Hypertension: When the vessels are exposed to high blood pressure for a long time, the risk of atherosclerosis and heart attack increases. When hypertension is associated with obesity, diabetes mellitus and hyperlipidemia, the risk increases even more.

-Hyperlipidemia: High LDL cholesterol (bad cholesterol) increases the risk of heart attack. High triglyceride levels, which are mostly associated with diet, also accelerate atherosclerosis. High HDL (good cholesterol) is protective against heart attack.

-Diabetes: Insulin is the hormone secreted from the pancreas that allows the body to use glucose. As a result of insufficient secretion or resistance to insulin, blood sugar rises. Diabetes, especially uncontrolled diabetes, high sugar for a long time accelerates atherosclerosis.

-Family history: If there is a history of heart attack before the age of 55 in first-degree male relatives and before the age of 65 in female relatives, the risk increases.

– Lack of physical activity: Physical activity has a positive effect on obesity, blood lipid level, blood pressure and sugar control. Aerobic exercise reduces the risk of heart attack.

-Obesity: Obesity is generally associated with high blood pressure, diabetes, and hyperlipidemia. 10% loss of body weight reduces the risk of heart attack.

-Stress

-Illegal drug: Cocaine, amphetamine causes a heart attack by spasms in the heart vessels.

-Autoimmune diseases: Autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis increase the risk of heart attack.

Complications:

Rhythm disturbances: Rhythm disturbances may develop due to electrical short circuits during a heart attack, and may even be fatal.

-Heart failure: Depending on the size of the heart attack, the heart muscle is damaged, the remaining heart tissue cannot pump enough blood, and as a result, heart failure develops.

-Heart rupture: Due to a heart attack, the heart muscle can be torn, often fatal.

-Valve failure: Severe insufficiency may develop due to dysfunction and/or rupture of the mitral valve due to a heart attack.

Diagnosis:Every patient who comes to the emergency department with the complaint of chest pain should be monitored; in this way, sudden rhythm disturbances can be detected immediately and treated.

-ECG (Electrocardiography): It allows recording the electrical activities in the heart with electrodes placed on the skin. Since the electrical activation will change during a heart attack, a heart attack is recognized in the EKG.

-Blood test: The blood tests that should be checked in the emergency room from every patient with a suspected heart attack are troponin and criatine phosphokinase. Usually, the pain rises 2-4 hours after it starts.

-Lung film: It is used to rule out diseases such as pneumothorax, pericarditis, pleural effusion, which are often confused with heart attack.

-Echocardiography: It is a kind of ultrasonography of the heart. It is useful both in diagnosing a heart attack and in detecting complications.

Treatment:

– Drugs that prevent clotting: These drugs prevent the formation of clots by preventing the platelets, which provide coagulation in the vein, from coming onto the clot.

-Coagulant drugs: These drugs dissolve the clot that causes heart attack. If the patient does not have a disease that may cause bleeding and cannot be taken to emergency angiography, these drugs should be given.

-Painkillers: Painkillers such as morphine are used to relax the patient.

-Nitroglycerin: These are drugs that relieve the patient’s pain by expanding the heart vessels.

-Beta blocker: It reduces the damage during a heart attack by lowering the heart rate and blood pressure, and is protective against a later heart attack.

-ACE inhibitors: They reduce stress on the heart by lowering blood pressure and intracardiac pressure during a heart attack.

Primary percutaneous coronary angioplasty:

The aim in a heart attack should be to open the vessel that caused the crisis as soon as possible so that the damage to the heart is kept to a minimum. The vessel should be opened in the first 4 hours, if possible, in the first 2 hours after the onset of pain. After entering the emergency room, the vessel should be opened within the first 90 minutes. After the tube is placed, it is done by giving dye to the heart vessel by means of a catheter (long tubes reaching to the heart vessels). Sometimes a heart attack is caused by only a clot without atherosclerosis in the vessel. Balloon dilatation and stenting can be dangerous for these patients. It would be more appropriate to give special clot-dissolving drugs to such patients for 1-2 days.

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