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Heart Attack
OVERVIEW: Heart attack, or acute myocardial infarction (AMI), is the rapid development of heart muscle death resulting from a sustained and complete reduction of blood flow. The blockage is caused by a blood clot generated by an atherosclerotic plaque on the lining of the artery. The consequences of heart attack depend on the size and location of the blockage and how quickly blood flow can be restored.
SIGNS AND SYMPTOMS: • Pain of the arm, back, jaw, upper abdomen, neck, chest
• Heaviness, viselike tightness of the chest
• Anxiety
• Lightheadedness, pallor, weakness, fainting
• Nausea, vomiting, profuse sweating
• Cough, difficulty breathing, wheezing
• Irregular heart rhythms
CAUSES: • Blockage of heart artery by blood clot
• Coronary artery disorders
• Oxygen imbalance
• Cocaine
SCOPE: There are about 600 heart attacks per 100,000 persons in the United States.
MOST OFTEN AFFECTED: Individuals over 40 years of age; more common in males until age 70, when frequency among females becomes equal
RISK FACTORS: • High levels of cholesterol in the bloodstream
• History of early heart disease in family
• Smoking
• Diabetes mellitus
• High blood pressure
• Sedentary life style
• Aging
• Hostile, high-strung, frustrated personality
• High levels of fats and triglycerides in bloodstream
DIAGNOSIS PHYSICAL EXAMINATION: • The Physician will perform a physical examination to identify the presence of heart attack.
• Conditions that can cause similar signs and symptoms include aortic aneurism, lung disorders, pancreatitis, spasm of the esophagus, and other heart conditions.
• The degree of heart impairment will be assessed.
TESTS AND PROCEDURES: • Blood tests
• Chest x-ray
• Electrocardiography (EKG) and echocardiography may be done.
• Special radiology procedures, radionuclide studies, may be done to assist in diagnosis.
• Blood vessels of the heart may be assessed by an imaging procedure, angiography.
TREATMENT GENERAL MEASURES: • Heart attack requires hospitalization.
• Call 9-1-1 for help; do not drive to hospital.
• Provide emergency first aid as needed, including rescue breathing and cardiopulmonary resuscitation (CPR).
• In hospital, goals are pain relief, treatment of electrical and mechanical complications, and limiting damage to heart muscle.
• Emergency percutaneous transluminal angioplasty (PTCA), or balloon angioplasty, may be done.
ACTIVITY: • Bed rest for first 24 hours
• Medically supervised rehabilitation plan
DIET: Nothing by mouth until stable; later, low-fat, low-salt diet
MEDICATIONS COMMONLY PRESCRIBED DRUGS: • Acute phase:
• Alteplase [tissue plasminogen activator (TPA), Activase]
• Heparin
• Aspirin
• Nitrates
• Lidocaine
• Oxazepam, Lorazepam
• Morphine
• Metoprolol (Lopressor)
• Oxygen
• Stool softeners: milk of magnesia, docusate sodium (dioctyl sodium sulfosuccinate)
• Recovery phase:
• Beta-blockers
• Nitrates
• Angiotensin-converting enzyme (ACE) inhibitors
CONTRAINDICATIONS: Read drug product information.
PRECAUTIONS: Read drug product information.
DRUG INTERACTIONS: Read drug product information.
Other Drugs: • Streptokinase
• Atenolol
FOLLOW UP PATIENT MONITORING: The Physician should be seen as often as needed.
PREVENTION/AVOIDANCE: • Avoid risk factors
• Recognize the signs and symptoms of heart attack and take prompt action.
• Aspirin, 81 milligrams per day, may be helpful in preventing heart attacks. See your doctor before taking daily aspirin.
COMPLICATIONS: • Acute phase:
• Alteplase [tissue plasminogen activator (TPA), Activase]
• Heparin
• Aspirin
• Nitrates
• Lidocaine
• Oxazepam, Lorazepam
• Morphine
• Metoprolol (Lopressor)
• Oxygen
• Stool softeners: milk of magnesia, docusate sodium (dioctyl sodium sulfosuccinate)
• Recovery phase:
• Beta-blockers
• Nitrates
• Angiotensin-converting enzyme (ACE) inhibitors
WHAT TO EXPECT: • Overall mortality rate of heart attack is 10% during the hospital phase, with an additional 10% mortality rate during the year after. More than 60% of the deaths occur within 1 hour of the onset of the heart attack.
• Outcome can be good with prompt diagnosis and proper treatment.
MISCELLANEOUS OTHER FACTORS: N/A
PEDIATRIC: N/A
GERIATRIC: Complications are more frequent among the elderly.
OTHERS: N/A
PREGNANCY: N/A
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