A heart attack refers to a medical emergency where the arteries of the heart become blocked (due to a clot, or due to the deposition of fat and other elements along the inner lining of the artery), cutting off supply of oxygen-rich blood to the heart. A heart attack can be preceded by early warning and early detection symptoms (read up on them here), while in other cases, there may be no tell-tale symptoms involved (this condition is technically referred to as a ‘silent myocardial infarction’).
A heart attack cannot be managed by administering nitroglycerin under the tongue (though this may help the patient gain some valuable time before getting full-fledged medical management) or by simply taking rest. There are specific procedures that one must follow, and without losing time. It is therefore important to know the steps one must take during, and immediately after, a heart attack.
For starters, one has to move quick, so you must call for professional help – or an ambulance – immediately. Treating a heart within the first one or two hours provides the highest probability of survival or long-term reversal of cardiac tissue injury. The longer one waits, the higher the chances of permanent damage.
The diagnosis of a heart attack depends on the symptoms and the findings of the tests. The goal of diagnosis after a heart attack is to avert the immediate danger, limit the damage to the heart muscle and tissue, and try and get the patient on the road to recovery as quickly and painlessly as possible.
The ECG – which is sometimes referred to as EKG or Electrocardiogram – is a test to figure out the extent of damage that has taken place on the heart muscles. It may also be used to detect any cardiac angina, heart blood flow compromise leading to changes or even a heart attack which is setting in. An ECG also helps us measure and monitor heart rhythm and heart rate after a heart attack.
Post a heart attack, a blood test helps in determining the level of cardiac enzymes in the blood. Cardiac enzymes reside inside the heart cells and are important for the normal functioning of the heart. When heart cells suffer injury during an attack, the enzymes inside these cells make their way into the blood stream. By measuring their count, it is possible to get an idea of the magnitude of the heart attack (small or massive), as well as make an estimate about the time when the attack took place. A blood test will also help us know the level of Troponins in the blood stream. An excess of Troponin (that is, as compared to the regular level) may indicate that a heart attack has happened recently.
Echocardiography refers to an Imaging Test that is done to assess the overall functioning of the heart, especially during and post a heart attack. It shows us how the heart pumping is happening, and indicates the areas that are showing irregular or abnormal pumping. An Echocardiography can also help us find out parts and structures of the heart that have suffered damage during the attack.
If medication does not bring relief in the immediate aftermath (first few hours) of a heart attack – that is, it is not helping the ischemia (loss of blood supply to a tissue) or other symptoms – a Cardiac Catheterization (also referred to as Cardiac Cath or cardiac angiography) may be done. It helps the attending medical professional visualize and detect the blocked area of the artery and can thus help in deciding upon the best treatment approach including application of stents if needed.
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When it comes to treating a heart attack, speed – which includes a combination of agile thinking and swift action – is perhaps the most important thing. Heart attack treatment begins immediately after the diagnosis has been completed. A heart attack can be treated in two ways: With drugs, or via invasive options including surgical procedures.
The objective of drug treatment is to prevent blood platelets from sticking to the deposition (plaque) on the inner lining of the artery, to prevent blood clots, to halt further ischemia and to bring the plaque changes under control (i.e., stabilize it). If drug therapy is the route taken to treat a heart attack, then the medication must be administered ‘ASAP’, that is, as quickly as possible. In fact, this must be done within the first two hours of the attack, this is known as the “Golden Hour”. The longer one delays, the less the chances of success. Some of the drugs used for treating a heart attack are:
ASPIRIN: This keeps the blood clotting under check.
ANTIPLATELETS: Brilinta or Effient) can be effective in preventing the clotting of blood. Antiplatelets (for example, Plavix
Thrombolytic therapy: Clot busters may be resorted to, in order to dissolve blood clots that have taken place inside the arteries of the heart.
COMBINATION: Depending on the specifics of the case, various combinations of the above drug treatments may be tried.
POST TREATMENT: Once the immediate danger has been handled and the threat averted, there are various drugs and medication that may be prescribed. The goal here is strengthening the heart and improving its functions, reducing the pressure and work load on the heart, to dilate and widen the blood vessels that had become narrow due to plaque or deposition, reduce the patient’s pain and to protect from fatal and potentially life-endangering rhythm of the heart.
If a Cardiac Cath is done during or after the heart attack to evaluate the health of the heart and arteries, the subsequent diagnosis may call for various procedures.
One such treatment is referred to as angioplasty (or placement of stents), which is done to dilate or widen the inner passageways of the arteries.
In certain cases, a Bypass Surgery may be the best way to go, which is done to create an alternative ‘route’ or passageway to supply blood to the heart (it ‘bypasses’ the original route or artery which has become blocked, hence the name ‘Bypass’ surgery).
There are other treatments as well, such as rehabilitation therapy, lifestyle modification, and other interventional procedures as may be deemed fit by the treating cardiologist.
It is important to note that none of the above treatments is a fool-proof ‘insurance’ against another heart attack. The best way to ensure that the next attack doesn’t happen is to eat wisely, adopt an active and healthy lifestyle, take regular tests to monitor your heart’s fitness and consult a professional regularly.
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