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[W491]What Is Heart Attack

by K Bakhru, K B

In case angina pectoris is ignored, and the disease is allowed to progress, the blockage in coronary arteries/or in its branches may go on increasing. The end-result of such a severe blockage in coronary arteries/branches would be that the blood supply of a part of heart muscle (supplied by the respective branch of coronary artery) may suddenly stop completely leading to severe damage / injury / necrosis / death of the affected portion of the heart muscle. However, the patient may directly go into the stage of heart attack without undergoing the stage of angina pectoris.

There may be only sudden spasm/narrowing/constriction of a coronary artery or its branches, either of a normal vessel or already involved coronary artery as a result of atherosclerosis. If the spasm is momentary, the patient may get only angina, but if it is a prolonged one, blood supply of a portion of heart muscle will suffer adversely, leading to a heart attack.

As regards clinical manifestations in a heart attack, the patient suddenly gets very severe pain in the centre of the chest (retrostemal) which may radiate to the left upper arm. In some cases, the pain may radiate to the back of the chest or towards the neck/lower jaw. In atypical cases, the pain may only be present in any of these areas i.e. back of the chest or the neck, etc.

Unlike the pain in angina, the pain in a heart attack is not relieved by rest, or by the administration of quick-acting coronary dilator drugs like glyceryl trinitrate. It may last more than half an hour, and may be accompanied by profuse sweating. The pain, truly speaking, may be highly unbearable, the worst the patient has ever suffered/experienced and may be only relieved by a strong analgesic/pain-killer. The patient may even get breathlessness/syncope/vertigo. Some patients may quickly go into shock called cardiogenic shock which becomes a grave emergency, and the patient may die if proper aid is not given. However, a patient may die even instantaneously if the heart attack is very severe. Hence, after the immediate first aid he should be shifted to the hospital. Such patients are treated in an intensive care unit (ICU) of the hospital. The sooner the patient is given aid, the lesser will be the damage to the heart. For this reason, in some of the places, there are mobile cardiac care units. The van, duly-equipped, reaches the place of emergency in no time, and the patient receives proper treatment in the van itself on the way to hospital. If some fatal complications occur on the way, they are also tackled right in the van. Many lives can be saved with such timely treatment.

Hence, early diagnosis as well as treatment is important to save the life of a patient in a case of a heart attack. One must bear in mind the solitary important warning signal to detect cases of heart attack, in most of the cases, that whenever there is pain in chest/difficulty in breathing/syncope (transitory unconsciousness)/vertigo (dizziness), especially in middle age, the physician should be consulted for an immediate check-up. Further, cases of stable/unstable angina pectoris may precede a heart attack and thus should be considered a most important early warning signal.

Women with rheumatoid arthritis (RA) have high rates of non fatal heart attacks. This occurs even without traditional risk factors being present. (Solomon, et al. Circulation 2003; 107: 1303-1307). The same is probably true for men with RA as well.

In addition multiple studies have demonstrated the increased risk of stroke occurring in patients with rheumatoid arthritis. Presence of intimal plaque (atherosclerosis in the inner walls of the carotid arteries) has been used as a surrogate marker of arterial disease elsewhere.

The conclusions drawn from multiple studies are that RA is an extremely potent risk factor for the development of atherosclerosis. More aggressive goals for risk factor modification should be instituted.

It's important to assess all risk factors in patients with RA. Control of hyperlipidemia and high blood pressure is mandatory. Dietary measures are primary. If dietary changes don't work, then statin therapy maybe needed. These drugs lower LDL cholesterol (?bad? cholesterol) and reduce levels of C-reactive protein. If a patient has diabetes, tight control of blood sugar is extremely important.

Discontinuation of cigarette smoking and proper weight management are important.

Rheumatoid arthritis (RA) patients could reduce their cardiovascular risk by spending more time walking.

Physical inactivity and sedentary behavior contribute to the risk of cardiovascular disease but little is known about energy expenditure from lifestyle physical activity in RA patients.

A recent study compared energy expenditure from exercise and lifestyle activities between 122 RA patients and 122 healthy controls.

At the beginning of the study, RA patients spent fewer kilocalories per week walking, exercising and participating in sports than did controls, the authors report.

Similar percentages of RA patients and controls met their recommended thresholds for total weekly energy expenditure, but the percent of RA patients meeting the recommended threshold for walking (32%) was notably lower than controls (48%).

At follow-up an average of 14 months later, RA patients continued to expend fewer kilocalories per week overall and were less likely to meet the threshold for walking, compared with controls.

"This study provides evidence that despite the fact that walking is an excellent lifestyle activity and it is markedly underutilized in RA patients," the authors note. "Our study supports the development and implementation of interventions to foster walking as part of a program to address cardiovascular risk in RA patients." (Mancuso C, et al. Arthritis Rheum 2007; 57:672-678).

Aspirin therapy has been shown to be effective prophylaxis for men and some studies also indicate its potential effectiveness in women.

In the final analysis, it must be mentioned that the most potent weapon against the increase in cardiovascular mortality is tight control of the rheumatoid arthritis- getting the disease into remission. Fortunately, the advent of first, second, and third generation biologic medicines have made this a reality.

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Both K Bakhru & Nathan Wei are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

K Bakhru has sinced written about articles on various topics from Medical Condition, Allergies and Medical Condition. Author sites: , and. K Bakhru's top article generates over 12100 views. to your Favourites.

Nathan Wei has sinced written about articles on various topics from Arthritis Pain, Health and Arthritis Signs. Nathan Wei MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info:. Nathan Wei's top article generates over 550000 views. to your Favourites.