Staten Island Heart's Doctors, Board Certified Cardiologists, Specializing in the treatment, care and prevention of Cardiovascular Disease. Located in Staten Island, New York.
Myocardial Infarction
What is myocardial infarction?
Myocardial infarction is the medical term for heart attack. Heart attack means there has been death of heart cells. This is the result of a complete blockage of one of the blood vessels that feeds the heart muscle (coronary artery). Cell death does not occur immediately once the artery is blocked. It takes several minutes to start the injury process and this continues for several hours unless the artery is opened up restoring blood flow. The blockage that causes a heart attack is usually a blood clot that forms inside the vessel in an area where there is hardening of the arteries (atherosclerosis). Coronary heart disease is a very common disease and is the leading cause of death in the United States. More than 500,000 men and women suffer a heart attack each year.
What causes myocardial infarction?
The basic disease process that leads to myocardial infarction is atherosclerosis or hardening of the arteries. An atherosclerotic plaque is a complex structure made up of cells, cholesterol, and other fatty substances. The plaque develops in the wall of the coronary artery and over time becomes large enough to start narrowing the channel through which the blood travels. The pool of lipid (fat) within the plaque is covered by a thin fibrous cap. This cap may split or fracture exposing the blood to elements within the plaque that stimulate blood clot formation. This clotting process may be controlled by the body, which contains substances to dissolve clots, or may lead to complete blockage of the artery. When the artery is blocked acutely for more than a few minutes, cell death starts to occur.
Are all heart attacks the same?
Much of what happens depends on the size of the heart attack, where it is located in the heart and if there has been damage previously. If the area of damage is small, recovery is usually rapid with few or no complications. If the area of involved heart muscle is large, the loss of normal heart contraction (pumping) may cause low blood pressure, shock, or congestive heart failure. Recovery may be prolonged and death may occur. In the early stages of a heart attack, the heart is particularly susceptible to heart rhythm abnormalities. Such abnormal rhythms can be quite serious and may lead to death if not treated promptly. Until the area of damage heals, the dead heart muscle is soft and weak and rupture of the heart wall can occur. This usually results in death. With prompt and effective treatment of myocardial infarction most potential complications can be avoided and the mortality rate has been reduced dramatically.
The body heals the heart damage caused by a heart attack by forming scar tissue. This healing process is usually complete in 4 to 8 weeks. In days past hospitalization was often prolonged, lasting 3 to 4 weeks. Today, hospitalization following a heart attack is usually brief in the absence of complications. Often patients are home within 4 to 5 days. Activities will be restricted for a few weeks to allow healing to occur. Many patients will participate in a formal cardiac rehabilitation program. Cardiac rehabilitation is a program of progressive exercise and education for people who have heart illnesses. Cardiac rehabilitation helps people to resume normal activity as quickly as possible.
What are the risk factors for myocardial infarction?
Risk factors for the development of coronary artery disease and myocardial infarction include heredity, being male, smoking, high cholesterol, high blood pressure, obesity, diabetes, stress and a sedentary life style. Heredity is a powerful factor predisposing people to early heart disease. Being male is a risk factor but the incidence of heart disease in women increases dramatically after menopause. The risk factors to concentrate upon are those that can be modified. These include cigarette smoking, high blood pressure, cholesterol, obesity, sedentary life style and stress. Cigarette smoking causes many deaths from myocardial infarction and other heart diseases. Smoking contributes to almost half of the heart attacks of women under age 55. Stopping smoking can greatly reduce your chances of having a heart attack. Controlling blood pressure can reduce your risk of heart attack. Lowering cholesterol to safe levels through diet and medications can reduce your risk and may even lead to some regression of the plaques already present. Lean body weight and a regular exercise program are helpful. If you are diabetic, precise control of your diabetes will help reduce your risk of blood vessel damage due to diabetes. Stress is a risk factor that is common, difficult to quantify and difficult to control effectively over time. Methods of stress reduction include meditation, regular exercise, time management and a supportive environment.
How is a heart attack diagnosed?
Chest pain is the most common symptom of heart attack. The chest pain is usually a burning or pressure sensation beneath the mid or upper breast bone. The pain may radiate into the upper mid back, neck, jaw or arms. The pain may be severe but often is only moderate in severity. There may be associated shortness of breath or sweating. If patients have had angina previously, the heart attack pain will feel the same as their usual angina only stronger and more prolonged. If you have a pain like this that lasts longer than 15 minutes, it is best to be evaluated immediately. Calling your medic unit is the fastest and safest way to ask for help. If you have symptoms like this that wax and wane, this is often a warning sign that a heart attack is about to occur and prompt medical attention is indicated.
Once you are in an emergency room or a doctor's office, an electrocardiogram (ECG) will be obtained. The ECG is often helpful in diagnosing a heart attack. Sometimes, however, the ECG is normal even when heart injury is present. When heart cells die, certain enzymes present in heart cells are released into the blood stream that serve as a marker of heart injury. These enzymes can be measured by blood tests. The amount of enzyme released into the blood stream can also help assess how much heart damage has occurred.
How are heart attacks treated?
The best way to limit the size of a heart attack is to restore the flow of blood to the heart muscle as fast as possible. There are two basic methods to do this. Because most heart attacks are caused by clots forming within the coronary artery, dissolving the clot quickly will restore blood flow. Drugs called thrombolytics are quite effective. The sooner these drugs are given, the quicker the blood flow will be restored. An alternative method involves the use of balloon angioplasty. This involves taking the heart attack victim promptly to the cardiac cath lab in the hospital. An angiogram is performed to show the blocked blood vessel leading to the heart attack. Then a balloon catheter is placed across the blockage and flow is restored. Sometimes a stent is placed to create a large channel.
Smaller heart attacks, often those not producing significant abnormalities on the ECG are often treated with bed rest and blood thinners such as heparin as well as drugs to reduce the work the heart does. These heart attacks are called non-transmural myocardial infarctions. Before discharge, x-ray studies of the heart arteries are often carried out to see if angioplasty or surgery will be necessary.
Following thrombolytic therapy, angiograms are often performed to outline the coronary anatomy to help determine if additional therapy such as angioplasty or bypass surgery is indicated. This may be done during the initial hospitalization or later as an outpatient procedure.
You will be hospitalized after a heart attack for 3 to 5 days, longer if there are complications or if heart surgery is necessary. A variety of medications are used. Beta blockers reduce the work your heart does and are usually prescribed. ACE inhibitors may help the heart work better. Aspirin is usually given as a blood thinner. Heparin, an intravenous blood thinner, is usually given early. If you receive a stent, medication is often given to help prevent clotting within the stent. Before your discharge from the hospital, a low level exercise test on a treadmill may be performed. The cardiac rehabilitation program often starts in the hospital with a progressive exercise program and counseling about any lifestyle or diet changes that need to be made.
When can I return to work?
Your return to work depends on how much your heart was damaged, if there were complications with your heart attack, the need for further therapy such as angioplasty or bypass surgery and the type of work you do. Patients with uncomplicated heart attacks who do office-type work may often return to work within 2 to 3 weeks. More vigorous work demands may require you to be off work for 6 to 8 weeks.
How can I prevent further heart attacks?
Following your heart attack, it is very important to modify your risk factors. If you are a smoker, you must stop. Your cholesterol level will be checked and your doctor will give you advice about how to lower your cholesterol. This will require a low cholesterol, low fat diet, and often medications are required. A sensible exercise program is important and is often started through a formal cardiac rehabilitation program. Periodic examinations by your physician are important. This may include periodic testing to assess your heart blood flow.
What causes myocardial infarction?
The basic disease process that leads to myocardial infarction is atherosclerosis or hardening of the arteries. An atherosclerotic plaque is a complex structure made up of cells, cholesterol, and other fatty substances. The plaque develops in the wall of the coronary artery and over time becomes large enough to start narrowing the channel through which the blood travels. The pool of lipid (fat) within the plaque is covered by a thin fibrous cap. This cap may split or fracture exposing the blood to elements within the plaque that stimulate blood clot formation. This clotting process may be controlled by the body, which contains substances to dissolve clots, or may lead to complete blockage of the artery. When the artery is blocked acutely for more than a few minutes, cell death starts to occur.
Are all heart attacks the same?
Much of what happens depends on the size of the heart attack, where it is located in the heart and if there has been damage previously. If the area of damage is small, recovery is usually rapid with few or no complications. If the area of involved heart muscle is large, the loss of normal heart contraction (pumping) may cause low blood pressure, shock, or congestive heart failure. Recovery may be prolonged and death may occur. In the early stages of a heart attack, the heart is particularly susceptible to heart rhythm abnormalities. Such abnormal rhythms can be quite serious and may lead to death if not treated promptly. Until the area of damage heals, the dead heart muscle is soft and weak and rupture of the heart wall can occur. This usually results in death. With prompt and effective treatment of myocardial infarction most potential complications can be avoided and the mortality rate has been reduced dramatically.
The body heals the heart damage caused by a heart attack by forming scar tissue. This healing process is usually complete in 4 to 8 weeks. In days past hospitalization was often prolonged, lasting 3 to 4 weeks. Today, hospitalization following a heart attack is usually brief in the absence of complications. Often patients are home within 4 to 5 days. Activities will be restricted for a few weeks to allow healing to occur. Many patients will participate in a formal cardiac rehabilitation program. Cardiac rehabilitation is a program of progressive exercise and education for people who have heart illnesses. Cardiac rehabilitation helps people to resume normal activity as quickly as possible.
What are the risk factors for myocardial infarction?
Risk factors for the development of coronary artery disease and myocardial infarction include heredity, being male, smoking, high cholesterol, high blood pressure, obesity, diabetes, stress and a sedentary life style. Heredity is a powerful factor predisposing people to early heart disease. Being male is a risk factor but the incidence of heart disease in women increases dramatically after menopause. The risk factors to concentrate upon are those that can be modified. These include cigarette smoking, high blood pressure, cholesterol, obesity, sedentary life style and stress. Cigarette smoking causes many deaths from myocardial infarction and other heart diseases. Smoking contributes to almost half of the heart attacks of women under age 55. Stopping smoking can greatly reduce your chances of having a heart attack. Controlling blood pressure can reduce your risk of heart attack. Lowering cholesterol to safe levels through diet and medications can reduce your risk and may even lead to some regression of the plaques already present. Lean body weight and a regular exercise program are helpful. If you are diabetic, precise control of your diabetes will help reduce your risk of blood vessel damage due to diabetes. Stress is a risk factor that is common, difficult to quantify and difficult to control effectively over time. Methods of stress reduction include meditation, regular exercise, time management and a supportive environment.
How is a heart attack diagnosed?
Chest pain is the most common symptom of heart attack. The chest pain is usually a burning or pressure sensation beneath the mid or upper breast bone. The pain may radiate into the upper mid back, neck, jaw or arms. The pain may be severe but often is only moderate in severity. There may be associated shortness of breath or sweating. If patients have had angina previously, the heart attack pain will feel the same as their usual angina only stronger and more prolonged. If you have a pain like this that lasts longer than 15 minutes, it is best to be evaluated immediately. Calling your medic unit is the fastest and safest way to ask for help. If you have symptoms like this that wax and wane, this is often a warning sign that a heart attack is about to occur and prompt medical attention is indicated.
Once you are in an emergency room or a doctor's office, an electrocardiogram (ECG) will be obtained. The ECG is often helpful in diagnosing a heart attack. Sometimes, however, the ECG is normal even when heart injury is present. When heart cells die, certain enzymes present in heart cells are released into the blood stream that serve as a marker of heart injury. These enzymes can be measured by blood tests. The amount of enzyme released into the blood stream can also help assess how much heart damage has occurred.
How are heart attacks treated?
The best way to limit the size of a heart attack is to restore the flow of blood to the heart muscle as fast as possible. There are two basic methods to do this. Because most heart attacks are caused by clots forming within the coronary artery, dissolving the clot quickly will restore blood flow. Drugs called thrombolytics are quite effective. The sooner these drugs are given, the quicker the blood flow will be restored. An alternative method involves the use of balloon angioplasty. This involves taking the heart attack victim promptly to the cardiac cath lab in the hospital. An angiogram is performed to show the blocked blood vessel leading to the heart attack. Then a balloon catheter is placed across the blockage and flow is restored. Sometimes a stent is placed to create a large channel.
Smaller heart attacks, often those not producing significant abnormalities on the ECG are often treated with bed rest and blood thinners such as heparin as well as drugs to reduce the work the heart does. These heart attacks are called non-transmural myocardial infarctions. Before discharge, x-ray studies of the heart arteries are often carried out to see if angioplasty or surgery will be necessary.
Following thrombolytic therapy, angiograms are often performed to outline the coronary anatomy to help determine if additional therapy such as angioplasty or bypass surgery is indicated. This may be done during the initial hospitalization or later as an outpatient procedure.
You will be hospitalized after a heart attack for 3 to 5 days, longer if there are complications or if heart surgery is necessary. A variety of medications are used. Beta blockers reduce the work your heart does and are usually prescribed. ACE inhibitors may help the heart work better. Aspirin is usually given as a blood thinner. Heparin, an intravenous blood thinner, is usually given early. If you receive a stent, medication is often given to help prevent clotting within the stent. Before your discharge from the hospital, a low level exercise test on a treadmill may be performed. The cardiac rehabilitation program often starts in the hospital with a progressive exercise program and counseling about any lifestyle or diet changes that need to be made.
When can I return to work?
Your return to work depends on how much your heart was damaged, if there were complications with your heart attack, the need for further therapy such as angioplasty or bypass surgery and the type of work you do. Patients with uncomplicated heart attacks who do office-type work may often return to work within 2 to 3 weeks. More vigorous work demands may require you to be off work for 6 to 8 weeks.
How can I prevent further heart attacks?
Following your heart attack, it is very important to modify your risk factors. If you are a smoker, you must stop. Your cholesterol level will be checked and your doctor will give you advice about how to lower your cholesterol. This will require a low cholesterol, low fat diet, and often medications are required. A sensible exercise program is important and is often started through a formal cardiac rehabilitation program. Periodic examinations by your physician are important. This may include periodic testing to assess your heart blood flow.
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