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Coronary Artery Disease and Heart Attack

Your coronary arteries are blood vessels on the surface of your heart. They bring oxygen and nutrients to your heart muscle (myocardium). The right coronary artery carries blood to the right side and bottom of the heart. The left coronary artery carries blood to the left side of the heart and to the wall of muscle (septum) which separates the heart into right and left sections.

The left coronary artery is made up of the "left main" artery, the "circumflex branch" and the "left anterior descending branch." The left and right coronary arteries further divide into smaller branches. Each person's pattern of smaller branches is unique, like a fingerprint.

Sometimes fat, circulating cholesterol, and other substances combine to form a hard substance known as, "plaque", which is deposited on the inner lining of your coronary arteries. The build up of plaque may clog (occlude) the arteries and restrict blood flow to the heart. This is called, "coronary artery disease" "atherosclerosis", or "hardening of the arteries."

Sometimes so much plaque is deposited, that it partially blocks the flow of blood from an artery to your heart. Even though some blood continues to flow through the artery, you may experience symptoms.

What are the symptoms of coronary artery disease?
Angina is the main symptom of coronary artery disease. If you have angina, you experience intermittent pain, pressure or discomfort in your chest. You may also experience angina in your, neck, jaw, arm or fingertips. Some people describe the feeling as a dull ache, numbness, or pressure. Others say it resembles heartburn, gas, or indigestion.

If you have angina, you probably experience the discomfort during or immediately after exertion or sudden intense stress. Angina usually disappears with rest and the use of nitroglycerin. Angina can also be controlled with medications such as nitrates, beta blockers or calcium channel blockers..

Shortness of breath (difficulty in "catching air") after mild exertion may be another symptom. Weakness, fatigue, sweating, belching, nausea, and irregular heartbeats are other symptoms of CAD.

Twenty-five to 30% of the people who have CAD, do not experience symptoms, and many of the symptoms listed above can be caused by other conditions. It is important to check with your physician if you experience these symptoms.

Are there tests which diagnose coronary artery disease?
If you have symptoms, or are at high risk, your doctor may perform or order tests to confirm the diagnosis of coronary artery disease. or to asses its severiety the severity. These tests include: an electrocardiogram (ECG), an echocardiogram, an exercise stress test (treadmill test), cardiac catheterization or a gated blood pool scan.

What can I do to prevent coronary artery disease?
Many factors increase the risk of developing coronary artery disease. They include: high levels of cholesterol in the blood, age (45 or older for males, 55 or older for women), diabetes, menopause without estrogen replacement therapy, family history of premature coronary heart disease, smoking, high blood pressure (hypertension), sedentary lifestyle, obesity, and poor stress management.

Although you cannot change your age, gender, or family history, you can take steps to lower the other risks. Don't smoke. Follow a diet that is low in saturated fat and cholesterol. Take your medications to control your high blood pressure and diabetes. Lose weight, exercise regularly, and employ stress avoidance/stress reduction techniques.

What is a heart attack?
A heart attack (myocardial infarction) occurs when a coronary artery abruptly fails to deliver blood to a part of your heart. The portion of the heart's muscle (myocarium) that is deprived of oxygen, will be permanently destroyed.

The heart muscle affected doesn't die all at once; rather a heart attack is a continuous process that may last from four to six hours. As time passes, without an intervention to improve blood flow, more heart muscle is deprived of oxygen and dies.

Although a part of your heart has died, the rest of your heart continues to work and pump blood throughout your body.

What causes a heart attack?
Usually, a heart attack is caused when a plaque abruptly cracks or "ruptures" Plaque sometimes abruptly cracks and breaks off from the arterial wall. A blood clot may then rapidly form over the disrupted plaque. This clot can completely clog the coronary artery.

Sometimes a coronary artery contracts in a spasm. This can also narrow the artery, prevent blood flow to part of the heart, and cause a heart attack.

What are the symptoms and warning signs of a heart attack?
During a heart attack, you may experience angina which is not relieved with rest or nitroglycerin.

The pain may be intense. It may feel like a tight band or as if an elephant is sitting on your chest. Some people experience the pain as a squeezing, burning, crushing, or choking sensation.

For others, a heart attack feels like intense indigestion. The pain may spread to your shoulders, neck, arms, back, abdomen, teeth or jaw.

You may feel weak, lightheaded, or short of breath. You may faint. You may feel nauseated, and may vomit. Some people sweat profusely; others have dry mouth. Many people experience anxiety and/or have a feeling of "impending doom."

What should I do If I am having a heart attack?
First you must admit that you may be having a heart attack. Unfortunately, due to fear and anxiety, many people deny this possibility, and fail to get the immediate medical attention they require. It is better to face embarrassment if you are mistaken in your belief that you are having a heart attack, than to make a fatal error through denial.

Next, remember that time is of the utmost importance. You can prevent further injury to your heart by getting to a hospital emergency room immediately. Hospitals are equipped to provide therapy which limits the extent of damage to your heart. Every minute that you delay in obtaining treatment can mean additional permanent damage.

If you have angina or are at risk for coronary artery disease, you can prepare in advance for such an emergency.

  1. Ascertain if your neighborhood has a 911 emergency calling system. If not, find and post by your telephones, the numbers of all the local. ambulance services Keep a copy of this list with you as well.
  2. Determine which hospitals in your area have emergency cardiac care.
  3. Consider wearing a medical alert bracelet or necklace.
  4. Consider subscribing to a medical alert phone system which allows you to get emergency help by pressing a button on a necklace.

What happens when I get to the hospital?
The staff in the Emergency Room (ER) will work on three aspects of your situation, simultaneously: they will confirm the diagnosis of myocardial infarction, they will treat your symptoms and make you feel comfortable, and they will try to prevent further damage to your heart and other complications.

You will be given nitroglycerin to lower the demands on your heart and help your blood flow. You may be given morphine intravenously for your pain. You will receive supplemental oxygen through a nasal tube.

The ER staff will take electrocardiograms. They will assess the difference between your initial ECG and one after nitroglycerin. The doctors will try to dissolve the blood clot which may be blocking your artery. This is usually accomplished through administration of a thrombolytic agent (a clot-busting drug ), such as streptokinase or tissue plasminogen activator .

A non-surgical technique known as "coronary angioplasty", can be performed to facilitate the flow of blood without using a clot-busting drug. At some centers, angioplasty is the preferred method of treating a heart attack.

You may have to undergo emergency open-heart surgery called, "coronary artery bypass surgery" which will enable other blood vessels to take over for the occluded coronary artery or arteries.

The doctors will also diagnose and treat potential complications, such as life threatening abnormal heart rhythms (arrhythmias).

What complications may occur immediately?
Immediate complications may include cardiac arrest and less severe arrhythmias.

If there is a significant amount of heart muscle damage, the heart may be temporarily weakened and pump blood inefficiently (heart failure). In rare cases, heart failure will be so severe that blood flow to the other parts and organs of your body. is inadequate (cardiogenic shock).

What will my recovery in the hospital be like?
As your heart heals, scar tissue will form to replace the damaged cells

While you are in the hospital you will be monitored and tested to determine the extent of damage to your heart, the level of your heart's functioning, the severity of your underlying coronary artery disease, and whether there were any complications from the heart attack.

You may undergo: blood tests, blood pressure monitoring, electrocardiograms, exercise stress tests, echocardiograms, gated blood pool scans, and cardiac catheterization.

As you get stronger, your activities in the hospital will increase. You will move from complete bed rest, to sitting in a chair, to walking. You will graudally increase your levels of exercise, self care, and amount of time with visitors.

How long will I have to stay in the hospital?
Your hospitalization may be a few days to two weeks.

What are the consequences of a heart attack?
Your prognosis will be based on the extent of damage, the severity of the underlying coronary disease, and whether or not therehave been any long term complications. Complications may Include: inflammation of the sac which surrounds the heart (pericarditis), arrhythmias, low blood pressure, weakness, fatigue, and heart failure.

Is there anything I can do to prevent another heart attacks?
You can make lifestyle changes to control your risk factors for a heart attack.

In addition, avoid strenuous physical activity if it is very hot or cold outside. Stay indoors during extreme weather.

Avoid eating large meals as they may make your heart work harder. Eat several small meals throughout the day.

Aspirin has been proven to lower the risk of a second heart attack. Other medications that can lower the risk of a second heart attack include beta blockers and some drugs which lower cholesterol. Talk to your doctor about which medications are best for you.

What will my life be like after a heart attack?
After your heart attack, you may have new feelings and concerns. It is not unusual to feel depressed, worried, angry or afraid. Avoid keeping these feelings bottled up. Share them with your family or close friends. You may choose to speak with a professional counselor.

Your family members may also have strong feelings concerning your heart attack. Among these feelings are fear, guilt, and anger. Members of your family can join "Mended Hearts", a national support organization which helps family members deal with the emotional recovery from heart disease.

According to the American Heart Association (AHA), most people are able to go back to work in one to three months following their heart attack. If you are interested in changing to a less stressful job, the AHA has vocational rehabilitation programs which can help you.

Consult with your doctor as to when you may resume sexual activity. Most people are able to have sex from three to six weeks after a heart attack. Do not hesitate to voice your concerns to your physician. He will answer your questions and advise you as to the safest and most comfortable methods.

Ask you physician to recommend a cardiac rehabilitation program for you Rehabilitation programs provide excellent opportunities to lower your cardiac risks and prevent another heart attack. These programs usually consist of monitored exercises, cardiac testing, nutritional counseling, and classes in smoking cessation and stress reduction.

Your doctor will help you develop a plan for gradually increasing your levels of activity. Most likely you will be able to return to your former lifestyle (including recreational activities and less strenuous sports, such as golf) within a few weeks to months after your heart attack.

What are the statistics concerning heart attacks?
According to the American Heart Association:

  • Coronary heart disease (CHD) is the single largest killer of Americans.
  • About every 29 seconds, an American will suffer a heart attack. About every minute, someone will die from one.
  • At least 250,000 people a year die of CHD within one hour of the onset of symptoms and before they reach a hospital. These are sudden deaths caused by cardiac arrest, usually resulting from ventricular fibrillation.
  • Approximately 7,200,000 people in the United States suffer from angina.
  • Among people who've had a heart attack, sudden death occurs at from 4 to 6 times the rate of the general population.
  • Within 6 years of a recognized heart attack: 23 percent of men and 31 percent of women will have another heart attack; 13 percent of men and 6 percent of women will experience sudden death.; but 20 percent will be disabled with heart failure.
  • About two-thirds of heart attack patients don't make a complete recovery, but 88 percent of those under age 65 are able to return to their usual work.


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