Myocardial infarction is usually due to a blood clot being formed that completely or partially clogs the heart’s coronary artery so that the blood cannot pass as it usually does. The part of the heart that would have received the blood from the blocked coronary artery may be deficient in oxygen and damage to the heart muscle.

In the event of a heart attack, the heart may be damaged so that it cannot work as well as before. Myocardial infarction can be life-threatening and requires immediate hospital care. The earlier you receive care, the greater the possibility of limiting the development of myocardial infarction.

Symptoms of myocardial infarction

Here are some common symptoms of a heart attack:

  • Strong and persistent chest pain that can radiate into the arms
  • The feeling of discomfort in the chest that can radiate up to the neck, jaws, and shoulders
  • Nausea
  • Respiratory distress
  • cold sweats
  • Fear and anxiety
  • Pain in the back
  • Palpitations and dizziness
  • Influenza-like symptoms at the same time with chest pain.

Vague symptoms can also be infarction

You may not get chest pain if you are older or have diabetes and have a heart attack. The symptoms may then be diffuse, such as shortness of breath or severe fatigue. It can hurt less and you may not think it is that serious.

Chest pain may be different than infarction

Chest pain is one of the most common reasons for seeking emergency hospital care. That you have chest pain does not mean that you have a heart problem. They can occur for many other reasons, such as the following:

  • Irritation of the mucous membrane in the lower part of the esophagus
  • Stomach and gallbladder wall disorders
  • Diseases of the lungs
  • Disorders of the chest or upper body muscles
  • infections
  • anxiety or anxiety.

How can you have such different symptoms in myocardial infarction?

When and where should I seek care?

  • You have a pressing or spasmodic pain in the chest that does not go over. 
  • You have an unclear and unpleasant feeling in your chest that lasts longer than 15 minutes and that you do not know what it is due to.
  • You have chest pain and at the same time are breathless and cold sweaty or have chest pain in combination with irregular heartbeats.
  • Someone has fainted and has fainted for more than a minute.

Surveys

If you have chest pain that may be due to myocardial infarction, an ECG is taken which can provide your doctor with information about the heart being affected by oxygen deficiency. The ECG means that ten electrode plates are attached over the chest and over the wrists and joints. The ECG plates can be fixed already at home or in the ambulance by the ambulance staff. They send the results to the hospital so that a doctor can look at them.

If you are admitted to a cardiac-intensive care unit, you may also have ECG plates on you so that the healthcare staff can monitor whether your heart is getting oxygen deficiency or arrhythmia.

You may have blood tests every few hours to allow your doctor to determine if the heart muscle is damaged and if so, how much.

Other investigations

An ultrasound examination of the heart is always done to determine how big the heart attack is and how it has affected the heart’s pumping capacity.

Most often, a coronary x-ray is also done to survey the coronary vessels. Then insert the doctor into a thin plastic tube called a catheter through a blood vessel in the groin or wrist up to the coronary artery. When a contrast agent is injected, the constrictions possibly present in the coronary vessels are visible.

Sometimes you have to do a work test, which shows how the heart pumps during physical exertion. A work test is performed on an exercise bike or on a treadmill. During the test, symptoms, heart rate, blood pressure and ECG are checked. 

Treatment for myocardial infarction

If you have a heart attack, the coronary artery that has been blocked by a blood clot needs to be opened as soon as possible so that the blood can pass properly again. This is usually done with the so-called acute balloon dilation of the vessels and in some cases with a blood clot-releasing drug. You also receive treatment with other types of medication after discharge.

The faster the vessel can be opened, the greater the chance that the blood flow to the heart muscle is restored and the heart damage is minimized. If you live near a hospital that can do emergency balloon dilatation, the ambulance usually runs directly there. If you are more than two hours away from such a hospital, you will instead receive a propellant solution already at home or in the ambulance on the way to the hospital. 

A myth that it is possible to ward off a heart attack

There are myths that you avert a heart attack yourself, for example by coughing. But you cannot treat or ward off a heart attack on your own but must receive immediate care.

Common drugs for myocardial infarction

If you have a heart attack, you are given a variety of medicines that reduce the risk of a new heart attack.

Anti-platelet drugs

Anti-platelet inhibitors are blood clotting inhibitors that prevent clots called platelets from clumping and forming clots in the vessels.

Among the antiplatelet group are drugs that contain the active substances acetylsalicylic acid, clopidogrel, ticagrelor or prasugrel.

Beta-blockers

The drug lowers your heart rate and blood pressure so that your heart works more calmly and efficiently. Beta-blockers reduce the risk of a new heart attack. It is also an important treatment for heart failure, which is common after myocardial infarction.

Blodfettsänkare

In particular, the drugs called statins to lower the level of the harmful cholesterol LDL in the blood and reduce the risk of you getting new constrictions in the coronary vessels. At the same time, they can prevent the exacerbations that already exist from being exacerbated. Most often, you will receive a blood fat-lowering treatment as soon as possible if you have a heart attack.

ACE inhibitor

These drugs widen blood vessels and allow the heart to work more easily. 

Balloon angioplasty

In a balloon dilation, a physician inserts a plastic tube through a blood vessel into the arm or groin, into the coronary artery that has a constriction or stoppage. The balloon is placed in the middle of the constriction and filled with liquid so that it is inflated for a minute. Then the vasoconstriction is widened to improve blood flow. 

Balloon enlargement is done in conjunction with a coronary x-ray if the examination shows that it is appropriate.

Coronary artery surgery, or bypass surgery

Occasionally, the doctor will find distress in several places in the coronary vessels or in difficult-to-treat places. It can then be difficult to make an effective balloon expansion. Then the doctor can instead perform a  coronary artery operation, a so-called bypass operation. 

The surgery is done to direct the blood past the constrictions in the coronary heart, which improves blood circulation so that the heart gets more oxygen. This relieves the symptoms of angina and reduces the risk of a new heart attack ..

Unstable angina prior to infarction

It is common to have had unstable angina for days or weeks before the heart attack. The symptoms are chest discomfort or difficulty breathing when exerted or even when resting. Unstable angina can be a sign of a threatening heart attack. It is a warning signal which means that you should immediately go to a hospital for examination. 

You will be treated with antiplatelet drugs if you have angina to prevent the formation of a clot and a heart muscle injury. It is the same treatment as for acute myocardial infarction. At the same time, you usually have to undergo a coronary x-ray in order for the doctor to find out if the vessels are constricted and if a balloon enlargement or bypass surgery is needed.

Unstable angina and myocardial infarction are usually summarized in the concept of acute coronary artery disease.

About half of all myocardial infarctions occur suddenly without the trouble of angina.

What happens in the body?

The heart is a muscle that is large as a clenched hand and pumps out oxygen-rich blood to all organs of the body. The heart muscle also needs oxygenated blood for its work. It is the coronary arteries that supply the heart muscle with blood. The coronary vessels lie in pits on the outside of the heart and are filled with blood as the heart muscle rests between the heartbeats.

The constriction in the coronary arteries is caused by the fact that cholesterol, blood cells, and connective tissue have been stored in the vessel wall for many years. It is called atherosclerosis or atherosclerosis. Probably the vein fatigue starts by causing a small amount of damage to the inner vessel wall. When a blood clot later occurs due to damage to the vessel wall, the blood supply is blocked and the heart muscle is damaged by oxygen deficiency. 

In the event of acute myocardial infarction, stress hormones are released into the bloodstream, leading to increased blood pressure and the faster heartbeat. This further stresses the heart and increases the dangerous oxygen deficiency. The size of the heart attack depends on how long the oxygen deficiency has been going on and on the size of the vessel area that has been affected.

Other organs may also be affected

Because a heart attack damages part of the heart muscle, the heart can no longer work as usual. It can cause other organs in the body to function poorly. If the heart does not recover, you may develop heart failure as a result of the heart attack.

The most common cause of death in many countries

Cardiovascular disease is the most common cause of death in many counties. About half of the population of the Western world falls ill and dies in any of these diseases. A large part is due to acute coronary artery disease, ie unstable angina, and heart attacks.

Thanks to improved investigation and treatment, the number of people who have a heart attack has decreased. The increased knowledge of the importance of a healthy lifestyle that means eating healthy, being physically active and avoiding tobacco may have contributed to the reduction.

The prognosis after myocardial infarction has improved and mortality has decreased due to better treatment with effective drugs and coronary artery surgery. Mortality after myocardial infarction is very low but increases with older age. 

Gender differences in myocardial infarction

Men under the age of 60 are three times more likely to have a heart attack than women of the same age. Women usually have a heart attack five to ten years later than men. An explanation for the difference may be a protective effect of the female hormone estrogen. The older a woman gets, the lower the estrogen content she gets in the blood, and then gradually approaches the man’s risk of having a heart attack. 

Although more men than women fall into myocardial infarction, a higher proportion of women die from the disease. This is partly because the chance of surviving a heart attack is greater the younger you are when you get sick. 

How can I prevent myocardial infarction?

There may be things you do that increase the risk of having a heart attack. Most things you can influence with a changed lifestyle. The risk also increases as you get older. Here are some ways to reduce the risk of a heart attack:

  • Stop smoking and other tobacco use. Even if you have already become ill, there are major health benefits to quitting smoking.
  • Reduce harmful cholesterol (LDL) by eating more healthily. High blood fats increase the risk of getting artery fat, which in turn increases the risk of a heart attack.
  • Keep good control of your illness if you have type 1 diabetes or type 2 diabetes. Two out of three people who have a heart attack have an impaired turnover of sugar in the body.
  • Prevent high blood pressure, as it increases the risk of a heart attack. You can usually lower blood pressure with physical activity, but often drugs are also required. 
  • Be physically active regularly. A daily brisk walk of 30 minutes is good exercise and reduces the risk of getting coronary heart disease.

Heredity matters

The body’s ability to take care of blood fats and to transfer sugar into the blood is often hereditary. The cholesterol value depends a lot on heredity but also on the diet. There are some families where many have greatly elevated cholesterol levels with an increased risk of heart attack, known as hypercholesterolemia. If you have an inherited condition that increases the risk of atherosclerosis, you can receive treatment with special cholesterol-lowering drugs. It is extra important to try to influence the risk factors that exist and to test other relatives. 

Life after a heart attack

After a heart attack, it is common for you to be hospitalized for three to four days. Then you are on sick leave for a few weeks. How long depends on the size of the heart attack, what work you have, any complications and if you have other illnesses that worsen the condition.

It can be a shocking experience to suddenly fall ill in a heart attack. Thoughts on death and how things should go in the future are very common. You may be wondering if you can work, have sex or how the medications will affect your life. You can talk to healthcare professionals who are used to talking about these things.  

You usually get both oral and written information on a number of occasions, in order to more easily absorb the information.

Rehabilitation with hospital assistance

You will be called for continued checks after printing. In most hospitals, there are special cardiac rehabilitation units where doctors, nurses, dieticians, physiotherapists, occupational therapists, curators and sometimes psychologists work. As soon as possible, you will have access to the special unit’s resources for your rehabilitation if you have had a heart attack.

Having a myocardial infarction can make you feel less tired the first time after the infarction. It is then common to be scared to get sick again and it may prevent you from doing things that you would otherwise do. Try to listen to the body’s signals and adapt to the new situation. Ask your doctor or other healthcare professional about what applies in your particular situation.

The goal of rehabilitation is to be able to return to your normal life as soon as possible. The disease can bring limitations, and you must expect to change your lifestyle to reduce the risk of relapse. Keep in mind the following:

  • Physical exercise is part of the treatment and is harmless.
  • Increase your activities step by step.
  • Pay attention to the body’s signals.
  • Try to live healthily and eat healthily.

Advice to related parties

It can be difficult to cope with the new situation when someone near you gets a heart attack. To increase your readiness, you can take a course in cardiac rescue. You can also make sure there is a heart starter in your immediate area. 

You who are related to someone who has had a heart attack can be affected both practically and emotionally by the disease. A large part of the rehabilitation after a heart attack occurs at home. Your involvement in the recovery of your relatives can, therefore, be of great importance. You can ask to be involved in planning the rehabilitation already during hospital time. 

National guidelines for care

The National Board of Health and Welfare has developed national guidelines for how heart attacks and a number of other chronic diseases should be investigated and treated. The guidelines contain recommendations for health care about certain examinations and treatments that may be relevant to treating those with asthma.

Ehtisham Nadeem

Leave a Reply