HEART ATTACK

HEART ATTACK Heart attack (myocardial infarction), (myocardial infarct), (myocardial infarction) is a situation where all of a sudden happen restriction or termination of blood flow to the heart, causing the heart muscle (myocardium) to die from lack of oxygen. CAUSE A heart attack usually occurs when a blockage in a coronary artery results in limited or cut off blood flow to a part of the heart. If the interruption or reduction of blood flow lasts longer than a few minutes, the heart tissue will die. Pumping ability of the heart after a heart attack is directly related to the extent and location of tissue damage (infarct). If more than half of the damaged heart tissue, the heart can not function normally and the possibility of death. Even though the damage was not extensive, the heart can not pump properly, resulting in heart failure or shock. Damaged heart may enlarge, and partly an attempt pumping ability of the heart to compensate for the decline (due to the larger heart will beat more powerful). An enlarged heart is also a picture of the damage to the heart muscle itself. Enlargement of the heart after a heart attack gave a poorer prognosis. Another cause of a heart attack are: # A clot from the heart itself. Sometimes a clot (embolus) are formed in the heart, then broke and lodged in the coronary arteries. # Spasm of the coronary arteries that lead to the cessation of blood flow. Seizures can be caused by drugs (such as cocaine) or because of smoking, but sometimes the cause is unknown. SYMPTOMS About 2 out of 3 people who had a heart attack, a few days before the attack pain intermittent chest, shortness of breath or fatigue. Chest pain more often appear even after light physical activity. Unstable angina like this could end up being a heart attack. Pain in the middle of the chest radiating to the back, jaw or left arm, or more rarely spread to the right arm. Pain can occur in places where it no chest pain at all. Pain similar to a heart attack angina pain but more intense and longer, not relieved by rest or giving nitroglliserin. Sometimes the pain is felt in the abdomen and misinterpreted as a meal, especially because after burping pain sufferers somewhat diminish or disappear for a while. Other symptoms are feeling like going to faint and palpitations. Abnormal heart rhythms (arrhythmias) can affect the heart's pumping ability or may cause cardiac arrest (heart stops pumping effectively), resulting in a decrease of consciousness or death. During the attack, the patient may feel restless, sweating and anxiety and can feel his end was coming soon. The lips, hands and feet look bluish. Patients with advanced age may experience disorientation (daze). A total of about 1 in 5 people who had a heart attack, have only mild symptoms or no symptoms at all. Heart attack like this could only be identified from routine ECG examination some time later. COMPLICATIONS Is a frequent complication of myocardial rupture, blood clots, arrhythmia (heart rhythm disorders), heart failure or shock or pericarditis. Myocardial rupture The damaged heart muscle becomes weak, so sometimes have tears because of the pressure of the pumping action of the heart. 2 parts of the heart that often have rips during or after a heart attack is the muscular wall of the heart and the muscles that control the opening and closing of one of the heart valves (valve mitralis). If the muscle tear, the valve can not function so sudden severe heart failure. Heart muscle wall that restricts both ventricles (septum) or on the outer wall of the heart muscle may also experience tears. A torn septum can sometimes be corrected by surgery, but a tear in the outer wall almost always results in death. Heart muscle damaged by a heart attack will not contract properly despite not having a tear. Damaged muscle is replaced by fibrous scar tissue is rigid and can not be contracted. Sometimes this section will swell when it should contract. To reduce the extent of the area that this function can not be given an ACE-inhibitor. Damaged muscle could form a small protrusion on the heart wall (aneurysm). The existence of the aneurysm can be known from an abnormal EKG, and to reinforce this notion can be done echocardiogram. Aneurysm will have no rips, but can cause irregular heart rhythm and can cause a reduction in the heart's pumping ability. The blood flow through the aneurysm will be slower, because it can form clots in the heart chambers. Blood clot In about 20-60% of people who have had a heart attack, a blood clot formed in the heart. In 5% of patients, the clot may break, flow in the artery and lodged in a smaller blood vessels throughout the body, causing blockage of blood flow to part of the brain (causing a stroke) or to other organs. To find a clot in the heart or to determine predisposing factors owned by the patient, performed an echocardiogram. To help prevent the formation of blood clots, often given anticoagulants (such as heparin and warfarain). This medicine is usually taken for 3-6 months after a heart attack. Diagnosis If a man over 35 or a woman over 50 years old complained of chest pain, usually considered the possibility of a heart attack. Diagnosis of heart attacks could be strengthened by doing the following checks: 1. ECG When a suspected heart attack, the ECG is the initial diagnostic examination of the most important. Some abnormalities can be seen on an EKG, depending on the size and location of damage to the heart. 2. Blood tests Blood tests are performed to determine the levels of certain enzymes. CK-MB enzyme normally found in heart muscle and is released into the blood when there is damage to the heart. Elevated levels of this enzyme will appear within 6 hours after a heart attack and persist for 36-48 hours. Enzyme levels are usually checked at the time of patient admission and every 6-8 hours during the next 24 hours. 3. Echocardiogram Echocardiogram will describe the reduced movement of a portion of the wall of the left ventricle (heart chamber that pumps blood throughout the body), which is an indication of damage due to a heart attack. 4. Radionuclide imaging. The depiction of the radionuclides may show reduced blood flow to a part of the heart muscle, which is indicative of scar tissue (dead tissue) caused by a heart attack. TREATMENT A heart attack is an emergency. Half of deaths from heart attack occur within the first 3-4 hours after the occurrence of symptoms. The sooner help is given, the more likely the patient can be helped. A person suspected of having a heart attack is usually treated in the cardiac care unit and to assess heart damage, strict monitoring of the heart rhythm, blood pressure and the amount of oxygen in the blood. Early Treatment Usually immediately given aspirin tablet must be chewed. This medication reduces the formation of blood clots in the coronary arteries. Beta-blockers are given to slow the heart rate and the heart that do not work too hard to pump blood around tubuh.Oksigen often administered through a facemask or a small tube that is inserted into the nostrils. By administering oxygen, the pressure of oxygen in the blood will increase so that more oxygen to the heart and heart damage can be minimized. If a blockage in a coronary artery can be overcome, then the cardiac tissue can be saved. Blood clots in the arteries can often be dissolved by thrombolytic therapy, by giving streptokinase, and tissue plasminogen activator urikinase. To be effective, the drug is given intravenously within 6 hours after the symptoms of a heart attack, because if it is more than 6 hours, some will settle its damage. Early treatment improves blood flow in 60-80% of patients and can minimize the damage to heart tissue. Aspirin (to prevent blood clots from forming platelets) or heparin (to stop bleeding) can add to the effectiveness of thrombolytic therapy. Thrombolytic therapy may cause bleeding, so it is usually not given to people who: - Gastrointestinal bleeding - Have severe high blood pressure - Recently suffered a stroke - New surgery. Patients older who do not have the above-mentioned circumstances, can safely undergo thrombolytic therapy. Some hospitals are using angioplasty or coronary artery bypass surgery immediately after a heart attack. Nitroglycerin can overcome the pain by reducing the workload of the heart, and is usually given intravenously initially. If the drug is used to improve coronary artery blood flow was also not successful in reducing the symptoms of a heart attack, it is usually given an injection of morphine. Morphine is also sedative and reduces the heart's workload. Advanced Treatment Someone who has had a heart attack, should undergo complete bed rest in a quiet room for several days, due to excitement, physical activity and emotional stress can aggravate the jantung.Pelunak feces and laxatives can be used to prevent sembelit.Kecemasan and depression often occur after a heart attack. Severe anxiety could weigh on the heart, so it is given a sedative. ACE-inhibitors are routinely given to reduce heart enlargement, which often occurs after a heart attack. Prognosis The majority of patients who survive for several days after a heart attack may experience complete healing: but about 10% die within 1 year. Death occurs within the first 3-4 months, especially in patients who re-experiencing angina, ventricular arrhythmias and heart failure. REHABILITATION Cardiac rehabilitation is an important part of the healing process. Staying in bed for more than 2-3 days will cause the cessation of physical activity and sometimes lead to depression and a sense of dependence. On the third or fourth day after a heart attack, the patient is gradually trained to sit, passive activities, walked into the bathroom and engage in activities that do not cause stress (eg reading). After 3-6 weeks, the patient should gradually increase their activity. If no shortness of breath and chest pain, normal activities can be re-done after about 6 weeks. PREVENTION # As much as possible reduce the factors that lead to coronary artery disease, especially those that can be changed by the patient: Stop smoking # Lose weight # Controlling blood pressure # Lowering blood cholesterol levels with diet or with medication # Perform regular exercise.