HEART ATTACK

Compiled By R.Solainathan, CPF No. 36875 Mine-I, Planning. NLC Phone No - 3054

Cardiovascular System - Heart Attack

I. Definition of a heart attack -Coronary (crown) Artery Disease -Heart attack = loss of blood to heart due to artery damage -What causes artery damage?

Definition of a Heart Attack

Sudden blockage of blood flow to a portion of the heart. Medical term: MI myocardial infarction (heart muscle Copyright 2006 Dr. Salme damage) Taagepera, All rights reserved.

http://www.ehealthmd.com/yms_images/exhr0001.jpg

Obstruction blood flow -Blood clots can form in Brain blood vessel: thrombus (60%) atherosclerosis! Body blood vessel, then travel to brain: embolus (20%)
Copyright 2006 Dr. Salme Taagepera, All rights reserved.

Key component of plaques: cholesterol

What is cholesterol? Cholesterol is a fatty substance found in all parts of the body Used by the body to make: Cell membranes Steroid hormones Vitamin D Sources of cholesterol Liver and diet

Bad v. Good Cholesterol!

Lipoprotiens
A lipoprotein is a biochemical assembly containing both proteins and lipids (fats).

Function of LDL v. HDL? LDL = carries cholesterol to cells HDL = carries cholesterol away from cells Here the driver and truck would be the lipoprotien.
Lipoproteins in the blood, a water medium, carry fats around the body.

Copyright 2006 This is an example of aDr. Salme good artery. Taagepera, All rights fairly reserved.

This one is not so good. Note the narrowing of the artery, which decreases the Copyright 2006 Dr. Salme amount of blood flow. Taagepera, All rights reserved.

Copyright 2006 Dr. Salme Good, or not so good?

Taagepera, All rights reserved.

This is an example of an artery with 100% blockage.

Copyright 2006 Dr. Salme Taagepera, All rights reserved.

Copyright 2006 Dr. Salme Taagepera, All rights reserved.

Heart Attack

Unlike angina, heart muscle dies during a heart attack, and loss of the muscle is permanent. While heart attacks can occur at any time, most heart attacks occur between 4:00 A.M. and 10:00 A.M. because of the higher blood levels of adrenaline released from the adrenal glands during the morning hours. Increased adrenaline may contribute to rupture of cholesterol plaques.
http://www.medicinenet.com/heart_attack/article.htm

Warning signals of a heart attack

Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting more than a few minutes. Pain spreading to the shoulders, neck or arms. The pain may be mild to intense. It may feel like pressure, tightness, burning, or heavy weight. It may be located in the chest, upper abdomen, neck, jaw, or inside the arms or shoulders. Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath. Anxiety, nervousness and/or cold, sweaty skin. Paleness or pallor. Increased or irregular heart rate. Feeling of impending doom. Dr. Salme Copyright 2006
Taagepera, All rights reserved.

 Not all of these signs occur in every attack. Sometimes they go away and return. If some occur, get help fast. IF YOU NOTICE ONE OR MORE OF THESE SIGNS IN YOURSELF OR OTHERS, DON'T WAIT. CALL EMERGENCY MEDICAL SERVICES (9-1-1) RIGHT AWAY!
http://www.heartinfo.org/hrtatkang.html

Cardiovascular System II - Heart Attack I. II. Definition of a heart attack How is a heart attack diagnosed? - Coronary risk factors
Smoking Lack of physical activity Stress Alcohol Family history

- Blood test
Standard markers : cholesterol, tri glycerides New: homocysteine, C-reactive protein, fibrinogen

How do doctors diagnose a heart attack?

1. Review the patient's complete medical history. 2. Give a physical examination. 3. Use an electrocardiogram (or EKG) to discover any abnormalities caused by damage to the heart. 4. Use a blood test to detect abnormal levels of certain proteins/enzymes in the blood.

Medical history/physical exam reveals risk factors

High blood pressure promotes vessel damage High blood cholesterol levels promotes atherosclerosis Smoking - increases vessel inflammation promoting increased atherosclerosis, promotes excessive blood clotting Lack physical activity leads to high blood pressure and obesity Stress raises blood pressure Alcohol in moderation can increase HDL (good cholesterol), excessive levels lead to increased blood pressure and triglyceride levels Family history of heart attack genetic conditions may raise cholesterol levels, blood pressure; poor health habits

What lasting damage can a stroke cause?

The effects of a stroke depend on the extent and the location of damage in the brain. Among the many types of damage that can result from a stroke are: Inability to move part of the body (paralysis) Weakness in part of the body Memory loss Inability to speak or understand words Change in personality Confusion or poor judgment Difficulty swallowing Question: Why does a stroke affect different parts of the body? Answer: ???

How to help a stroke victim: Call 911 Have him lie down Lift chin to clear airway Check for breathing and pulse If he is unconscious, roll him on his side Do not give food or drink Reassure and comfort

Heart Attack analysis - blood test

Cholesterol: LDL, HDL Triglycerides High levels of blood

1. Homocysteine 2. C-reactive protein 3. fibrinogen

http://www.coral-cure.com/images/Cholesterol-test.jpg

Cardiovascular System II - Heart Attack

I. Definition of a heart attack II. How is a heart attack diagnosed? III. Treatment - medication - intervention - bypass surgery

Copyright 2006 Dr. Salme Taagepera, All rights reserved.

Heart attack - treatment

Medications for this purpose may include:
aspirin
anti-inflammatory prevents platelets from sticking together to form clots

heparin
blood-thinner

thrombolytic therapy
"clot busters" break apart fiberous tissue holding clot together

Statins?
typically used to lower cholesterol levels appears to lower inflammation of heart muscle after attack

Interventional procedures
Angioplasty Stents
open up the narrowed arteries break up any clots that are blocking them

Coronary artery bypass surgery

If necessary, bypass surgery may be performed to restore the heart muscle's supply of blood.

Heart attack treatment: medication

Clot buster drugs need to be administered within three hours heart attack -Every minute of delay shaves 11 days off a heart attack patients life

Heart attack treatment: Balloon Angioplasty

A catheter (fine, hollow tube) passed into an artery in groin or arm X-ray used to guide catheter to blocked vessel Balloon inflated As balloon is inflated, stent (short tube of stainless steel mesh) expands Balloon removed, leaving stent in place
http://images.google.com/imgres? imgurl=http://www.bhf.org.uk/hearthealth/uploaded/coronaryangioplasty-withs.gif&imgrefurl=http://www.bhf.org.uk/hearthealth/index.asp %3FsecID%3D1%26secondlevel%3D79%26thirdlevel %3D456%26artID %3D1589&h=511&w=350&sz=17&tbnid=ObJvlfDtbWoJ:&tbnh=128&

Heart attack treatment: bypass surgery

Bypass surgery creates new pathways of circulation around existing blockages A healthy blood vessel from another part of the body becomes a "conduit" to the coronary artery at a point beyond the narrowed artery. The blocked or narrowed portion of the artery is "bypassed" with this vessel, allowing blood to flow to the heart muscle again.
http://www.well-net.com/cardiov/bypass1.jpg

Bill Clinton to Undergo Bypass Surgery Sept. 3, 2004

Former President Bill Clinton will undergo heart bypass surgery as early as Saturday, sources tell CNN. Clinton was in New York-Presbyterian Hospital on Friday undergoing tests for chest discomfort.

Cardiovascular System II - Heart Attack

I. Definition of a heart attack II. How is a heart attack diagnosed? III. Treatment IV. What can you do to prevent a heart attack? -Improve your diet!
vs.

What fats should you eat?

Saturated fats Most animal fats are saturated

Unsaturated fats Most plant fats are unsaturated (canola, olive oil)

Copyright 2006 Dr. Salme Taagepera, All rights reserved.

Key points to remember

Dietary Habit
Healthy amounts of unsaturated Too much of saturated Any amount trans

How it effects us
fat
Reduces LDL and increases HDL

fat

Increases LDL

fat

Increases LDL and reduces HDL

Too much of any type of fat

Increases weight ** and increases triglycerides

Diet rich with Essential Fatty Acids with Lowers triglycerides, lowers blood proper ratio of omega-3 and omega-6 fats pressure, increases HDL ** could lead to increase in blood sugars, blood pressure as well as cholesterol.

Heart Attack - SUMMARY

1. Coronary artery disease (CAD): blockage of the arteries leading to the heart muscle resulting in
- partial (heart attack) or - full loss (heart failure) of heart muscle activity 2. Causes of CAD: - poor diet (increases cholesterol levels) - anything that increases inflammation of the blood vessels 3. Diagnosis of heart attack complex: - cholesterol, homocysteine, C-RP, fibrinogen 4. Current treatment: - intervention or bypass surgery recommended - recent study shows medications are equally effective?

5. How avoid CAD?

- eat well: =replace animal fats with plant fats (oils) =avoid partially hydrogenated / trans fat products =eat correct levels of ocean fish

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