Heart

Overview

When an area of the heart muscle does not get enough blood (ischemia), chest pain or discomfort, called angina, occurs. Unstable angina may mean that impaired blood flow is worsening or that you have an unstable plaque that may soon rupture and cause a heart attack. However, a heart attack can also occur in blood vessels that have normal blood flow. A heart attack (also called myocardial infarction, or MI) occurs when an area of heart muscle is completely deprived of blood and the heart muscle cells die.

A heart attack may result when the plaque inside the heart arteries breaks open or ruptures, resulting in a blood clot that significantly blocks blood flow through the artery. The amount of heart muscle that dies during a heart attack depends on how long the blood was blocked and how large an area of heart muscle was deprived of its normal blood supply. Quick treatment of a heart attack can help restore blood flow and save heart muscle tissue.

The classic symptom of a heart attack is sudden, often severe chest pain. During a heart attack, chest pain may occur along with a cold sweat, nausea, a sense of doom, difficult breathing, or numbness or pain that spreads down the shoulder and arm. However, chest pain may not always occur with a heart attack; a recent study reported that as many as one-third of people diagnosed with heart attack did not experience chest pain.

Chronic heart failure is a lifelong, progressive condition that may require many lifestyle changes. Symptoms may include:

Shortness of breath at rest or with mild exertion.
Shortness of breath that wakes a person from sleep (paroxysmal nocturnal dyspnea).
Shortness of breath when lying flat (orthopnea).
Severe leg swelling.
Fatigue.
Dizziness or fainting (rare).
Over time, symptoms may worsen until they are always present.

Heart failure can also develop suddenly. This is called acute heart failure, a medical emergency that causes sudden severe shortness of breath, a sudden irregular or rapid heartbeat, and a cough that brings up foamy pink mucus.

Treatment for heart failure may involve managing the underlying cause of heart failure, relieving symptoms, reducing the need for hospital stays, and reducing the risk of premature death. Medications may help to manage symptoms, and in some cases, surgery may help treat underlying causes, such as coronary artery disease or heart valve problems.

Treatment

A person in the emergency room having chest pain or signs of heart attack is quickly evaluated and treated. If there is no indication of heart attack, treatment for unstable angina usually involves using medications that help thin the blood and prevent blood clots. Other medications may also be used to decrease the workload on the heart. In some cases, emergency revisualization procedures such as angioplasty or coronary artery bypass may be needed.

Hospitalization is needed to monitor and treat a person for complications caused by a heart attack and to provide bed rest and oxygen therapy. Medications to control blood pressure, prevent sudden death, and decrease the workload on the heart also may be given. In some cases, nitroglycerin or morphine are needed to control chest pain.

If there is an indication that a heart attack has occurred, early treatment (within a few hours of when the heart attack starts) is very important to reduce the amount of injury to the heart muscle. Emergency treatment of a heart attack usually involves oxygen therapy, medications to break up the blood clot causing the heart attack, and medications to prevent new blood clots from forming. Emergency angioplasty may be needed. Early use of medications that dissolve blood clots (thrombolytics), aspirin, emergency angioplasty and/or stent placement, or bypass surgery can sometimes help prevent permanent injury to the heart muscle from a heart attack.

Treatment following a heart attack involves specific medications and cardiac rehabilitation to reduce your risk of another heart attack or complications of a heart attack, such as heart failure. Medications called angiotensin-converting enzyme (ACE) inhibitors and beta-blockers can help prevent heart failure and irregular heartbeats (arrhythmias), both of which can develop after a heart attack. Cholesterol-lowering medications usually are started as well to lower blood cholesterol levels into the safe range. Anticoagulants (blood thinners) may be used after a heart attack to lower the risk of another heart attack or to prevent blood clots from forming in the heart, which could cause a stroke.

When a heart attack is in progress, you have little time to make decisions. Because prompt treatment can save heart muscle from being permanently damaged, treatment decisions must be made quickly. Early use of medications, angioplasty, stenting, or surgery to restore blood flow soon after symptoms first begin is important to prevent permanent injury to the heart muscle.

Some aspects of treatment for a heart attack and unstable angina will vary from invasive emergency treatment (such as angioplasty) to a more conservative approach (such as treatment with medications), depending on how stable you are and whether it is possible to prevent an impending heart attack. For example, if you have unstable angina, aggressive treatment may be tried in an attempt to prevent a heart attack. If you have already suffered a heart attack, treatment will be focused on assessing the damage to heart muscle and preventing complications.

A recent important study showed that taking aspirin combined with another ant platelet called clopidogrel (Plavix) for unstable angina or heart attack reduced the risk of death, another heart attack, or stroke by 20%. 3

After a heart attack, people usually require long-term treatment with medications (such as aspirin, beta-blockers, and ACE inhibitors) and lifestyle changes to prevent complications.

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