Are there different types of heart attacks? If so, what are they?
Based on the variation in the ECG during a heart attack, doctors recognize two types of heart attacks.
ST-elevation Myocardial Infarction (STEMI)
Non-ST-elevation Myocardial infarction (NSTEMI).
STEMI and NSTEMI differ not only in the variation in the ECG but also in their severity. In general, STEMI is more likely to be immediately fatal or disabling than NSTEMI. Consequently, STEMI requires more urgent treatment than NSTEMI in most instances.
However, this is just a thumb rule: Some NSTEMIs can be equally ominous and may require emergency treatment just like STEMI.
What should I do if I have symptoms suspicious of a heart attack?
First, seek help. Make any person in proximity aware of your situation. The most important step to ensure a safe outcome in a heart attack is to see that you reach a hospital with appropriate facilities as soon as possible. It is a good practice to be aware of the hospitals around you and the facilities they provide.
When someone has chest pain or other symptoms suggestive of a heart attack, the immediate first aid should be to take 350 mg of the soluble form of Aspirin (common trade names Disprin or Aspisol in India). Ideally, the tablet should be chewed because the medicine is absorbed from the mucosal membrane of the oral cavity and starts to act immediately. If the patient cannot chew the tablet for some reason, the tablet can be dispersed in a small quantity of water and taken orally.
If I see someone who is having a heart attack, what can I do to ensure he survives till help arrives?
Call the nearest hospital with cardiac facilities as soon as you recognise that someone around you might be having an ongoing attack. Shift the person to a comfortable position and reassure them. If possible, give them an Aspirin tablet to chew. While waiting for help to arrive, monitor their breathing and pulse. If they lose consciousness, initiate Cardiopulmonary resuscitation (CPR).
What are the common causes of heart disease?
Various risk factors increase the chances of a person having a heart attack. Smoking, High Blood pressure, Diabetes. physical inactivity, high cholesterol levels, obesity, and poor diet are important risk factors. These can be potentially controlled to reduce heart attack risk. Therefore, these are termed Modifiable Risk factors.
Older age, male sex, family history, Post-menopausal state in women are factors that can increase heart attack risk but cannot be altered. These are called non-modifiable risk factors.
South Asians appear to have a very high risk of having heart attacks at a younger age, compared to Caucasians and Asians such as Japanese.
What is Coronary Angiography?
It is a procedure to detect blockages in the blood vessels of the heart. A thin hollow tube or catheter is inserted via the artery of the forearm or the thigh. Through this catheter, a special contrast dye is injected into the coronary arteries and X-ray images are obtained to visualize the blood flow in the coronary arteries.
What is Coronary Angioplasty?
Coronary angioplasty is a procedure performed to widen narrow or blocked sections of the coronary vessels thereby restoring the blood flow. A thin balloon is inserted into the coronary artery and inflated at the site of the block to widen the narrowed artery. This makes a way for the opening of the blockages. A stent is generally then placed to prevent future blockages.
What is Coronary Artery Bypass Grafting (CABG) Surgery?
Coronary Artery Bypass Grafting (CABG) is a procedure where a surgeon makes new routes (bypass) around blocked or narrowed coronary arteries with one or more grafts allowing increased blood flow to the vessel past the blockage. These grafts are typically healthy blood vessels from the chest, arm, or leg of the patient.
What are the various types of heart diseases?
There are various types of disorders related to the heart.
Congenital heart disease is a defect of the heart which are present since birth.
Arrhythmias are abnormal heart rhythm or irregular heartbeat affecting the electrical conduction.
Coronary artery disease is caused by the narrowing of the coronary arteries leading to the decreased blood supply to the heart.
This can potentially lead to angina, heart attacks, weakening of the heart muscle, or sudden death.
Cardiomyopathy refers to diseases affecting the heart muscle. Some types of cardiomyopathy are genetic, while others occur because of an infection or reasons that are less well understood.
Heart failure happens when the heart is not properly pumping blood throughout the body. In this condition often the heart's pumping capacity is reduced.
Valvular heart disease affects how the valves function to regulate blood flow in and out of the heart chambers.
Hypertension is a condition in which the blood vessels have persistently increased pressure, putting them under increased stress. It is often known as high or raised blood pressure.
Pericardial diseases affect the outer layer (pericardium) of the heart. It can be affected by a variety of conditions that include inflammation (pericarditis), stiffness (constrictive pericarditis), and fluid accumulation (pericardial effusion).
How are heart attacks treated?
As soon as a diagnosis of heart attack is made, blood-thinning medications (Aspirin, Clopidogrel are common ones) are administered. The definitive treatment is Coronary angiography followed by primary coronary angioplasty to restore blood flow in the coronary artery causing the attack.
However, if for some reason, angioplasty cannot be performed, certain medicines (thrombolytic drugs, or clot busters) are administered in the form of injections. Primary Angioplasty is a more effective and safer form of treatment for a heart attack, but in some circumstances (e.g., remote areas) these drugs can be life-saving.
Can a stent get blocked again? Is it possible to insert another stent in the same place?
Yes. In about 5-10% of patients, especially those who are not on medication, have uncontrolled diabetes, develop kidney failure, or continue to smoke, stents can show narrowing (restenosis). If a disciplined lifestyle is not followed, new blockages can appear in other areas of the vessels too.
Stent restenosis can be treated by balloon angioplasty, a second stent, drug-coated balloons, or by Bypass surgery.
What is Normal blood pressure?
Normal blood pressure is defined as blood pressure of 120 mmHg systolic, 80 mmHg diastolic. Blood pressure of 140/90 or higher is termed as hypertension.