Heart Attack: Causes, Symptoms, and Treatment

A heart attack is a life-threatening condition that occurs when blood flow to a part of your heart is suddenly cut off. Heart muscle needs oxygen and nutrients. This need is met through the coronary arteries that feed the heart. When one of these vessels becomes blocked, the heart muscle is deprived of oxygen and its cells begin to die. Therefore, a heart attack is a condition that requires emergency medical intervention. Early diagnosis and treatment are vital to limit damage to the heart muscle and save lives.

What is a Heart Attack?

A heart attack, medically called myocardial infarction, is a life-threatening condition that occurs when blood flow in one of the coronary arteries that feed your heart is suddenly cut off. Heart muscle needs continuous oxygen and nutrients to function healthily. This need is met through coronary arteries. When one of these vessels, usually completely blocked by a blood clot, causes that part of the heart muscle to be deprived of oxygen and its cells begin to die. This condition requires emergency medical intervention because every minute is critical to prevent or minimize permanent heart damage.

What are the Symptoms of a Heart Attack?

Heart attack symptoms can vary from person to person. While some people experience sudden and severe symptoms, others may encounter milder, vague, or gradual symptoms. Recognizing these symptoms well is vital for quick action.

• Chest Pain or Discomfort: This is the most common symptom of a heart attack. It can be in the form of pressure, squeezing, fullness, or crushing sensation in the center of the chest. This discomfort can last for minutes or come and go.
• Pain Radiating to Other Parts of the Body: Pain can radiate from the chest to the left arm, shoulder, back, neck, jaw, or stomach. In some cases, it is only felt in these areas.
• Shortness of Breath: Can occur together with chest pain or alone.
• Cold Sweating, Nausea, or Vomiting: Sudden and unexplained cold sweating, nausea, and vomiting sensation can be experienced.
• Dizziness and Weakness: Due to the heart’s inability to pump enough blood, sudden dizziness, lightheadedness, or extreme fatigue can be seen.
• Palpitation Sensation: Can manifest as irregular or rapid beating of the heart.

What are Heart Attack Symptoms in Women?

Heart attack symptoms in women are usually more different and less pronounced than in men. This situation can lead to misdiagnosis or delayed medical help. Symptoms commonly seen in women include:

• Chest Pain: Instead of sharp pain like in men, it can be in the form of pressure, tension, or fullness sensation in the chest.
• Shortness of Breath: Sudden onset shortness of breath that occurs before chest pain or without chest pain.
• Back, Shoulder, or Jaw Pain: Pain felt in these areas instead of chest pain is a common condition in women.
• Nausea and Vomiting: These symptoms, usually confused with flu or digestive problems, are more common in women.
• Extreme Fatigue: Unexplained and sudden onset extreme fatigue felt even while doing daily activities.

What Causes a Heart Attack?

The most important cause of heart attack is blockage of coronary arteries that feed the heart. The basic process leading to this blockage is atherosclerosis (arterial hardening). Atherosclerosis is plaque formation in vessel walls due to the effect of risk factors such as high cholesterol, hypertension, and diabetes. The mechanism that triggers a heart attack is usually as follows:

• Plaque Rupture and Clot Formation: Sudden rupture of a plaque in a coronary artery causes the body to send a blood clot to this area. This clot completely blocks the vessel, stopping blood flow. The vast majority of heart attacks occur this way.
• Coronary Spasm: Rarely, blood flow can be cut off as a result of sudden and severe contraction (spasm) of a coronary artery. This condition can especially be seen in people who smoke or consume stimulant substances like cocaine.

What are the Types of Heart Attack?

Heart attack is classified according to the severity of the blocked vessel and the extent of damage in the heart. This classification is usually made with electrocardiogram (ECG) and blood tests:

• STEMI (ST-Elevation Myocardial Infarction): This is the most serious type of heart attack. The coronary artery is completely blocked and a large part of the heart muscle is deprived of oxygen. Significant ST segment elevation is seen on ECG. Requires rapid treatment.
• NSTEMI (Non-ST-Elevation Myocardial Infarction): In this type, the coronary artery is partially blocked. Blood flow is reduced but not completely cut off. No significant ST elevation is seen on ECG, but an increase in enzymes showing heart damage is detected in blood tests.
• Silent Heart Attack: Although it occurs with the same mechanism as a normal heart attack medically, it is a type that does not show obvious symptoms.

How Does a Silent Heart Attack Occur?

Silent heart attack does not typically show obvious symptoms such as chest pain, shortness of breath, or cold sweating. Factors such as decreased pain sensation due to nerve damage (neuropathy) seen in diabetes patients or age-related perception changes can cause this condition. Most of the time, the patient thinks this condition is simple indigestion, fatigue, or muscle pain. As a result, medical help is not sought and the heart muscle continues to be damaged silently. The danger of this condition is that it can lead to permanent and serious damage because it cannot be diagnosed.

What are the Symptoms of Silent Heart Attack?

The symptoms of silent heart attack are so vague that they are often confused with other diseases. These symptoms may include:

• Mild Chest Discomfort: A mild pain or pressure sensation perceived as heartburn or indigestion.
• Extreme Fatigue: Unexplained, prolonged, or sudden onset extreme fatigue sensation.
• Mild Shortness of Breath: Shortness of breath that suddenly occurs at rest or with light exertion.
• Upper Body Discomfort: A mild discomfort sensation in the upper back, shoulders, or jaw instead of chest pain.

How is a Heart Attack Diagnosed?

Heart attack diagnosis is made through a combination of the patient’s medical history and physical examination along with various diagnostic tests.

• Electrocardiogram (ECG): Measures the electrical activity of the heart. ECG can quickly detect damage and rhythm disorders occurring during a heart attack. It is a basic tool for STEMI diagnosis.
• Blood Tests: When heart muscle cells are damaged, special enzymes like troponin are released into the bloodstream. Measuring the level of these enzymes in blood confirms the heart attack diagnosis.
• Echocardiography: Known as heart ultrasound, this test shows how well the heart muscle is working and the extent of damage.
• Angiography: After a heart attack diagnosis is made, angiography is performed to find the blocked vessel. In this procedure, contrast agent is given to vessels through a catheter and blockages are visualized under X-ray.

What Should Be Done During a Heart Attack?

When you notice a heart attack symptom or think someone is having a heart attack, you should immediately apply the following steps without delay:

• Call Emergency Services: Immediately call emergency services and clearly explain the situation. This is the fastest and safest way.
• Rest: Sit or lay down the patient and ensure they remain calm. Any exertion should be prevented.
• Aspirin: If the patient has no aspirin allergy and your doctor has previously recommended it, chewing one chewable aspirin can slow blood clotting and somewhat stop the blockage from growing. However, this should never delay medical intervention.

How is Heart Attack Treated?

Heart attack treatment encompasses emergency intervention applied in the hospital and a long-term management process that begins afterward. The goal is to quickly open the blocked vessel, minimize damage to the heart muscle, and prevent future crises.

Emergency Treatment

When you reach the hospital, doctors quickly intervene to open the blockage.

Blood Thinning Medications: In the emergency room, medications that prevent clotting or dissolve existing clots (thrombolytics) are given. These medications help restore blood flow.

Angioplasty and Stent: This is the most effective and most common method to stop a heart attack. Angiography is performed to find the blocked vessel. Then, entering the vessel through a catheter, the narrowed area is expanded with a balloon and a small wire cage called a stent is placed to keep the vessel open. This procedure gives the best results when performed within the first 90 minutes after the heart attack begins.

Coronary Bypass Surgery: If the blockage is not suitable for stent placement or if there are serious blockages in multiple vessels, bypass surgery may be necessary. In this operation, a new path is created around the blocked area using a healthy vessel piece taken from the leg or chest.

Long-term Treatment and Recovery Management

After emergency intervention, what is really important is ensuring your heart’s recovery and preventing a new heart attack. This process is not just about medication use; it requires comprehensive lifestyle changes and a rehabilitation program.

Cardiac Rehabilitation: This is a program conducted with a team consisting of doctors, physiotherapists, and dietitians, aimed at helping the patient regain physical and mental health. The main components of the program are:

• Exercise Training: You learn how to safely strengthen your heart after a heart attack.
• Healthy Living Education: You receive information about nutrition, stress management, medication use, and risk factors.
• Psychological Support: You are helped to cope with emotions such as anxiety, depression, and fear that may arise after a heart attack.

Medication Treatment: After a heart attack, various medications are used regularly to prevent a new crisis and protect your heart. These medications keep blood pressure, cholesterol, and clotting under control.

Lifestyle Changes: This is the most important way to protect your heart health in the long term. Quitting smoking, eating healthily, maintaining ideal weight, and managing stress form the foundation of this process.

What Medications Are Used After a Heart Attack?

After a heart attack, a series of medications are used regularly to prevent a new crisis and protect your heart:

• Aspirin and Antiplatelet Drugs: Reduce the risk of new blockage by preventing blood clotting.
• Beta Blockers: Reduce the heart’s workload by decreasing heart rate and force.
• ACE Inhibitors or ARBs: Help the heart work more comfortably by dilating blood vessels and lowering blood pressure.
• Statins: Prevent arterial hardening by lowering LDL cholesterol levels.

What Can a Heart Attack Lead To?

Various complications can develop after a heart attack depending on the size and location of the damaged area of the heart.

• Heart Failure: Damage to the heart muscle can lead to the heart’s inability to pump enough blood. This condition can occur especially when the crisis is severe and can become permanent.
• Arrhythmias: Damaged areas in the heart muscle can disrupt the heart’s electrical signals and cause irregular beats. This condition, especially serious arrhythmias like ventricular fibrillation, increases the risk of sudden cardiac arrest.
• Cardiogenic Shock: An emergency life-threatening condition where the damage to the heart muscle is very large and the heart cannot pump enough blood to the rest of the body.
• Heart Aneurysm: Swelling and ballooning of a weakened area in the heart muscle.

How is a Heart Attack Prevented?

The most effective way to minimize heart attack risk is to keep your risk factors under control.

• Healthy Nutrition: Adopt a diet low in saturated fat, trans fat, and salt, rich in vegetables, fruits, whole grains, and fish.
• Regular Exercise: Doing at least 150 minutes of moderate-intensity aerobic exercise per week significantly protects your heart health.
• Quit Smoking: Smoking is one of the most dangerous habits that multiply heart attack risk.
• Limit Alcohol Consumption: Excessive alcohol raises blood pressure and can damage heart muscle.
• Weight Control: Maintaining a healthy weight reduces the load on the heart.
• Manage Chronic Diseases: Do not neglect treatment of diseases such as diabetes, high blood pressure, and high cholesterol.
• Stress Management: Chronic stress can harm heart health. Learn to manage stress through methods such as meditation, yoga, or regular exercise.

Reference: Myocardial Infarction