HEART ATTACK

The SYMPTOMS of a HEART ATTACK

•Central crushing chest pain.

•Heavy sweating.
•Nausea and/or vomiting.
•Dizzyness.
•Cold, clammy feeling hands.
•Palpitations.
 DIFFERENTIAL
Pain from the heart DIAGNOSIS OF CHEST
1)Angina 2)Heart attack PAIN
Heart-related pain
1)Pericardial pain (pericarditis) Post-operative pain
Chest pain that is not from the heart
Pain from the oesophagus
Heartburn
Pain from the lung
1)Pleurisy 2)Blood clots 3)Punctured lung
Chest wall pains
Pain from the aorta
 ETIOLOGY

Family
history HIGH BP

Sedentary
Smoking lifestyle

obesity Elevated
cholesterol
Normal coronary arteries
 A narrowed coronary artery is then
Heart attack blocked further, sometimes
completely, by an obstruction,
usually a blood clot that sticks to the
plaque. The formation of a blood
clot in an area of an a artery in
which plaque has built up is
called a coronary thrombosis. If
the supply of oxygen-rich blood to
the heart is severely blocked and
remains blocked for too long, the
lack of oxygen causes irreversible
damage to the heart muscle.
Extensive damage to the heart
muscle is often fatal because the
heart can no longer continue to
pump blood to the rest of the body.
 Pathology of CHD

Coronary artery disease - also known as coronary heart

disease (CHD) or ischemic heart disease (IHD) - affects
most people as they age. The coronary arteries become
constricted or blocked by atheromas - bulging masses or
"plaques" that form within the walls lining the arteries.
"Atheroma" is the Italian word for porridge, because it
resembles porridge when viewed under a microscope. It
contains a mix of cholesterol-filled cells, inflammatory cells, and
fibrous scar tissue.
Atherosclerosis is the term used to describe the gradual
build-up and hardening of atheromas within the arterial walls. It
is commonly referred to as "hardening of the arteries."
 Pathology of CHD

The more atheromas that line the coronary arteries, the

narrower the pathway for blood. Atherosclerosis often
restricts as much as 70% of the blood that flows through
the coronary arteries. Although the heart muscle receives
enough blood for routine activities like walking or sitting,
myocardial ischemia (insufficient blood in the heart muscle)
results when the narrow arteries do not allow enough blood to
reach the heart during periods of physical or emotional
stress. This lack of blood will trigger an episode of angina.
If the flow of blood is blocked completely, a heart attack,
which is damage to the heart muscle can result.
 DIAGNOSIS

Electrocardiogram (ECG or EKG)

Exercise thallium test
Echocardiography
Coronary angiography
Positron emission tomography (PET) scanning
 Electrocardiogram (ECG or EKG)

A baseline electrocardiogram
(ECG or EKG), which records
your heart's electrical activity
while you sit quietly. An
exercise ECG, also known as a
stress test, will show how your
heart responds to increasing
exercise. Both tests are
designed to show if your heart
is not working properly, most
likely due to a lack of oxygen
 Exercise thallium test

An exercise thallium test, also called

a nuclear stress test, which uses a
radioactive substance that is
injected into your bloodstream to
show how blood flows through your
arteries. Doctors can see if your Images taken at rest
(left) and during exercise
heart muscle is damaged or dead, or
(right) from a nuclear
if you have a serious narrowing in an stress test. The dark
artery. For people who cannot take area shows a location
an exercise test, medicines can be where blood flow is
given that make your heart beat like abnormal
it would if you were exercising.
 Echocardiography

Echocardiography, which
uses sound waves to
produce an image of the
heart to see how it is
working.
 Coronary angiography

Coronary angiography, which is performed

in the cardiac catheterization laboratory.
After you are given medicine to relax you,
dye is injected into your bloodstream to
give doctors an x-ray "movie" of heart
action and blood flow through your valves
and arteries (called an angiogram). Doctors
can see the number of blockages that you
have and how serious those blockages are.
Doctors often use this test to find out which
treatment option may be best for you.
 Positron emission
tomography (PET) scanning

Positron emission tomography (PET)

scanning, which uses information
about the energy of certain elements
in your body to show whether parts of
the heart muscle are alive and
working. A PET scan can also show if
your heart is getting enough blood in
order to keep the muscle healthy.
 MEDICAL MANAGEMENT OF CAD

 Nitroglycerin (nitro) can widen or dilate the arteries and

improve blood flow to your heart. Nitro can be given through a skin
patch, pills, an ointment, or a spray.
Beta blockers"block" the chemical or hormonal messages
sent to heart,under physical or emotional stress, body sends
signals to heart to work harder. Beta-blockers block the effect of
these signals on heart, so they reduce the amount of oxygen your
heart demands.
Calcium channel blockers can help to keep arteries open and
reduce blood pressure by relaxing the smooth muscle that
surrounds the arteries in the body. The oxygen demand of the
heart is also reduced by these medicines.
 Percutaneous Interventions
and Surgery

Angioplasty,
A stent procedure
Atherectomy
Laser ablation
Percutaneous transmyocardial
revascularization (PTMR)
 Angioplasty

Angioplasty, which opens narrowed

arteries, is performed by interventional
cardiologists. They use a long, thin
tube called a catheter that has a small
balloon on its tip. They inflate the
balloon at the blockage site in the
artery to flatten the plaque against the
artery wall. Angioplasty is also called
percutaneous transluminal coronary
angioplasty (PTCA)
 A stent procedure

A stent procedure is used along with balloon angioplasty.

It involves placing a mesh-like metal device into an artery
at a site narrowed by plaque. The stent is mounted on a
balloon-tipped catheter, threaded through an artery, and
positioned at the blockage. The balloon is then inflated,
opening the stent. Then, the catheter and deflated balloon
are removed, leaving the stent in place. The opened stent
keeps the vessel open and stops the artery from
collapsing. Restenosis rates with this procedure are
generally around 15% to 20%.
 Atherectomy

Atherectomy may be an option

for certain patients who cannot
have balloon angioplasty. A
high-speed drill on the tip of a
catheter is used to shave plaque
from the artery walls
 Laser ablation

Laser ablation uses a catheter

that has a metal or fiberoptic
probe on the tip. The laser uses
light to "burn" away plaque and
open the vessel enough so that a
balloon can further widen the
opening
 Percutaneous transmyocardial
revascularization (PTMR)

Percutaneous transmyocardial revascularization (PTMR) is

performed by a cardiologist in the cardiac catheterization
laboratory. After the area is numbed with anesthesia, the
cardiologist inserts a catheter in an artery in the leg that leads to
the heart. A laser is then fed through the catheter and used to
create tiny holes in the heart muscle. These holes become
channels for blood to flow to oxygen-starved areas of the heart.
Researchers believe that the procedure may cause new vessels
to form, reducing the pain of angina. PTMR is currently being
used on patients who have not responded to other treatments
such as medicines, angioplasty, or coronary artery bypass
surgery
 Coronary artery bypass surgery

Coronary artery bypass surgery means "bypassing" blood flow

around one or more narrowed vessels. To do this, the surgeon
removes a vein from the thigh (called the saphenous vein) or
uses an artery from the upper part of the chest wall (called the
internal mammary artery). Sometimes, an artery from another
area of the body may be used. This surgically removed vessel
is called a graft. The graft may be cut into sections for use in
routing blood flow around blocked coronary arteries. After
making an incision through the chest, the surgeon connects a
graft at points above and below the blockage to restore blood
flow
 Prevention of CHD

STOP CONTROL
EAT CONTROL WEIGHT
SMOKING HEALTHY BLOOD
DIET PRESSURE

MANAGE GET EXERCISE

STRESS CHECK
REGULAR CHOLESTEROL
MEDICAL
CHECK UPS
 PREVENTION OF
HEART ATTACK
1. Improve diet. Eating fiber, fruit and vegetables. Should pay
attention to high blood cholesterol. Doctor or dietician who
can help the patient to plan new healthy menu.
2. Should be active. Should stay moving, exercise with a
friend; vary the patients activities to keep interested.
3. Controlling weight. Talk to doctor about the risks
associated with extra pounds and what should do next.
4. Stop smoking. Smoking cessation is not easy, but when
The patient quit smoking, the chances of heart disease are
greatly reduced.
5. Recognize the signs and symptoms of a heart attack.
 Diet and CAD

Population studies
have found diet --
one rich in fruits,
vegetables, fish,
grains and beans --
protects against
coronary heart
disease
 Regular exercise
improves the sense of
well being and
Exercise prognosis by reducing
many risk factors
Treating obesity
 Weight must be reduced to a
target of body mass index (BMI)
28.
 Recognize metabolic syndrome
and consider starting combination
therapy with a statin and fibrate