Heart attack: characteristics, causes and treatment of myocardial infarction

By Cristiano Antonino On Feb 19, 2023

The generic term ‘heart attack’ refers to a condition that is referred to in medical jargon as a ‘myocardial infarction’

From an etymological point of view, myocardium is a compound word: ‘my’ meaning ‘muscle’ and ‘cardio’ meaning ‘heart’, thus indicating the heart muscle.

When we speak of ‘infarction’, we are referring to the death of a tissue due to an insufficient blood supply (and therefore reduced oxygenation), necessary for its survival.

The heart, in fact, like every other tissue in the human body, needs a constant and important amount of blood to survive, which has passed through the pulmonary circulation and, consequently, is rich in oxygen.

If – for the reasons that will be seen shortly – the heart were to stop receiving the correct supply of oxygenated blood, there could be consequences that can be mild or severe and can, in the most serious and sudden cases, lead to death.

What are the causes and risk factors of a heart attack?

As briefly mentioned, a heart attack – or more appropriately, a myocardial infarction – occurs when the blood flow, which carries oxygenated blood to the heart muscle through the coronary arteries, is reduced to the point of near exhaustion.

Usually, the decrease in this flow is due to a build-up of cholesterol and other substances at the level of the arterial walls (atherosclerotic plaque) that prevent the heart muscle from being properly supplied with blood.

When one of these plaques ruptures, a blood clot forms at the rupture site, which, if large, can partially or completely obstruct blood flow through the coronary artery.

Less frequently, it can happen that a clot is formed at the muscular component of the coronary arteries, which suddenly stops the passage of oxygenated blood in the direction of the heart.

Typically, myocardial infarction is a process that takes place over the course of a few hours, during which the tissue increasingly suffers the lack of physiological blood supply and dies.

There are certain risk factors, the ‘cardiovascular risk factors’, which increase the possibility of a person suffering a heart attack

Smoking, and exposure to second-hand smoke for long periods, could damage the inner walls of the coronary arteries, making it easier for cholesterol deposits to accumulate and obstruct blood flow.

High blood pressure (or hypertension) is caused by increased exercise pressures in the cardiovascular district.

This condition, if left untreated, could weaken the walls of the arteries.

High blood pressure is a condition whose incidence increases with increasing age, especially in association with a sedentary lifestyle and a diet rich in salt.

It goes without saying that leading a sedentary lifestyle and having an unhealthy diet, with an abuse of saturated fats, salt and alcohol, is one of the most important and frequent risk factors related to heart attack.

Obesity – associated with high blood cholesterol levels, high blood pressure and diabetes – is also a decisive risk factor for the development of myocardial infarction.

Diabetes, i.e. the inability to adequately produce or respond to the message of insulin, a protein produced in the pancreas, can significantly increase the risk of heart attack.

Stress is also among the risk factors

In a period of high stress and agitation, an individual may be inclined to smoke or eat more haphazardly. Nervous tension is also recognised as a possible cause of increased blood pressure.

Heart attack: recognising the symptoms

Recognising and identifying a heart attack may not be simple and straightforward.

The first symptom that occurs is almost always discomfort or pain in the chest.

In fact, most heart attacks are manifested by a twinge in the chest that appears suddenly, lasts a few minutes, then disappears and reappears later.

This uncomfortable or painful twinge may be accompanied by a feeling of tightness or swelling in the chest.

Secondary symptoms of a heart attack may be shortness of breath, excessive sweating, feeling of fatigue, fainting, nausea and vomiting.

The more numerous – and the more intense – the symptoms experienced, the greater the chance that a heart attack is in progress.

The inconstancy with which the symptoms of a heart attack manifest themselves may mean that the patient does not immediately take the first warnings seriously, procrastinating, out of fear or underestimation, and further aggravating a medical situation that, instead, needs timely intervention by a specialist.

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Diagnosing the heart attack

When a patient arrives at the emergency room complaining of the symptoms described above, he or she will be examined as soon as possible by a cardiologist, who will take a thorough history of the patient.

Knowing his or her lifestyle, habits and personal and family medical history helps enormously in the formulation of a correct diagnosis.

In order to arrive at a timely and accurate diagnosis, however, the anamnesis will not be sufficient.

This must be accompanied by a series of diagnostic tests, including an electrocardiogram, blood tests and coronary angiography.

The electrocardiogram is a test that records the heart’s electrical activity and – from the trace obtained – it will be possible to visualise any abnormalities in the rhythm and morphology of the heart’s electrical waves that can be traced back to myocardial infarction.

Blood tests during a heart attack are essential for an accurate diagnosis.

In fact, during a myocardial infarction, certain cells of the heart muscle die and release particular proteins into the blood, the course of which can be monitored through blood tests performed at certain time intervals.

Coronary angiography is a test that uses X-rays to visualise the morphology of the coronary vessels and is useful in detecting any obstructions present at this location.

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Heart attack: the most appropriate therapy

The more time that passes from the start of the heart attack, the more the myocardial tissue – deprived of oxygen – will be affected by a progressive deterioration that will lead to death.

The only way to intervene in time is to be able to restore proper cardiac flow as quickly as possible, so that the tissue is once again supplied with oxygenated blood.

The drug therapy used in these cases involves the use of drugs such as aspirin or antiplatelet agents to inhibit blood clotting; thrombolytics to dissolve the blood clot that blocks blood flow in the direction of the heart; heparin might be administered to thin the blood and make it less prone to form further clots. Painkillers may also be administered to alleviate the pain symptoms, which often occur with great intensity.

Drug therapy may not be sufficient.

Depending on the clinical condition, the patient may have to undergo surgery.

A coronary angioplasty will be performed with the placement of medicated coronary stents to dilate the obstructed arterial tracts so that oxygenated blood can flow properly back to the heart.

This procedure is performed by inserting a catheter with a balloon at the end of which is inflated near the area affected by the obstruction to dilate the artery.

Subsequently, the stent is inserted which, once the balloon is deflated, will remain in place, preventing the artery from becoming occluded again.

Alternatively, a coronary bypass operation will be performed, but this remains a secondary choice to be resorted to in emergencies, or later, when the heart has had a chance to recover from the infarction in order to improve overall cardiac muscle supply.

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Heart attack: prevention

The best way to avoid being caught in a heart attack is to take preventive measures.

In addition to a regular cardiological examination, prevention involves adopting a healthy lifestyle.

Do not smoke or stop smoking; keep your diet under control so as to avoid the occurrence of diseases such as hypertension or hypercholesterolaemia; perform regular physical activity that helps improve the function of the heart muscle and keep weight and body fat accumulations under control.

Reducing stress and not splurging on unhealthy foods, alcohol and smoking is also a good way to avoid any heart-related problems.

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