Heart: what is a heart attack and how do we intervene?
A myocardial infarction occurs when part of the heart tissue is necrotic due to a blockage in one of the coronary arteries, which supply the heart with oxygenated blood
The blockage, which may be partial or complete, is often due to a build-up of fat, cholesterol or other substances that forms plaque in the arteries (atherosclerosis), which breaks down and leads to thrombosis, interrupting blood flow and causing death (necrosis) of the tissue.
Are there any signs to look out for and how to intervene in a heart attack?
Symptoms of a heart attack
The symptoms of myocardial infarction vary: not all patients report the same symptoms or experience them at the same intensity; in other cases, the infarction may be asymptomatic and in still other cases the first sign of an infarction is sudden cardiac arrest.
The most typical manifestation of a heart attack is a feeling of weight or pain in the chest that lasts for more than ten minutes.
The pain may extend from the chest to one or both arms and may also radiate to the neck, jaw and back.
In addition, chest pain may be associated with nausea, heartburn or abdominal pain, shortness of breath, fatigue, cold sweats, lightheadedness or dizziness.
In most cases the onset of heart attack symptoms is sudden, but there may also be warning signs over the preceding hours, days or weeks, such as recurrent chest pain or a feeling of pressure (called angina pectoris) that is triggered by movement and resolves at rest.
Angina is due to a temporary decrease in blood flow to the heart, but not so prolonged that it leads to tissue necrosis.
In the event of a heart attack, it is essential to intervene early, as late access by the patient to appropriate treatment increases the risk of mortality.
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Heart attack: who is most at risk?
Some factors, divided into modifiable and non-modifiable ones, can expose you to an increased risk of atherosclerosis and heart attack.
Non-modifiable factors are increasing age, sex (in youth and old age the risk is greater in men, but after the female menopause the risk is the same for both sexes) and family history (cases of heart attack in the family expose the patient to a greater risk, especially if they occur after the age of 55 in men and 65 in women).
Modifiable risk factors include smoking, high blood pressure (which damages the arteries), high levels of LDL cholesterol (the so-called bad cholesterol which narrows the arteries) or triglycerides, diabetes (excess blood glucose damages the arteries and promotes atherosclerosis), obesity (which is associated with high cholesterol and triglyceride levels, hypertension and diabetes), metabolic syndrome (a picture that includes obesity, diabetes and hypertension), sedentariness (lack of physical activity contributes to high cholesterol levels and exposes the body to the risk of elevation), stress and drug use.
The importance of early diagnosis
In general, the diagnosis of a heart attack is made in the light of the symptoms reported by the patient.
An electrocardiogram, a test that records the electrical activity of the heart, can be used to confirm or rule out a heart attack, as the damaged heart muscle has an altered conduction of electrical impulses.
In addition, blood tests can be used to determine the presence of cardiac enzymes, substances released into the bloodstream by the heart muscle cells that have undergone necrosis.
An echocardiogram, an ultrasound examination that allows us to visualise and observe the size, shape and movement of the heart, can sometimes be useful.
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What is done in the event of a heart attack?
The diagnosis is confirmed by performing an urgent coronarography, an invasive examination that is carried out by introducing a small catheter through an arterial access in the wrist or groin.
Coronarography allows us to visualise the coronary arteries and identify the site of the blockage.
Once the diagnosis has been confirmed and the site of the coronary blockage identified, the vessel is immediately reopened by angioplasty.
This is performed at the same time as the coronarography, using the same arterial access.
The procedure involves dilating a balloon in the occluded coronary artery to reopen it and allow blood flow to resume.
Dilation of the balloon is followed by the implantation of a coronary stent, a small cylindrical metal mesh that is placed at the level of the occlusion to keep the diseased coronary artery open.
Angioplasty is followed by medical therapy based mainly on drugs that reduce the risk of new thrombosis (antiplatelet drugs such as aspirin and ticagrelor or prasugrel) and that reduce cholesterol (such as statins).
These drugs are crucial in reducing the risk of recurrence.
Can a heart attack be prevented?
Although an event such as a heart attack cannot be completely avoided, it is possible to reduce the risk factors associated with it, in particular by acting on the modifiable factors, i.e. by paying attention to your lifestyle and, on the advice of your doctor, to medical therapy to control risk factors such as high blood pressure and hypercholesterolemia.
It is good, for example, to ensure a varied and balanced diet that prefers cereals, legumes, fruit and vegetables and that – to saturated fats and cholesterol (butter, red meat) – prefers extra virgin olive oil, fish and white meat.
Regular aerobic physical activity (at least three times a week for 45 minutes, such as running, brisk walking, swimming, cycling) also plays an important role in maintaining a normal body weight, improving the heart’s ability to pump blood and keeping blood pressure under control.
It is also important not to smoke.
Stress also has an impact on heart health as it affects blood pressure: continuous stress increases blood pressure values, which are related to cardiovascular risk.
In addition, stress can change the atherosclerotic plaques in the coronary arteries, causing them to rupture and thus promoting an event such as a heart attack.
Keeping blood pressure values under control can help to monitor the situation: a stressful condition can lead to a rise in blood pressure.
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