Heart attack is the death of a segment of heart muscle caused by the loss of blood supply.

The blood supply is usually lost because a coronary artery, one that supplies blood to the
heart muscle, has a blood clot, a blockage (coronary thrombosis). If some of the heart
muscle dies, the patient experiences chest pain and electrical instability of the heart muscle
tissue.

Another name for a heart attack is myocardial infarction, cardiac infarction and coronary
thrombosis.

According to Medilexicon's medical dictionary, a heart attack is:
"Infarction of a segment of heart muscle, usually due to
occlusion of a coronary artery."


(Infarction = the process whereby an area of dead tissue is caused by a loss of blood supply).
Blood supply to the heart can also be undermined if the artery suddenly narrows, as in a spasm.

The animation below shows how..
Plaque buildup, or
A coronary artery spasm
..can eventually lead to a heart attach, and how a heart attack can occur when blood flow in a
coronary artery is blocked.


What are the symptoms of a heart attack?
Chest discomfort, mild pain
Coughing
Nausea
Vomiting
Crushing chest pain
Dizziness
Dyspnea (shortness of breath)
Face seems gray
A feeling of terror that your life is coming to its end
Feeling really awful (general feeling)
Restlessness
The patient is clammy and sweaty
If you experience these symptoms, or witness another person with them, call the emergency
services immediately. In the United Kingdom the telephone number is 999, in the USA and
Canada it is 911, Australia 000, and New Zealand 111.

When somebody has a heart attack, they usually feel pain in their chest first. The pain then
spreads to the neck, jaw, ears, arms, and wrists. The pain may also make its way into the
shoulder blades, the back, and the abdomen.

Changing position, resting or lying down does not alleviate the pain. It is typically a constant
pain, but it may sometimes come and go. Patients describe the pain as one of pressure, like a
clamp squeezing inside your chest. The pain can last from a few minutes to many hours.

Silent heart attack - people with diabetes, and/or those over the age of 75 may experience a
"silent heart attack", one with no pain at all. Painless heart attacks are more common among
women than men.

Studies indicate that about 1 in every 5 mild heart attacks are not diagnosed. If this is the case,
there are many people who are suffering progressive heart muscle damage because it is not being
treated.

Heart attack warning signs in women

What are the causes of a heart attack?
Age - the largest risk factor. When a man is over 45 years, and a woman is over 55 years
of age, their risk of having a heart attack starts to rise significantly.

Scientists from the University of Copenhagen, Denmark, found that the visible physical
signs of aging, such as the accumulation of fatty deposits on the eyelids and baldness are
associated with a higher risk of developing heart disease and having a heart attack.

Senior researcher, Anne Tybjaerg-Hansen, said "The visible signs of aging reflect
physiologic or biological age, not chronological age, and are independent of
chronological age."

The researchers found that a receding hairline, baldness, earlobe crease and
xanthelasmata (fatty deposits around the eyelids) increased heart attack risk by 57% and
ischemic heart disease by 39%.

They presented their findings at the American Heart Association's Scientific Sessions
2012 in Los Angeles.

Angina - angina is an illness where not enough oxygen is reaching the patient's heart.
This raises the risk of a heart attack. In some cases a diagnosis of angina was wrong - it
could have been a mild heart attack instead. The main difference between a heart attack
and angina is that the patient with angina will feel better about 15 to 30 minutes after
taking medication, while the heart attack patient won't.

Blood cholesterol levels - if a person's blood cholesterol levels are high, he/she runs a
higher risk of developing blood clots in the arteries. Blood clots can block the supply of
blood to the heart muscle, causing a heart attack.

Living near major highways - heart attack survivors who live near major highways
have a 27% higher risk of another heart attack within a decade compared to survivors
who live further away, researchers from the Beth Israel Deaconess Medical Center
reported in the journal Circulation (May 2012 issue).

The researchers compared heart attack survivors who lived within 328 feet (100 meters)
or less from a major highway to their counterparts who lived at least 3,280 feet (1,000
meters) away.

Diabetes - people with diabetes have a higher risk of developing several diseases and
conditions, many of them contribute to a higher risk of heart attack.

Diet - a person who consumes large quantities of, for example, animal fats, or saturated
fats, will eventually have a higher risk of having a heart attack.

Gut bacteria can cause heart problems - the action of bacteria in the intestines on
certain compounds contained in digested food, especially lecithin, is linked to an
increased risk of heart attack and stroke, researchers from the Cleveland Clinic, Ohio,
USA, reported in NEJM (New England Journal of Medicine (April 2013 issue). Eggs are
rich in lecithin.

A growing number of studies have been suggesting a link between the action of gut
bacteria and heart attack and stroke risk.

In another study, published in Nature Medicine (April 2013 issue), scientists explained
that L-carnitine, a compound added to energy drinks and found in red meat, may increase
heart risk, because gut bacteria digest it and produce TMAO (trimethylamine-N-oxide).
TMAO is a metabolite that experts believe clogs up the arteries.

Genes - you can inherit a higher risk of heart attack from your parents, and/or their
parents. A person whose sibling died of a heart attack has a higher risk of suffering a fatal
heart attack, a report published in the Journal of the American Heart Association
informed.

Heart surgery - patients who have had heart surgery have a higher risk of having a heart
attack.

Hypertension (high blood pressure) - this could be due to lack of physical activity,
overweight/obesity, diabetes, genes, and some other factors.

Obesity, overweight - as more and more people are overweight, especially children,
experts believe heart attacks will become more common in future (if the overweight
children become overweight adults).

Physical inactivity - people who do not exercise have a much higher risk of having a
heart attack, compared to people who exercise regularly.

Previous heart attack - anybody who has already had a heart attack is more likely to
have another one, compared to other people.

Smoking - people who smoke heavily or regularly run a much higher risk of heart attack,
compared to people who never smoked and those who gave up. Smoking regularly means
smoking every day.

Being HIV positive - people who are HIV positive have a 50% higher risk of heart
attack, researchers reported in JAMA Internal Medicine (March 2013 issue)

Work stress - if you have a very demanding job, not much freedom to make decisions,
i.e. a job with a lot of stress, your risk of heart attack is higher-than-normal, researchers
from University College London reported in The Lancet.

Shift work was also linked to a higher risk of heart attack, according to an analysis that
reviewed studies covering over two million people.

Calcium supplements - a study published in the journal Heart (May 2012 issue), which
analyzed data on nearly 24,000 people over a ten-year period, suggested that taking
calcium supplements may raise the risk of heart attack.


How is a heart attack diagnosed?
Any doctor, nurse, or health care professional, will send a patient straight to hospital if he/she
suspects the person may have a heart attack. In hospital several tests may be done:
ECG (Electrocardiograph)

An ECG is a medical device that monitors the electrical activity of the heart muscles. Our
hearts produce a small electric signal at every beat. A heart specialist (cardiologist) can
use this device to see how well the heart is functioning, whether there is any damage to
the heart muscle, or abnormalities with the heart rhythm. A doctor can tell, when
checking the data coming from the ECG, whether the patient has had a heart attack
recently, or even earlier.

Visit our specialized news sections

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Smoking / Quit Smoking News
Cardiac enzyme tests

When a person has a heart attack some enzymes make their way into the bloodstream. A
blood test can detect these enzymes. Usually, enzyme blood levels are checked regularly
over a few days.

Chest x-ray

This can be useful to see if the heart has any swelling.
What are the treatments for a heart attack?
The faster the heart attack patient can be treated, the more successful his/her treatment will be.
These days, the majority of heart attacks can be treated effectively. It is crucial to remember that
the patient's survival depends largely on how quickly he can be taken to hospital.

Treatment during a heart attack
CPR (cardio-pulmonary resuscitation)

Some heart attack patients stop breathing; they do not move or respond when spoken to
or touched, they may also be coughing. If this is the case CPR should be started straight
away. This involves:

Manual chest compressions and mouth-to-mouth
30 chest compressions to the heart
followed by
two mouth-to-mouth resuscitation breaths (mouth-to-mouth)

Defibrillator
This is a CPS medical device. It sends electric shocks across the patient's chest - the aim
is to use electricity to shock the heart back into proper activity.

300mg of Aspirin

A 300mg dose of aspirin is often given to patients during a heart attack. Aspirin will help
stop the clot in the artery from growing.

Thrombolytics

These dissolve the blood clots. These include alteplase and streptokinase. They should be
injected into the patient as soon as possible. If the blood supply to the muscle can be
restored soon enough, much of the affected heart muscle will survive.

Painkillers

Morphine is sometimes injected into the patient to control the pain and discomfort.
Experts say this also reduces anxiety.
Treatment after the heart attack

Most patients will need several different medications after their heart attack. The aim being to
prevent future heart attacks from occurring.
Aspirin and other Anti-platelets

Our blood has platelets. These are tiny particles that help the blood to clot. They can
eventually, if they are very sticky, stick to fatty deposits, or plaques, and form a
thrombosis. A thrombosis is a clot. A thrombosis in a coronary artery can cause a heart
attack. Anti-platelets reduce the stickiness of the platelets.

Patients are often prescribed a daily 75mg dose of aspirin - this is called low-dose aspirin.
Those who have stomach ulcers may be given medication to prevent the aspirin from
damaging their stomachs. Patients who suffer from asthma may be prescribed
clopidogrel, rather than aspirin.

Beta-blockers

These drugs make the heart beat more slowly and with less force, thus easing the heart's
workload. They also stabilize the heart's electrical activity. Examples include metoprolol,
propranolol, timolol, and atenolol.

ACE (Angiotensin-converting enzyme) inhibitors

These drugs help ease the workload on the heart by opening up blood vessels and
lowering blood pressure. Experts say ACE inhibitors also protect the heart from further
damage. Patient will have a blood test to make sure their kidneys are working properly
before starting on this type of medication. Then, about ten days after starting treatment,
the patient will undergo further tests to make sure his/her kidneys are still working fine.
Over a period of about 3 weeks the patient's dose is gradually increased. Examples of
ACE inhibitors include lisinopril, perindopril and ramipril.

Statins

Statins make the liver produce less cholesterol, consequently lowering blood cholesterol
levels. Patients with high cholesterol levels have a higher risk of developing fatty
deposits in their blood vessels, especially their arteries. Statins include atorvastatin,
fluvastatin, pravastatin, rosuvastatin and simvastatin.

Surgery after a heart attack

If the patient's heart has been severely damaged he/she may need to be operated on. The
most common surgeries performed on heart attack patients are:

o Angioplasty

This can be performed either after the heart attack, or in some specialist units
during the attack. Angioplasty opens up the coronary artery. A small wire goes up
the artery from the patient's groin or arm and is pushed until it reaches where the
clot is in the coronary artery. There is a small balloon, shaped like a sausage, at
the end of the wire. The balloon is placed at the narrowest part of the artery and is
then inflated, squashing the clot away. A flexible metal mesh, called a stent, is
then placed there to keep that part of the artery open.

o CABG (Coronary artery bypass graft)

The damaged blood vessel is by-passed with grafts taken from blood vessels
elsewhere in the body. The bypass effectively goes around the blocked area of the
artery, allowing blood to pass through into the heart muscle.
Bone marrow stem cells

Researchers at the Stem Cell Research laboratory, NHS Blood and Transplant at the John
Radcliffe Hospital in Oxford, UK, believe that stem cells derived from bone marrow may
improve heart function after a heart attack.
Convalescing/recovering after a heart attack
Recovery from a heart attack can be a slow and gradual process. It may involve liaising with
various types of health care professionals, including doctors, dieticians, nurses, physio therapists,
pharmacists, and personal trainers. The patients' recovery will generally start in hospital, and
then continue at home.
Physical activity

Experts say it is vital that a recovering heart attack patient try to stay active. Exercise is a
crucial part of recovery, as it strengthens the heart muscles, and significantly lowers the
risk of another heart attack. Most patients will be given some kind of exercise program
while they are still in hospital. It is important that any exercise program is devised by an
exercise specialist who is part of the patient's health professional team. Most initial
exercise programs will be about 12 weeks long.

Most heart attack patients are able to go back to their normal everyday domestic
activities. Of course, this will depend on the patient's physical and mental state. Doctors
advise most patients to take it easy at first.

Going back to work

When a heart attack patient can go back to work depends on various factors: The severity
of the heart attack, the type of job, the physical status of the patient after the heart attack,
the financial situation of the patient, etc.

Some people are eager to get back to work for various reasons. It is vital that people do
not rush back - a proper recovery period is needed to prevent recurrences. Patients should
be guided by their doctors' advice.

Heart attack and depression

According to the National Health Service (NHS), UK, about one fifth of heart attack
patients go on to have a major episode of depression not long afterwards. Another quarter
of all heart attack patients experience minor depression or depressed moods.

The patient should understand that it is common to feel depressed or anxious after a heart
attack. The worry about being able to cope, losing one's job or work status, are
contributory factors.

The severity of the depression can influence the patient's rehabilitation - making recovery
a slower process.

Heart attack patients who feel depressed or anxious should tell their doctors immediately.

Driving

In the UK it is advised that a person refrains from driving for at least 4 weeks after
his/her heart attack. Most countries will not require that the patient does another driving
test. Patients who have other conditions should check with their car insurance company to
make sure they are still covered before they start driving again. In the UK anybody who
drives large goods vehicles has to tell the DVLA about their heart attack. In most cases
they will not be allowed to drive for six weeks, and will only be able to do so after
passing a basic health and fitness test.

Erectile dysfunction after a heart attack

Approximately one third of all men who have a heart attack suffer from erectile
dysfunction - they have problems getting, or sustaining an erection. Experts say that
sexual activity does not raise a person's risk of having another heart attack. It is important
that men with erectile dysfunction talk to their doctors - in the majority of cases certain
medications, such as Viagra (sildenafil citrate), Cyalis (tadalafil), and Levitra (vardenafil)
are very effective at restoring erectile function. Other treatments are also available.
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Complications after a heart attack
There are two types of complications, those that occur pretty much straight away, and those that
happen afterwards.

Immediate complications
Arrhythmias - the heart beats irregularly, either too fast or too slowly. Patients may be
given cardioversion - an electric current is passed through the heart. Most patients, with
time, will return to regular rhythms. There are also medications for arrhythmias.

Cardiogenic shock - the patient's blood pressure suddenly drops dangerously. The heart
cannot supply enough blood for the body to work adequately. The following drugs will
raise blood pressure and heart functioning, Dopamine, Dobutamine, Epinephrine, and
Norepinephrine.

Hypoxemia - levels of blood oxygen become too low.

Pulmonary edema - there is fluid accumulation in and around the lungs.

DVT (deep vein thrombosis) - the deep veins of the legs and pelvis develop blood clots
which either block or interrupt the flow of blood in the vein.

Myocardial rupture - the heart attack damages the wall of the heart. This increases the
risk of a heart wall rupture.

Ventricular aneurysm - one of the chambers (ventricles) of the heart forms a bulge.
Complications that can occur later:
Aneurysm - scar tissue builds up on the damaged heart wall. This leads to blood clots,
low blood pressure, and abnormal heart rhythms.

Angina - Not enough oxygen is reaching the heart. Symptoms may be similar to those of
a heart attack, especially the chest pain.

Congestive heart failure - the heart can only beat very weakly. The patient feels
exhausted and breathless.

Edema - fluid accumulates in the ankles and legs (they swell).

Future heart attacks - a person who has had a heart attack runs a higher risk of having
another one, compared to other people.

Loss of erectile function - erectile dysfunction is generally caused by a vascular
problem. However, it can also be the result of depression.

Loss of libido - this is especially the case with men.

Pericarditis - the lining of the heart becomes inflamed, causing serious chest pain.

Patients who comply with their doctors instructions have a much better chance of recovery than
those who don't. It is important that the doctor monitor a heart attack patient for several months
afterwards.





QUESTIONS
1. What does Heart Attack mean? (Write in Indonesia)
Heart attack is the death of a segment of heart muscle caused by the loss of blood
supply. The blood supply is usually lost because a coronary artery, one that supplies
blood to the heart muscle, has a blood clot, a blockage (coronary thrombosis). If
some of the heart muscle dies, the patient experiences chest pain and electrical
instability of the heart muscle tissue.
Serangan Jantung adalah kematian pada salah satu segmen dari otot jantung yang
disebabkan oleh hilangnya suplai darah. Suplai darah biasanya hilang karena arteri
koroner, salah satu yang menyuplai darah ke otot jantung terdapat bekuan darah, sebuah
blokade (trombosis koroner). Jika salah satu otot jantung mati, pasien dapat merasakan
sakit dan ketidakstabilan elektrik dari jaringan otot jantung.

2. What is the function of STATINS?
Statins

Statins make the liver produce less cholesterol, consequently lowering blood cholesterol
levels. Patients with high cholesterol levels have a higher risk of developing fatty
deposits in their blood vessels, especially their arteries. Statins include atorvastatin,
fluvastatin, pravastatin, rosuvastatin and simvastatin.

3. Why is exercise important for patients with Heart attack?
Exercise is a crucial part of recovery, as it strengthens the heart muscles, and significantly
lowers the risk of another heart attack.

4. What complications are happened after a heart attack?
Complications after a heart attack
Types of complications, those that occur pretty much straight away, and those that
happen afterwards.

Immediate complications
Arrhythmias - the heart beats irregularly, either too fast or too slowly. Patients may be
given cardioversion - an electric current is passed through the heart. Most patients, with
time, will return to regular rhythms. There are also medications for arrhythmias.

Cardiogenic shock - the patient's blood pressure suddenly drops dangerously. The heart
cannot supply enough blood for the body to work adequately. The following drugs will
raise blood pressure and heart functioning, Dopamine, Dobutamine, Epinephrine, and
Norepinephrine.

Hypoxemia - levels of blood oxygen become too low.

Pulmonary edema - there is fluid accumulation in and around the lungs.

DVT (deep vein thrombosis) - the deep veins of the legs and pelvis develop blood clots
which either block or interrupt the flow of blood in the vein.

Myocardial rupture - the heart attack damages the wall of the heart. This increases the
risk of a heart wall rupture.

Ventricular aneurysm - one of the chambers (ventricles) of the heart forms a bulge.

Complications that can occur later:
Aneurysm - scar tissue builds up on the damaged heart wall. This leads to blood clots,
low blood pressure, and abnormal heart rhythms.

Angina - Not enough oxygen is reaching the heart. Symptoms may be similar to those of
a heart attack, especially the chest pain.

Congestive heart failure - the heart can only beat very weakly. The patient feels
exhausted and breathless.

Edema - fluid accumulates in the ankles and legs (they swell).

Future heart attacks - a person who has had a heart attack runs a higher risk of having
another one, compared to other people.

Loss of erectile function - erectile dysfunction is generally caused by a vascular
problem. However, it can also be the result of depression.

Loss of libido - this is especially the case with men.

Pericarditis - the lining of the heart becomes inflamed, causing serious chest pain.

5. Is smoker getting greater risk of heart attack?
Yes, smoker is getting greater risk of heart attack.