We obtained an electrocardiogram and cardiac enzymes; both showed what we suspected. He was taken down to the catheterization lab to have a stent placed (a small instrument inserted to increase blood flow to the injured area of the heart). After several weeks of rehabilitation, our patient would recover.
Time is of the essence in a heart attack.
For patients, the symptoms may not always be obvious; for doctors, the initial tests not always clear. In medicine we constantly walk this edge of subjecting patients to treatment too soon, before having obtained all of the relevant information, and waiting too long to spring into action. The strategy is to weigh the benefits of treatment against the risks, to always think four or five steps down the line. It is often a very fine balance.
Atherosclerosis is the complex disease process that leads to coronary artery disease. The process starts with an injury to a blood vessel (from high cholesterol, high blood pressure or smoking) causing fats, platelets, debris and calcium to build up in the blood vessel wall over time. Eventually, this blockage can permanently occlude a blood vessel, break into pieces and travel to a joining vessel, or form a dangerous blood clot.
Many people with coronary artery disease experience chest pain (angina) brought on by physical exertion or stress and relieved by a period of rest. This is a sign of significant blockage in one or more coronary arteries. Some may experience chest pain and shortness of breath than increases in frequency and duration, occurring even at rest. This is known as “unstable angina.” Although not tantamount to a heart attack, unstable angina is a harbinger for one. Heart attacks can be fatal when occlusion of the coronary arteries results in lack of blood flow to an area of the heart, causing a dangerous abnormal heart rhythm.
The most common symptom of a heart attack is pain, fullness and/or “squeezing” sensation in the chest. Often the pain will travel to the back, jaw or one or both arms. Patients commonly experience associated shortness of breath, nausea, abdominal discomfort, sweating and/or general fatigue. However certain subsets of people, especially diabetics, women and the elderly, are less likely to experience these classic symptoms. For example, they may not experience prodromal (early) symptoms and instead may experience one of the above symptoms in isolation. Therefore heart attacks often go unrecognized in these patients and time to treatment prolonged.
If you experience symptoms that lend suspicion to a heart attack, go to the emergency room immediately. Simple blood tests and an EKG can quickly reduce the suspicion for serious pathology. People with known coronary artery disease are typically prescribed nitroglycerin and high dose aspirin, which can be taken as soon as one experiences symptoms of a heart attack.
As with most health problems, prevention is key. Having an active lifestyle, eating healthy foods and maintaining a normal BMI (body mass index) are essential in preventing plaque and calcium buildup within the coronary arteries.
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