Heart attack 

A consultant cardiologist explains what a heart attack is, the symptoms, surgical treatments and why it's important for coronary heart disease patients to reduce their risk factors.

Read about the causes of heart attacks

Transcript of Heart attack

Dr Peter Schofield,

Consultant Cardiologist at Papworth Hospital, Cambridge.

A heart attack is caused by blockage of a coronary artery,

one of the arteries that supply the heart,

and usually what happens is that there's a narrowing within the artery

and then a clot forms on the top of that narrowing

to block off the artery completely.

When you have a total blockage of the artery,

that can lead to a heart attack.

So when the artery blocks,

that acutely starves the heart of blood and therefore oxygen,

so patients feel discomfort in the chest,

typically a heavy, gripping pressure sensation in the chest.

Some people feel symptoms in their jaw or their neck,

some people in their arms.

In some cases people have a preceding history of angina,

so in the weeks or months preceding their heart attack

they will have symptoms of angina,

which again is a constriction, a tightness in the chest,

usually with exertion,

and as the patient stops exercising the symptoms resolve.

The treatment of a heart attack is to open that artery

and therefore restore the blood supply to the heart

so as little damage as possible is caused

in terms of the heart muscle function.

The two ways of opening the artery

are firstly to use a drug which dissolves the clot within the artery,

so-called thrombolysis or thrombolytic drugs,

and they can be administered even in the patient's home.

That's given as an intravenous injection

and it will start to dissolve the clot, open the artery and restore blood flow.

So thrombolysis has the advantage that it can be given

safely and quickly in the patient's home.

The disadvantage is it does not get rid of the original narrowing of the artery.

It will dissolve the clot that forms on the narrowing,

but patients are often left with a significant narrowing within the artery

and they will often then experience angina after their heart attack

and then go on to need treatment for the restriction,

which may be angioplasty and stenting

or even bypass surgery if they had very extensive disease.

The second approach to treating a heart attack is to do primary angioplasty,

whereby the patient is transferred from their home,

or wherever they experience their symptoms of a heart attack,

to a hospital which routinely carries out coronary angioplasty and stenting,

and therefore the patient then has the procedure in that hospital

and the artery is opened and stented

using a balloon to stretch the artery to start with

and then the stent is a metal mesh of scaffolding within the artery

to hold it open,

so that has the advantage

that it deals with both the clot and the narrowing at the same time.

In the patients who present with a heart attack

and receive thrombolysis, the drugs to dissolve the clot,

usually they're monitored in a coronary care unit for 24 hours

and then immobilised on a medical ward

and usually discharged from hospital

within three, four or five days after the event,

assuming there are no further complications.

It may be that some of the patients have residual angina

because they still have the narrowing within the artery

and therefore need stenting during that admission,

or some patients will have it done more electively

in a few weeks after their heart attack.

The patients who present with heart attack

who we treat by primary angioplasty,

where they have the artery opened and then stented,

usually have a shorter stay in hospital, usually between two and three days,

but again if complications ensue, the heart rhythm is a problem,

then they may need to stay in hospital for slightly longer.

That's an important part of treatment.

The acute treatment is very hi-tech and mechanical,

but preventative measures for further events

are extremely important and sometimes underplayed.

But lifestyle advice, diet and exercise are very important,

so we will advise patients to take more regular exercise,

to watch their diet, to lose weight,

to reduce their fat intake, dairy products, saturated fats particularly,

not to smoke,

to have their blood pressure monitored and treated if it's high.

So those changes and reducing their risk factors for coronary artery disease

are very important as part of the overall treatment.

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