Also referred to as an acute myocardial infarct, a heart attack occurs when an artery blockage prevents blood from flowing to a portion of a person’s heart. Heart tissue can be damaged or even destroyed if someone isn’t treated swiftly. A heart attack can be fatal. The American Heart Association states that approximately 735,000 people in the United States experience heart attacks each year. Around 120,000 of those people do not survive.
The symptoms and signs linked with insufficient blood flowing to the heart are referred to as Acute coronary syndrome (ACS). What separates a heart attack from other types of ACS is that the decrease in blood flows continues, which causes heart muscle cells to be damaged or destroyed. If someone is brought into the ER, healthcare workers need to run tests to see if the symptoms are caused by a heart attack or something else.
The human heart is an organ that’s primarily made from cardiac muscle. It uses a system of arteries and veins to pump blood through the body. As blood flows through the human body, it picks up oxygen from the lungs. The blood then passes through the pulmonary veins and enters the heart. The blood is then pumped out, bringing oxygen to the tissues. The veins return the blood to the heart, where it is pumped back out to collect more oxygen from the lungs. The heart is unable to carry out these tasks without a significant amount of oxygen, which is obtained from the heart’s network of arteries and veins.
In most cases, a blockage that leads to a heart attack occurs because of a blood clot in a coronary artery, the arteries that bring blood to the heart. This is more likely to happen when the walls of the arteries are thickened and narrowed. This occurs via a process known as atherosclerosis, which causes plaque to build up on artery walls gradually. If a clot in a coronary artery keeps blood from flowing to the heart for more than an hour, it can cause scarring in that area. Furthermore, it can cause heart muscle cells to die.
Several factors can increase the risk of a heart attack, such as:
- High cholesterol
- High blood pressure
- A sedentary lifestyle
- Advanced age
- A smoking habit
- History of heart disease in the family
- Drug use
- Autoimmune conditions like rheumatoid arthritis or lupus
- Pre-eclampsia, which is linked with high blood pressure in pregnancy
Symptoms and Warning Signs
Heart attacks and other types of acute coronary syndrome often cause abrupt pain in the chest. The pain frequently radiates into other body parts, such as the arm, shoulder, or jaw, and does not go away with rest. In some cases, this is a more intense version of reoccurring pain, but in other cases, people are experiencing this pain for the first time.
If someone has already experienced chest pain because their narrowed arteries do not allow an adequate amount of blood to flow to the heart, they may find that these symptoms are more intense or last for a more extended period of time.
It should be noted that not all people that have heart attacks experience this symptom. It is more likely that women will experience atypical symptoms. Women often experience milder symptoms, which are frequently attributed to another cause. A heart attack can occur abruptly, but it’s also possible for symptoms to slowly build up over time. People may find that their symptoms stop and then return in some cases.
Some common signs and symptoms are:
- Discomfort, pain, or pressure in the chest (this is the most common symptom)
- Elevated heart rate or skipping a heartbeat
- Stomach pain, nausea, and vomiting
- Shortness of breath or difficulty breathing
- Blood pressure changes
- Pain in the arms, back, neck, or jaw
People can experience these symptoms without feeling any chest pain, especially if they’re older or diabetic.
Testing for A Heart Attack
If a patient arrives at the ER showing acute coronary syndrome symptoms, it’s not always immediately apparent that they are experiencing a heart attack. Their chest pain could have another cause, or they may be dealing with unstable angina. Thankfully, there is a range of tests that allow healthcare workers to determine whether a heart attack occurs.
Typically, it’s necessary to run a blood test to determine whether someone has suffered a heart attack. When muscle cells are damaged, specific proteins are released. To see if a patient has suffered a heart attack, cardiac biomarkers are ordered, such as:
Troponin: This is the marker that is most frequently ordered. It’s focused on the heart. Troponin blood levels will be elevated in the hours after heart damage has occurred. These levels can remain elevated for as long as two weeks. If a patient arrives in the emergency room showing acute coronary syndrome symptoms, troponin tests will likely be ordered right away. Over the next few hours, these tests will be ordered a few more times to monitor concentration changes. If the tests show normal levels, stable angina is likely causing the pain, not heart muscle damage. However, if the results show levels rising or falling, it’s a clear indicator of a heart attack.
A high-sensitivity troponin test is like the standard test, but it can detect this protein at lower levels. Since this is a more sensitive version of the test, it can deliver positive results more quickly, allowing doctors to diagnose a heart attack more quickly. The test can also show a patient’s risk of heart attacks and other heart events in the future. The test can be positive even if a person has no symptoms. The test is not approved in the United States at writing, but research is still being conducted. It may be available at a future date. Canada, Europe, and several other countries already use this test as a cardiac biomarker.
CK-MB – This is a form of the creatine kinase that can be found in cardiac muscle tissue. When the cells of the heart muscle are damaged, it rises. Now that troponin testing is an option, this test isn’t ordered as often.
Additional tests that could be ordered are:
Myoglobin – When there is an injury to either the heart or skeletal muscle, this protein is released into the blood. This is another test that is ordered less often.
NT-proBNP or BNP – The body naturally releases this in response to heart failure. Although elevated BNP levels aren’t enough to diagnose a heart attack, it suggests that a person is at an increased risk for cardiac problems.
Additional screening tests could be ordered to look at a patient’s electrolyte balance, organ health, blood glucose levels, and red and white blood cell count. Examples of these tests are:
Comprehensive Metabolic Panel – This is a collection of 14 tests that can broadly screen the health of a patient’s liver, kidneys, blood proteins, blood glucose, and electrolyte and acid balance.
Complete Blood Count: This test is used to screen for various disorders that can impact blood cells, like infection and anemia.
The American Heart Association has released new cholesterol guidelines in unison with the American College of Cardiology. The premise behind these new guidelines is to understand and analyze the personal risk of cardiovascular disease (CVD) along with appropriate treatment options. These guidelines are now set as the standard by more than ten well-established medical organizations. These guidelines will make it easier to tailor recommendations and/or treatment plans using risk assessment processes. These treatments will encompass a variety of solutions, including statin/non-statin drug therapies.
A person that has been diagnosed with high cholesterol regardless of age can end up having a heightened risk profile for cardiovascular disease. Due to this high cholesterol, the blood vessels start to constrict because of the newly formed plaque. Based on this premise, the AHC guideline panel has taken the time to highlight what’s required during the decision-making process between healthcare professionals and their patients. These guidelines have been updated for the first time since 2013 with a greater assessment of lifetime risks for cardiovascular disease in combination with treatment options for lowering cholesterol levels.
Medical concerns involving heart disease, strokes, and heart attacks continue to plague Americans across the nation. Studies show over 836,000 people pass away in the U.S. due to this disease, with the number being greater than cancer-related or lung disease-related deaths. Along with these numbers, 360,000 people pass away due to coronary heart disease and 114,000 from heart attacks. It’s also important to note the presence of reoccurring heart attacks in America, which account for 335,000 cases in America per year.
These AHA guidelines will include a standardized risk calculator to determine a person’s risk profile for a possible cardiovascular event (i.e., stroke, heart attack) within the next decade. This calculator includes pre-determined guidelines from 2013, such as smoking, diabetes, high blood pressure, and unhealthy lipid levels, while also accounting for additional factors such as aspirin therapy and/or statin treatment. This risk calculator will act as a standardized method to determine a person’s risk profile while also accumulating personalized data from previous health exams.
Healthcare professionals are also asked to highlight the following risk variables to their patients:
It’s important to note; these AHA guidelines are aimed at helping to diagnose high LDL levels before providing appropriate lowering solutions. The goal is to help lower LDL levels to approximately 70 mg/dL or less for high-risk patients. This recommendation was removed during the 2013 guidelines but has found its way back in the recent update. The emphasis is on taking these new guidelines to pinpoint a specific coronary artery calcium score (via a cardiac CT scan) and assessing statin therapy in those with intermediate CVD risk.
These guidelines are all about shedding light on potential risk factors to patients with a greater likelihood of being diagnosed with cardiovascular disease. When those patients recognize these signs and start implementing preventive measures, it becomes easier to alleviate the possibility of heart disease or heart attack. These lifestyle changes include implementing a healthier diet, not smoking, and/or following a regular exercise regimen.
Healthcare practitioners can use these guidelines as a risk assessment tool while maintaining communication with their patients. This leads to improved and personalized decision-making due to the guidelines. It’s essential to personalize the treatment plan based on a patient’s medical history, medications, and/or lifestyle.
Based on new-age research, statins continue to be the best way to help lower LDL levels and can be used in different forms depending on an individual’s medical requirements. Additional non-statin drug therapies involving PCSK9 inhibitors and/or ezetimibe can be used for high-risk patients to lower their LDL levels.