Heart attack (myocardial infarction)

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What is it about ?

Hereditary factors or unhealthy lifestyle can increase the fat content in the blood. This can slowly clog the blood vessels. After a few decades, the fatty deposits in the lining of the arteries calcify. This is called arteriosclerosis (or atherosclerosis or atheromatosis).

The coronary arteries are the blood vessels that supply the heart muscle (myocardium) with oxygen. When a lump of fat comes off suddenly, a coronary artery can suddenly become partially or completely blocked. The part of the heart supplied by the blocked coronary artery no longer receives oxygenated blood and dies. This is called a myocardial infarction or heart attack.

Your way of life can have a big influence on your risk of cardiovascular disease. The main risk factors are smoking, excess weight, stress, lack of physical activity, increased cholesterol levels, high blood pressure and diabetes. Heredity, age and (for women) the period after menopause are also risk factors but cannot be influenced.

What is its frequency?

Cardiovascular diseases, in particular myocardial infarctions, are the main cause of death in Belgium. Each year, around 15,000 Belgians have a heart attack. A little less than half does not survive. Heart attacks don’t just affect older people; by the time of their first heart attack, a quarter of men are under 55 years old.

How to recognize it?

Before a heart attack, “angina” has sometimes already been present for some time: it is a painful and oppressive sensation in the chest, especially on exertion. Complaints decrease at rest.

With a myocardial infarction, it is often a painful and oppressive sensation, and sometimes even a feeling of tightness in the chest, usually behind the breastbone, which lasts at least 20 minutes. In men, the pain often radiates to the (left) arm, sometimes the shoulders, neck, jaw, back, or upper abdomen. In women, the symptoms of a heart attack are less typical. This sensation does not disappear with rest and it is not modified, neither by breathing, nor by a change in posture. You may also be nauseous, sweating excessively, chattering your teeth, or have shortness of breath or dizziness.

How is the diagnosis made?

The diagnosis must be evoked on the basis of the complaints. A physical examination, an ECG (electrocardiogram) and a blood test will then confirm the diagnosis.

What can you do ?

Be sure to adopt a healthy lifestyle. Eat healthy and watch your weight. Replace saturated fat (eg butter) with unsaturated fat (eg olive oil). Consume a maximum of 6 grams of salt per day (the average consumption in Belgium is 10 grams per person per day). Cut down on alcohol and quit smoking. Exercise for at least 30 minutes a day. Be aware of any cardiovascular disease in your family and let your doctor know.

The symptoms of a heart attack are sometimes not recognized by the patient himself or are underestimated. The message is clear: call your doctor and, if necessary, the emergency number 112 if you suspect a heart attack.

What can your doctor do?

Prompt medical attention is essential to maintain the viability of as much of the heart muscle (myocardium) as possible and to prevent or treat life-threatening complications such as disturbances in the rhythm of the heart (arrhythmias) of the heart. If the general practitioner is the first on the spot, he will call for help, give aspirin and if possible perform an ECG (electrocardiogram), while waiting for help.

The treatment options in the hospital depend, among other things, on the time elapsed since the onset of the infarction. Sometimes medicine can help clear the clot that is blocking the artery to the heart. This is only possible within 2 hours of symptom onset and it also increases the risk of bleeding.

The artery to the heart is sometimes unblocked mechanically by inserting a balloon into the artery until it reaches the clot and then inflating it. This procedure dilates the artery of the heart narrowed by the clot. Sometimes, a “stent” will be placed quickly to keep the artery open or a bypass will be performed.

Then, after the acute phase, begins a rehabilitation phase: rehabilitation with exercises and control (with or without medication) of the risk factors related to the lifestyle that led to the first infarction. This rehabilitation is accompanied by several different professionals. These medicines include antiaggregants (eg, aspirin or clopidogrel), a cholesterol lowering agent (statins), a beta blocker, and possibly an angiotensin converting enzyme (ACE) inhibitor.

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Sources

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