Heart Attack

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TOPIC: General Studies 2:

• Issues relating to development and management of Social Sector/Services relating to Health

September 29: World Heart Day

What is Heart Attack?

Death of a segment of heart muscle caused by a loss of blood supply

• The blood is usually cut off when an artery supplying the heart muscle is blocked by a blood clot.
• The blockage is most often a build-up of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries).
• During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can block the flow of blood through the coronary artery, starving the heart muscle of oxygen and nutrients (ischemia).

Types of Heart Attack

Rheumatic heart disease: A chronic heart condition that is caused by rheumatic fever (common heart disease in children). This disease is more prevalent in developing countries, especially in areas of poverty.

Valvular heart disease: Involves one or more of the four valves of the heart (the aortic and bicuspid valves on the left side of heart and the pulmonary and tricuspid valves on the right side of heart). These conditions occur largely as a consequence of aging, but may also be the result of congenital (inborn) abnormalities or specific disease or physiologic processes including rheumatic heart disease and pregnancy.

Hypertensive heart diseases: Due to High blood pressure – overburdens heart and blood vessels, causing damage

Cerebrovascular heart disease: Blood circulation to the brain is affected, caused mainly due to atherosclerosis

Inflammatory heart disease: Inflammation of the pericardium

• Bacterial or fungal infection
• Heart attack and myocarditis
• Consumption of medications that suppress immune system
• Radiation therapy to the chest
• Due to diseases such as Cancer, Leukaemia, TB, etc.

Ischemic Heart Disease: Due to decreased supply of oxygen to the myocardium i.e., the muscle of the heart (also known as coronary artery disease)

Symptoms

• A feeling of pressure, tightness, pain, squeezing
• Aching in the chest or arms that spreads to the neck, jaw, or back
• Coughing
• Nausea
• Vomiting
• Crushing chest pain
• Dizziness
• Shortness of breath called dyspnoea
• Face seeming grey in color
• A feeling of terror that life is ending
• Restlessness
• Feeling clammy and sweaty
• Shortness of breath

Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms; for others, the first sign may be sudden cardiac arrest.

Risk factors

• Age: Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women.

• Tobacco: This includes smoking and long-term exposure to second hand smoke.

• High blood pressure: Over time, high blood pressure can damage arteries that feed your heart. High blood pressure that occurs with other conditions, such as obesity, high cholesterol or diabetes, increases your risk even more.

• High blood cholesterol or triglyceride levels: A high level of low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the “good” cholesterol) lowers your risk of heart attack.

• Obesity: Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however.

• Diabetes: Not producing enough of a hormone secreted by your pancreas (insulin) or not responding to insulin properly causes your body’s blood sugar levels to rise, increasing your risk of heart attack.

• Metabolic syndrome: This occurs when you have obesity, high blood pressure and high blood sugar. Having metabolic syndrome makes you twice as likely to develop heart disease even if you don’t have it.

• Family history of heart attack: If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you might be at increased risk.

• Lack of physical activity: Being inactive contributes to high blood cholesterol levels and obesity. People who exercise regularly have better cardiovascular fitness, including lower high blood pressure.

• Stress: You might respond to stress in ways that can increase your risk of a heart attack.
• Illicit drug use: Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack.
• A history of preeclampsia: This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease.

• An autoimmune condition: Having a condition such as rheumatoid arthritis or lupus can increase your risk of heart attack.

Complications

• Abnormal heart rhythms (arrhythmias): Electrical “short circuits” can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal.

• Heart failure: An attack might damage so much heart tissue that the remaining heart muscle can’t pump enough blood out of your heart. Heart failure can be temporary, or it can be a chronic condition resulting from extensive and permanent damage to your heart.
• Sudden cardiac arrest: Without warning, your heart stops due to an electrical disturbance that causes an arrhythmia. Heart attacks increase the risk of sudden cardiac arrest, which can be fatal without immediate treatment. (Figure out the differences between heart attack and cardiac arrest)

What to do if you see someone who might be having a heart attack?

• If you see someone who’s unconscious and you believe is having a heart attack, first call for emergency medical help. Then check if the person is breathing and has a pulse. If the person isn’t breathing or you don’t find a pulse, only then should you begin CPR to keep blood flowing.
• Push hard and fast on the person’s chest in a fairly rapid rhythm — about 100 to 120 compressions a minute.
• If you haven’t been trained in CPR, doctors recommend performing only chest compressions. If you have been trained in CPR, you can go on to opening the airway and rescue breathing.

Causes of Death in India due to cardiovascular diseases

• Low quality of health care
• Lower access to healthcare facilities
• Lack of insurance  (an affordability barrier)
• Busy and stressful lifestyle leading to change in eating habits
• Household/Indoor air pollution 

PCSK9

• Use of PCSK9 inhibitors (PCSK9) helps in lowering cholesterol levels and reduce the risk of heart attacks.
• The PCSK9 are a new class of injectable drugs that reportedly reduce ‘bad’ cholesterol levels by up to 60% when combined with a statin (another class of drugs prescribed to help lower cholesterol levels).
• The discovery of cholesterol-lowering mutations in a human gene called PCSK9 led to the development of the most promising new drugs against heart disease since statins.

Do you know?

• Geneticist Helen Hobbs and her colleague Geneticist Jonathan Cohen, found that when people had a mutation in PCSK9, they ended up with lower levels of low-density lipoprotein (LDL) or bad cholesterol.
• Through this mechanism, the mutation protected people against heart disease, seemingly without side effects.
• In 2016, Ms. Hobbs was awarded the Breakthrough Prize in Life Sciences for her work.
• Low-density lipoprotein cholesterol, abbreviated as LDL-c, is considered the ‘bad’ variant of cholesterol as it contributes to plaque deposition, leading to the hardening and narrowing of arteries or ‘atherosclerosis’ (thickening of artery walls owing to accumulation of white blood cells).

Discuss on:

a) Differences between cardiac arrest and heart attack

b) State profile in terms of heart diseases

c) Air pollution is a new tobacco; it kills more people than smoking. Substantiate.

d) Consider the following statements with respect to ‘Heart Attack Rewind’

1. It is launched by World Health Organisation (WHO)
2. It promotes the elimination of industrially produced trans-fat in the food supply.

Select the correct statements

1 Only

2 Only

Both 1 and 2

Neither 1 nor 2