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Heart Attack

When the blood flow to the heart is reduced or blocked in the body, a heart attack occurs. Blockage usually occurs due to the buildup of fat, cholesterol, and other substances in the heart (coronary) arteries.

What is a heart attack?


Like all organs, the heart also requires a continuous supply of oxygen and nutrients to function. A heart attack, medically known as myocardial infarction, is an urgent medical condition primarily caused by coronary artery disease. It usually occurs when there is a significant reduction or complete cessation of oxygenated blood flow to the heart muscle after blood clotting.


What are the types of heart attacks?


When the blood vessels supplying the heart are blocked, a heart attack occurs. There are three types of heart attacks:

  1. ST-elevation myocardial infarction (STEMI)

  2. Non-ST-elevation myocardial infarction (NSTEMI)

  3. Coronary artery spasm

The "ST segment" refers to a pattern seen in an electrocardiogram, which is an indicator of your heart's rhythm. Only a STEMI will show elevated segments. Both STEMI and NSTEMI can cause significant damage and are considered major heart attacks.


What are the causes of heart attacks?


The heart, which supplies the blood needs of the entire body, also requires a good blood supply to function properly. The blood vessels that supply blood to the heart are called coronary arteries, and when they become blocked, a heart attack occurs. Blockage usually starts with the accumulation of fat, cholesterol, and other substances that form a plaque in the arteries that nourish the heart (coronary arteries). In some cases, these plaques can rupture, and a blood clot may form, completely blocking the blood flow over the plaque. In such a situation, the nourishment of the heart muscle supplied by the blocked coronary artery is disrupted, and depending on the duration of the blockage, a part or a large portion of the heart muscle can be damaged.


Coronary artery disease (also known as atherosclerosis or hardening of the arteries) is the most common cause of a heart attack. It occurs when substances like fats and cholesterol accumulate on the walls of the arteries responsible for blood flow to the heart, forming structures called plaques. Over time, these plaques grow and narrow the artery, reducing blood flow to the heart muscle. If one of these plaques ruptures, it can cause a blood clot that blocks the artery and leads to a heart attack.


One less common cause of a heart attack is a condition called spontaneous coronary artery dissection (SCAD), where one or more coronary arteries tear.


What are the risk factors of heart attacks?


  • Smoking and all tobacco products, including hookah (nargile).High levels of bad cholesterol (LDL) and low levels of good cholesterol (HDL).

  • Diabetes: Insufficient production of the hormone insulin by the pancreas or the body's inadequate response to insulin leads to an increase in blood sugar levels, increasing the risk of a heart attack.

  • Metabolic syndrome: This condition occurs with obesity, high blood pressure, and high blood sugar. Metabolic syndrome significantly increases the likelihood of developing heart disease.

  • Obesity: Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure, and diabetes. Even a 10% reduction in body weight can lower the risk of a heart attack.

  • Sedentary lifestyle: Individuals who spend prolonged periods sitting at a desk and don't engage in regular physical activity are at higher risk of diabetes, obesity, high cholesterol, and heart attacks. Sudden strenuous exercise or long and tiring journeys without prior medical examination can trigger a heart attack. Regular brisk walking for at least 30-45 minutes, five days a week, is highly important for people with a sedentary lifestyle. Opting for late afternoon/evening for exercise is safer for heart health compared to early morning exercises in cold weather.

  • Age: Men over 45 and women over 55 are at higher risk.Drug use: Stimulant drugs like cocaine or amphetamines can trigger spasms in the coronary arteries, leading to a heart attack.

  • Hypertension (high blood pressure).

  • Unhealthy diet (rich in saturated fats): Consuming heavy and salty meals, excessive alcohol consumption are among the triggers for a heart attack. It has been determined that heart attack risk increases by 7 times in patients at risk after heavy meals. Additionally, the consumption of caffeine-containing beverages can increase heart rate and blood pressure, potentially leading to a heart attack. Those who do not habitually consume coffee have a higher risk of heart attack after consuming coffee compared to regular coffee drinkers. Therefore, individuals who are not used to drinking coffee should avoid drinking it in succession.

  • History of preeclampsia: This condition causes high blood pressure during pregnancy and increases the lifelong risk of heart disease.

  • Autoimmune conditions: Diseases like rheumatoid arthritis or lupus can increase the risk of a heart attack.

  • Family history of heart disease in first-degree relatives (parents, siblings): Individuals with a family history of coronary heart disease, especially sudden and young deaths, should not start smoking or quit smoking if they already smoke. Monitoring blood pressure and seeking the advice of a cardiologist in case of an increase is essential. Additionally, these individuals should visit cardiology centers to investigate the presence of other factors contributing to coronary heart disease, such as diabetes and high cholesterol levels.


What are the symptoms of a heart attack?


The common symptoms of a heart attack, which is characterized by pain or a feeling of tightness lasting a few minutes in the left side or middle of the chest, are as follows:

  • Shortness of breath before or after chest pain

  • Dizziness, lightheadedness, and a feeling of faintness

  • Cold sweating

  • Pain in the neck, jaw, or back

  • Pain or tingling that starts from the chest and spreads to the left arm, and even to the shoulder (it can occur in both arms)

  • A feeling of anxiety similar to a panic attack

  • Unusually extreme fatigue, nausea, or vomiting can also be symptoms of a heart attack.


During this time, the pain increases when moving and decreases when resting, but it doesn't go away. Typically, the pain lasts for more than 20 minutes. In some cases, the symptoms can be quite subtle. Especially in elderly patients, those with diabetes, female patients, and patients with a history of heart failure, they may hardly feel any pain or experience a heart attack with only complaints of shortness of breath and cold sweating. In women, the symptoms of a heart attack can be slightly different.


On the other hand, heart attack symptoms in women may differ from those in men. For example, chest pain may not be the first sign of heart trouble for some women. Some women may experience symptoms such as unusual fatigue, difficulty sleeping, indigestion, and anxiety up to a month before a heart attack, which can signal a heart attack.


What should you pay attention to during a heart attack? How should emergency intervention be performed during a heart attack?


The most crucial aspect during a heart attack caused by sudden coronary artery blockage is for the person to immediately seek medical attention and receive healthcare at a fully equipped hospital as soon as symptoms, such as heart pain, arise. Approximately half of the deaths related to a heart attack occur within the first hour after the heart attack begins. Starting first aid early until the patient reaches the hospital allows clot-dissolving treatments to be administered promptly, preventing further damage to the heart. A rapid and accurate diagnosis and appropriate intervention during the patient's hospital care are essential.


If a person is alone during a heart attack:

• There is no maneuver the person can perform to open the blocked artery.

• First, as soon as the pain starts, the patient should use the phone to call someone close to inform them about the situation.

• Leave the door of the current location slightly open. This makes it easier for the person coming to help.

• A strong cough might temporarily increase blood flow. Although the chances of dislodging a newly formed blood clot are very low, the person should cover their nostrils and cough forcefully.

• If there is aspirin at home, take it with a glass of water.

• Besides that, the person should not eat or drink anything.

• Open the window to allow oxygen into the room.

• Await help while lying down or sitting. Avoid standing as a person coming to the hospital with a heart attack should not have any additional injury. If the person has fallen and hit their head, necessary treatments related to the heart attack may not be possible due to the head injury.

• Do not engage in exercise to reduce pain.

• Do not take a shower with cold or hot water. Especially cold water is very dangerous in such situations as it can constrict heart vessels and also narrow unaffected vessels.

If a person experiences a heart attack next to you:

• If you don't have medical experience, do not attempt to intervene in someone having a heart attack, do not administer your or others' heart medication.

• Immediately call for an ambulance and take the patient to the nearest fully equipped hospital.

• Lay the person down in a suitable position during this time.

• Elevate their feet above heart level to improve blood flow to the heart.

• Provide assistance by loosening tight clothing, such as untying their tie.

• The essential thing is to transport the patient to a hospital where their tests and treatments can be conducted properly and appropriately.


How is a heart attack diagnosed?


A heart attack is a medical emergency and requires immediate hospitalization and monitoring as soon as it is detected or suspected. A patient diagnosed with a heart attack is typically monitored in the intensive care unit during the first 24-48 hours. Those experiencing symptoms of a heart attack should immediately call for an ambulance. The majority of deaths related to a heart attack occur within the first few hours after the attack due to life-threatening arrhythmias. Rapid diagnosis and appropriate intervention are of vital importance. The treatment process begins on the way to the hospital through ambulance personnel, as early intervention prevents damage to the heart muscle. The patient's vital problems, such as blood pressure, rhythm, and respiration, are attended to first. Then, the necessary tests are initiated to make a definitive diagnosis.


Upon arrival at the hospital, the doctor will perform tests to diagnose whether a heart attack has occurred. These tests also measure the extent of damage to the heart and determine the most suitable treatment method.


The following tests are used:

  • Electrocardiogram (ECG): Should be performed immediately upon admission for every patient with chest pain or suspected heart attack, and may be repeated later.

  • Blood tests: Especially tests indicating heart damage, such as troponin, help diagnose patients who do not show indications for immediate angiography in the ECG. These tests are helpful both for diagnosis and for determining the extent of heart damage.

  • Coronary angiography (Cardiac catheterization): This is the definitive diagnostic method used to visualize and intervene in the blocked artery. It is performed from the wrist or groin depending on the patient's suitability.


What are the treatment methods for a heart attack?


Patients who present to the emergency room with suspected heart attack should consult a cardiologist after necessary emergency interventions have been applied. Depending on the patient's condition, the doctor may monitor and perform angiography to check the heart vessels. Based on the results of angiography, drug treatment, stent placement, or surgical procedures may be required. The faster the treatment process in a heart attack, the less damage the heart muscle will sustain.


The primary treatment for a heart attack is to open the blocked artery without delay. While dealing with life-threatening complications such as arrhythmias and cardiac arrest, the necessary treatment to restore blood flow in the blocked artery should also be initiated.


Common procedures for heart attack treatment include:


Balloon Angioplasty: The blocked artery is opened using a balloon or by removing plaque buildup through angioplasty.

Stent Placement: Coronary stents are commonly used in combination with balloon angioplasty to ensure full opening of the artery and prevent reblockage.

Bypass Surgery: Arteries taken from other parts of the body, such as arms or legs, are used to restore blood flow to the blocked coronary arteries.

Heart Valve Surgery: In cases where surgical intervention is required for coronary arteries, valve repair or replacement may also be performed simultaneously.

Cardiac Pacemaker: The cardiac pacemaker is an implanted device under the skin designed to help maintain a normal heart rhythm. Some patients who have had a heart attack may require different types of pacemakers in the short or long term.

Heart Transplantation: Heart transplantation is an advanced treatment method to be considered in severe cases where heart attack causes permanent tissue death in most of the heart.


Medical treatment may include the following:


Anticoagulant medications: Also known as "blood thinners," these drugs reduce the clotting effect of the blood to prevent clot formation and inhibit the growth of existing clots.

Antiplatelet medications: These drugs may be used in combination with others to prevent the formation of new blood clots and stop the growth of existing ones. Patients who have had a heart attack or angina, undergone stent placement, or bypass surgery are usually prescribed antiplatelet medications for a lifetime.

Beta-blockers: These drugs help relax the heart muscle, slow down heart rate, and lower blood pressure. The use of beta-blockers reduces the risk of heart attack due to heart workload. They may also be prescribed for arrhythmias or angina.

Antihypertensive medications: Angiotensin-converting enzyme (ACE) inhibitors dilate blood vessels to reduce pressure in the heart. They are used to lower blood pressure, improve heart function, and increase the chances of survival after a heart attack. Angiotensin II receptor blockers (ARBs) work similarly to ACE inhibitors. If there are side effects from taking ACE inhibitors, such as persistent cough, ARBs may be prescribed.

Nitrates: These medications dilate blood vessels to increase blood flow to the heart, preventing or treating chest pain or angina.

Statins: These drugs help lower cholesterol and reduce the risk of a heart attack. Even if the cholesterol level is within normal limits, statins may still be prescribed for individuals who have had a heart attack.

Thrombolytics: These "clot-busting" drugs dissolve blood clots that can narrow or block arteries. They are administered intravenously.


How to Prevent a Heart Attack?


Some lifestyle changes can help reduce the risk of a heart attack:


  1. Avoid smoking.

  2. Engage in regular exercise, especially suitable for individuals with heart disease. People over the age of 50 who lead a sedentary lifestyle should consult a doctor before starting an exercise program.

  3. Regularly visit a doctor for blood pressure and cholesterol monitoring.

  4. Maintain a healthy weight.

  5. Follow a diet low in fat, cholesterol, and salt. Choose healthy fat options such as nuts, avocados, olives, and olive oil.

  6. Consume plenty of vegetables, fruits, and whole grain foods.

  7. Limit daily salt intake to 5-6 grams to prevent high blood pressure.

  8. Include various healthy protein sources such as fish, legumes (beans and lentils), and nuts. Consume lean cuts of red meat and limit red meat consumption to 1-3 times per week.

  9. Monitor and control diabetes regularly.

  10. Manage stress effectively.

  11. Avoid or limit alcohol consumption.


Note: In addition to these measures, 'blood thinners,' beta-blockers, ACE inhibitors, and cholesterol-lowering medications can be prescribed to reduce the risk of a heart attack. For instance, your doctor may recommend taking low-dose aspirin regularly. Aspirin helps reduce the tendency of blood to clot, thereby lowering the risk of a heart attack. The use of aspirin should be initiated based on your doctor's advice.


How to prevent a second heart attack?


All tobacco use habits, such as smoking, cigars, pipes, and hookah, should be quit. Continuing to use tobacco after experiencing a heart attack increases the risk of a second heart attack by at least 2-3 times.


Efforts should be made to be more physically active. Regular exercise programs can help reduce stress and depression, maintain weight, cholesterol, and blood pressure levels.

Medications should be taken under the supervision of a doctor. Medications prescribed by a cardiologist should not be neglected and must be taken regularly. In case of any minor issues, it is essential to communicate with the doctor immediately.


A healthy diet should be maintained to promote quicker recovery, control weight, and keep cholesterol and blood pressure levels in check. One should never fall into the misconception of "I'm taking medication, nothing will happen to me," as lifestyle changes are as crucial as medications for heart health.


FREQUENTLY ASKED QUESTIONS ABOUT HEART ATTACKS?


What is the relationship between smoking and heart attack?


Most smokers experience a heart attack directly associated with their smoking habits.

The nicotine consumed while smoking causes many health problems, including:

  • Deprivation of oxygen to the heart

  • Increased blood pressure and heart rate

  • Blood clotting

  • Damage to the endothelial lining of coronary arteries and other blood vessels, which are serious issues.


If I am using medication to treat heart disease, does that mean I am no longer at risk of a heart attack?


No, it does not mean that. This situation means that you are trying to reduce your risk of having a heart attack in the future. Some factors leading to a heart attack may be hereditary or genetic, so even if you are taking medication, the risk of a heart attack may still exist. It is recommended to discuss with your doctor about what you can do to minimize the risk of a heart attack.


Is every chest pain related to a heart attack?


Chest pain can also arise from various causes other than a heart attack. (such as chest muscles, nerves, ligaments, gallbladder, stomach, esophagus, etc.)


What is Myocardial infarction?


Myocardial infarction is the medical term used for a heart attack.


How long does a heart attack last?


The symptoms of a heart attack can last for 30 minutes or longer if they do not subside with rest or under-the-tongue nitroglycerin.


Can stress cause a heart attack?


Stress can affect factors and behaviors that increase the risk of heart disease (such as high blood pressure and cholesterol levels, smoking, alcohol, physical inactivity, and overeating, etc.). While the connection between stress and heart disease is not entirely clear, chronic stress can elevate blood pressure and damage artery walls.


What are the recommendations to reduce the risk of heart and vascular diseases in women?


The estrogen hormone partially protects premenopausal women against heart and vascular diseases. Therefore, the risk of having a heart attack is lower in women compared to men. However, this risk becomes equal to that of men for women around 10 years after entering menopause, and it becomes particularly high for women over 70 years old. Women of reproductive age have a relatively low risk of heart attacks. Nevertheless, although rare, this condition is dangerous, especially for this age group. This is because, in addition to the typical symptom of chest pain, other symptoms more commonly associated with common cold or flu, such as shortness of breath, jaw, shoulder, or arm pain, nausea, vomiting, sweating, dizziness, and weakness, may also be observed. When these complaints arise, the patient should be evaluated for the possibility of a heart attack.


To reduce the risk of heart and vascular diseases in women, the following should be considered:

  • Reduce fat consumption.

  • Avoid fried foods as much as possible.

  • Reduce sugar and salt intake.

  • Prefer fresh vegetables, fruits, fish, and fiber-rich foods.

  • Consume foods with high antioxidant properties and omega-3 fatty acids, such as walnuts and hazelnuts.

  • Avoid smoking and alcohol.

  • Engage in physical activity or, if not possible, do not neglect to walk for 1-2 hours daily.

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