The heart is
the major organ of human circulatory system and hardest working organ of human
body. It continuously pumps blood enriched with oxygen and vital nutrients
through a network of arteries to all body tissues. It is a powerful pump, which
has got no match; during peak exercise it can pump about 50 liters of blood in
a single minute. To perform this arduous task of pumping blood to rest of the
body, heart muscle itself requires a good supply of oxygen rich blood. A
network of coronary arteries supplies this. There are 3 main coronaries- left
anterior descending (LAD), left circumflex (LCx) arising from left side and one
right coronary artery (RCA) from right side. If blood flow to the heart muscle
is interrupted or blocked the heart muscle suffers injury, which is called
myocardial infarction and is commonly known as heart attack.
Coronary artery disease:
The heart
attack is the severest form of coronary artery disease. Coronary artery disease
is said to be present when plaque starts accumulating inside the walls of
coronary arteries. Plaque is an atherosclerotic chunk of fatty deposits causing
hardening and narrowing of coronary arteries. There is slow accumulation of
fatty deposits causing gradual narrowing of coronary arteries and progressively
starving heart muscle of oxygen and nutrients. When heart muscle is deprived of
proper blood supply and oxygen, it becomes ischaemic and pain occurs. This pain
is called angina. This initially occurs during increased demand of the body
when heart has to pump more blood to body mainly during exertional activities.
So angina occurs when coronary arteries are unable to supply adequate amount of
blood to heart muscle as is required by it.
The plaque can
also rupture under certain circumstances, which causes sudden occlusion of
coronary artery by the formation of thrombus or blood clot. This sudden
occlusion totally stops the blood supply to heart muscle and it leads to heart
attack or myocardial infarction.
Anginal
syndromes:
Angina means chest pain;
it is the primary symptom of heart disease and heart attack. It occurs when
heart muscle doesn’t get as much blood (hence oxygen) as is required for a
given level of work. It is usually referred to as one of the two states: stable
and unstable. Anginal attacks can occur at any time during day, but a high
proportion seems to take place in the early hours of the day. The unstable
angina is often an intermediate stage between stable angina and a heart attack
and its course is unpredictable and is a sign of more serious disease. It is
usually diagnosed if one or more of following conditions occur.
- Pain awakens the patient or occurs at rest.
- A patient who has never experienced angina but is now having severe or moderate pain during mild exertion within last two months.
- Stable angina has progressed in severity, frequency and duration or medications are less effective in relieving pain.
Stable
angina: It is extremely painful situation, more
predictable course and less serious than unstable angina. It is usually
relieved by rest and responds well to medical treatment especially nitrates
which can be kept below the tongue. Any event that increases oxygen demand can
cause an anginal attack. Some typical triggers include exercise, cold weather,
emotional tension and heavy meals.
Unstable
angina is usually described as part of a condition called acute coronary
syndrome (ACS). It also includes patients with condition called NSTEMI (non
ST-segment elevation myocardial infarction) also referred to non-Q - wave heart
attack. In this ECG and blood tests suggest a developing heart attack. These
conditions are less severe than heart attack but may develop into full-blown
attacks without aggressive treatment. Full-blown heart attacks are usually
called ST elevation myocardial infarction.
Indicators of heart attack:
Anyone who
believes he or she is having heart attack should not hesitate to contact
emergency medical services. People with known heart disease, any unusual chest
pain or other symptoms of heart attack which are not clearing up with routine
medications are warning signals to go to the hospital. The severity of pain and
specific symptoms before heart attack vary greatly among individuals and onset
may be abrupt, gradual or intermittent.
Chest
pain is the
most common indicator and clinical expression of heart disease. People with
risk factors for heart disease or having heart disease should be very
particular about any chest pain. It is usually precipitated with exercise or
stress and interrupts normal activities and does not clear up after taking rest
and routine heart medicine. It may be experienced as crushing weight against
chest with profuse sweating. Pain may radiate to left shoulder, arm, neck or
jaw. Some may have sense of fullness, squeezing or pressure over the chest.
People may also experience nausea, vomiting, cold sweats, indigestion, heart
burn, abdominal pain, fainting and a great fear of impending doom i.e. angor
animi. Nearly half of the patients may not have chest pain, they may present
with shortness of breath and cardiac arrest.
Some people
with severe coronary artery disease may not experience angina, this condition is
called silent ischaemia. It may be
due to abnormal processing of heart pain by the brain. It is a dangerous
condition because patient has no warning signs of heart disease.
Symptoms that are less likely to indicate a heart attack:
Sharp pain brought on by
respiration/coughing. Pain mainly in lower or middle abdomen. Pain is pin
pointed with tip of one finger, pain reproduced by moving or pressing on chest
wall/ arms. Very brief pain lasting few seconds.
What actions need to be taken at onset of symptoms?
- Take nitroglycerin as spray or sublingual tablet and repeat after 5 minutes maximum upto 3 doses.
- Immediately call or reach emergency services, do not deceive yourself.
- Chew a tablet of aspirin
Dr TP SinghChief Consultant Cardiologist,SGHS Hospital, MohaliE-mail id: tpsinghtp@yahoo.co.inMobile No : 09872421946