Heart attack (Myocardial infarction)

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Heart pain

What is heart attack or Myocardial infarction?

Due to hereditary factors or an unhealthy lifestyle, the fat content in the blood can rise. Because this fat cannot dissolve, it will stick to the inside of blood vessels, which slowly but surely clog. This is also called arteriosclerosis, but it is actually more correct to speak of fatty arteries. Only after decades do the fat deposits calcify.

The coronary arteries are the blood vessels that supply the heart muscle with oxygen. When a fat deposit suddenly breaks loose, a coronary artery can suddenly be completely or partially closed. Then the part of the heart muscle tissue that was irrigated by the blocked coronary artery no longer receives oxygen-rich blood and dies. This is called a heart attack or heart attack.

Your lifestyle can strongly influence your personal risk of cardiovascular disease. The main risk factors are smoking, obesity, stress, too little exercise, elevated cholesterol levels, elevated blood pressure and diabetes. Heredity, age and (for women) the period after the menopause are uncontrollable risk factors.

How often does it occur?

Cardiovascular diseases, in particular heart attacks, are the leading cause of death in Belgium. About 15,000 Belgians have a heart attack every year. Slightly less than half do not survive this. A heart attack doesn’t just affect older people; at the time of their first heart attack, a quarter of men are younger than 55 years old.

How can you recognise it?

In the period preceding an infarction, heart cramps usually occur for some time: this is a painful, tight feeling in the chest, especially during exertion. The symptoms improve at rest. The pain attacks become more and more frequent, up to twice an hour or more.

During a heart attack, a painful, oppressive, sometimes band-shaped feeling suddenly develops in the chest, usually behind the sternum, which lasts at least 20 minutes. In men, the pain often radiates to the (left) arm, sometimes also to the shoulders, neck, jaw, back or upper abdomen. In women, the symptoms of an infarction are less typical. That feeling does not disappear at rest and is not affected by breathing in or changing position. You may also feel nauseous, sweat excessively, chatter teeth, be short of breath or dizzy. Sometimes these complaints are so frightening that they trigger a panic attack. A heart attack often occurs early in the morning.

How does your doctor diagnose the condition?

In addition to a good questioning (complaints? risk factors?) and clinical examination, an ECG (electrocardiogram) and a blood test are required to confirm the diagnosis.

What can you do yourself?

Take care of an active and healthy lifestyle. Eat healthy and watch your weight. Swap saturated fats (eg butter) for unsaturated fats (eg olive oil). Use a maximum of 6 grams of salt per day (average consumption in Belgium is 10 grams per person per day). Limit alcohol and quit smoking . Exercise for at least 30 minutes a day. Be aware of cardiovascular disease in your family and inform your doctor about it.

The symptoms of a heart attack are often not recognized by the patient (they think of stomach pain) or underestimated (the pain is not that bad). As a result, medical help often comes too late and the patient dies before arriving at the hospital. 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 care is essential to keep as much of the heart muscle viable as possible and to prevent or treat life-threatening complications such as cardiac arrhythmias. If the GP is on site first, he can make an EKG (heart film) to confirm the diagnosis, and give a blood thinner while waiting for the MUG. So-called blood thinners are medicines that make the blood clot less easily. These products do not make your blood thinner, but change the clotting speed.

The treatment options in the hospital depend on, among other things, the time that has elapsed since the onset of the infarction. Sometimes a medicine can help dissolve the blood clot. This is only possible within 2 hours of the onset of symptoms. There is also an increased risk of bleeding.

The artery is sometimes mechanically released by inserting and inflating a balloon. This is how the narrowed coronary artery expands. If that is not possible, a stent will be quickly placed or a bypass (bypass). Afterwards, exercise rehabilitation is started under multidisciplinary supervision and the lifestyle factors that led to the first heart attack are adjusted (with or without medication). This medication includes blood thinners (eg acetylsalicylic acid, clopidogrel), a cholesterol-lowering agent (statin), a beta-blocker (eg metoprolol) and possibly an ACE inhibitor.

What drugs are used in myocardial infarction (heart attack)?

Medicines for a heart attack are usually used preventively. That is, they are used to reduce the risk of a heart attack. These medicines are prescribed to people who have an increased risk of a heart attack, for example people who have already had a heart attack.

Anticoagulants inhibit the formation of blood clots and thus reduce the risk of blockage of a blood vessel. This reduces the risk of having a heart attack. Examples are acetylsalicylic acid, acenocoumarol, carbasalate calcium, clopidogrel, dalteparin, enoxaparin, phenprocoumon, heparin, prasugrel, rivaroxaban and ticagrelor.

ACE inhibitors
ACE inhibitors lower blood pressure and improve the heart’s pumping power. This improves the functioning of the heart. The chance of having a heart attack (again) decreases. Examples include captopril, enalapril, lisinopril, ramipril, trandolapril, and zofenopril.

Beta Blockers
Beta blockers lower blood pressure, slow the heart rate and reduce the oxygen demand of the heart. The chance of having a heart attack (again) decreases. Examples are atenolol, metoprolol and propranolol.

Eplerenone is used in severe heart failure due to a recent heart attack. It improves the pumping power of the heart, making the heart work better. The chance of dying from heart disease is then smaller.

Calcium blockers
Calcium blockers lower blood pressure, decrease the heart’s oxygen demand and affect the heart rate. This reduces the chance of having another heart attack. These drugs are only prescribed if other drugs do not qualify. Example is verapamil.

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