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Myocardial Infarction

PNS SHIFA

Online Consultation

Syed Intisar Hussain

Overview

<p>Myocardial infarctions commonly known as heart attacks, are brought on by an abrupt interruption in the heart&rsquo;s blood supply. Without this supply, cardiac muscles can start to deteriorate. The cardiac muscles will suffer permanent damage if treatment is not received in a timely fashion. This injury to a significant section of the heart might cause cardiac arrest, which can be fatal.</p>

<p>&nbsp;</p>

<p>Myocardial infarction (MI) is described as the death of myocardial (heart) cells due to persistent myocardial ischemia (insufficient oxygen supply to the myocardium). Every year, approximately 7.8 million Americans visit hospitals due to <a href="https://www.merisehat.pk/disease/angina" target="_blank">chest pain</a>, a common sign of acute MI<sup><a href="#accordion">[1]</a></sup>. Moreover, an eventual MI diagnosis affects about 7.6 million people<sup><a href="#accordion">[1]</a></sup>.</p>

<p>The accumulation of fat, cholesterol and other chemicals in the heart&#39;s (coronary) arteries typically causes obstruction. Plaques are the medical term for <a href="https://www.merisehat.pk/disease/cholesterol#causes-5532" target="_blank">cholesterol</a>-rich deposits. Atherosclerosis is the term for the accumulation of plaque.</p>

<div>&nbsp;</div>

<p>The ST segment of an ECG is a parameter that can be used to categorize heart attacks. The ST segment represents ventricular contraction. An abnormality in the ST segment typically corresponds to myocardial injury in the area, mostly due to myocardial ischemia or infarction<sup><a href="#accordion">[2]</a></sup>.</p>

<p>&nbsp;</p>

<h5><strong>Acute Coronary Syndrome</strong></h5>

<p>When the blood, oxygen, and nutrient-carrying arteries get blocked, it is known as an acute coronary syndrome (ACS). Myocardial infarctions are a form of ACS.&nbsp;</p>

<p>&nbsp;</p>

<p>The three primary kinds of ACS are as follows:</p>

<p>&nbsp;</p>

<ul>
	<li><strong>ST-Segment Elevation Myocardial Infarction (STEMI)</strong></li>
</ul>

<p>If there is a prolonged disruption of blood supply, it can result in a STEMI, which is the most deadly form of a heart attack. It results from complete obstruction of the coronary artery, which can seriously harm a significant portion of the heart. When &quot;heart attack&quot; is used, most people immediately picture a STEMI. The classic or important heart attack is another name for it.</p>

<p>&nbsp;</p>

<ul>
	<li><strong>Non-ST Segment Elevation Myocardial Infarction (NSTEMI)</strong></li>
</ul>

<p>Due to the possibility of a partial rather than complete blockage of blood supply to the heart, an NSTEMI may not be as dangerous as a STEMI. Consequently, a smaller area of the heart may sustain injury. Nevertheless, an NSTEMI is still thought of as a significant medical emergency. Without treatment, it may worsen and lead to STEMI, which is severe heart damage.</p>

<p>&nbsp;</p>

<ul>
	<li><strong>Unstable Angina Or Silent Heart Attack</strong></li>
</ul>

<p>The least dangerous type of ACS is unstable angina. It is also called a coronary spasm or silent heart attack. In this type, blood flow either stops or drastically reduces due to the tightening of the arteries of the heart. Only imaging and blood test results can tell your doctor if you&rsquo;ve had a silent heart attack. Its symptoms may be confused with other things like muscle discomfort or indigestion.&nbsp;</p>

<p>A coronary artery spasm does not cause long-term harm. Even though silent heart attacks are less severe, they increase your risk of another heart attack or possibly even experiencing a severe type of heart attack.&nbsp;</p>

<div>&nbsp;</div>

Signs And Symptoms

<p>Heart attacks can occur suddenly due to cardiac arrest. However, many people have warning symptoms and signs hours, days, or even weeks in advance. An early warning sign is persistent chest pressure or pain that doesn&#39;t go away with rest OR a brief, sharp pain in the back, arm, or neck.&nbsp;</p>

<p>&nbsp;</p>

<p>Heart attacks often go unnoticed in women (30-55%). The underlying reasons for this include:&nbsp;</p>

<p>&nbsp;</p>

<ul>
	<li>Women do not experience the same kind of chest pain as men&nbsp;</li>
	<li>They might present with other types of&nbsp; symptoms (atypical presentation)</li>
</ul>

<p>&nbsp;</p>

<p>These reasons result in women either ignoring warning signs or experiencing delays in getting adequate treatment. Patient education can offer a solution to overcome these issues. Hence, researchers are experimenting with the acronym CURB, which stands for Chest Pain, Unusual Fatigue, Radiating Pain, and Breathing Difficulties, which can help educate women about heart attack symptoms.</p>

<p>Another acronym FACTSS (Fatigue, Anxiety, Chest discomfort, Tummy pain, Shortness of breath, Sleeping difficulties) is being considered to teach women the early indicators of a heart attack.&nbsp;</p>

<p>&nbsp;</p>

<h5><strong>Symptoms Of A STEMI</strong></h5>

<p>The typical symptom of a STEMI is chest pain. Instead of searing pain, this chest discomfort may be perceived as pressure or tightness. Some STEMI sufferers also mention having discomfort in their back, neck, or jaw, as well as in one or both arms.</p>

<p>Other symptoms that may accompany chest pain include:</p>

<ul>
	<li>Nausea</li>
	<li>Anxiousness&nbsp;</li>
	<li>Breathing difficulties</li>
	<li>Lightheadedness</li>
	<li>Developing a chilly sweat</li>
</ul>

<p>&nbsp;</p>

<h5><strong>Symptoms Of NSTEMI</strong></h5>

<p>Numerous symptoms of NSTEMI resemble those of other diseases. Any signs of a heart attack should be taken seriously. Regardless of the severity, anyone suffering NTEMI symptoms should go to an emergency room immediately. When having a heart attack, every second counts.&nbsp;</p>

<p>Symptoms of NSTEMI are:</p>

<ul>
	<li>Breathing difficulties&nbsp;</li>
	<li>Feeling heavy or pressure in the chest</li>
	<li>Stiffness or tension in your chest</li>
	<li><a href="https://www.merisehat.pk/disease/angina" target="_blank">Chest pain</a></li>
	<li>Neck discomfort&nbsp;</li>
	<li>Discomfort or pain in the stomach</li>
	<li>Jaw discomfort&nbsp;</li>
	<li>Back pain</li>
	<li>Nausea&nbsp;</li>
	<li>Dizziness</li>
	<li>Feeling lightheaded</li>
	<li>Sweating more frequently (unexplained)</li>
	<li>Heart palpitations</li>
</ul>

<div>&nbsp;</div>

Causes

<p>&nbsp;</p>

<h5><strong><a href="https://www.merisehat.pk/disease/coronary-artery-disease" target="_blank">Coronary Heart Disease</a></strong></h5>

<p>Heart attacks are most commonly caused by coronary heart disease (CHD). The coronary arteries which supply the heart with blood become clogged with cholesterol deposits in CHD.</p>

<p>These deposits are referred to as plaques. When a plaque ruptures (bursts), it results in the formation of a blood clot at the location of the rupture. A heart attack can result from this clot obstructing the heart&#39;s blood flow.</p>

<p>&nbsp;</p>

<p>You run a higher chance of having CHD if:</p>

<ul>
	<li>You smoke&nbsp;</li>
	<li>Consume a lot of fat</li>
	<li>Have <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2" target="_blank">diabetes</a></li>
	<li>Have elevated <a href="https://www.merisehat.pk/disease/cholesterol#causes-5532" target="_blank">cholesterol </a>level</li>
	<li>Your blood pressure is high (<a href="https://www.merisehat.pk/disease/hypertension-57" target="_blank">hypertension</a>)</li>
	<li>You are <a href="https://www.merisehat.pk/disease/obesity" target="_blank">obese </a>or overweight</li>
</ul>

<p>&nbsp;</p>

<h5><strong>Less Frequent Causes</strong></h5>

<p>Here is a list of some less frequent causes:</p>

<p>&nbsp;</p>

<p><strong>1. Drug Abuse</strong></p>

<p>Cocaine, amphetamines (speed), and methamphetamines (crystal meth) are stimulants that can narrow coronary arteries, hence impeding blood flow and resulting in a heart attack.</p>

<p>One of the most frequent causes of unexpected mortality in young individuals is heart attack brought on by cocaine use.</p>

<p>&nbsp;</p>

<p><strong>2. Low Blood Oxygen Levels (Hypoxia)</strong></p>

<p>The heart will receive deoxygenated blood if oxygen levels drop due to carbon monoxide poisoning or a loss of normal lung function. This reduced flow will cause damage to the heart muscles, resulting in a heart attack.</p>

<div>&nbsp;</div>

<p>Cardiac biomarkers are molecules the heart releases into the blood when injured or under stress. These biomarkers help to know if symptoms are due to a heart attack (myocardial infarction), <a href="https://www.merisehat.pk/disease/angina" target="_blank">angina</a>, heart failure or another problem, and an increase can be indicative of ACS or myocardial ischemia.&nbsp;</p>

<p>&nbsp;</p>

<p>Cardiac marker levels are used for :</p>

<ul>
	<li>Screening purposes e.g., for heart damage and other underlying problems.</li>
	<li>Diagnosing of&nbsp;heart conditions which present with chest pain, angina and shortness of breath.</li>
	<li>Monitor the efficacy of treatment (medications and/or surgery).</li>
</ul>

<p>&nbsp;</p>

<p>Cardiac troponin is the preferred biomarker due to its specificity. Other biomarkers are less specific and could be raised in other circumstances such as skeletal muscle damage. These include:</p>

<ul>
	<li>Creatine kinase (CK) and CK-MB</li>
	<li>High-sensitivity C-reactive protein (hs-CRP)</li>
	<li>BNP&ndash;brain natriuretic peptide (or NT-proBNP&ndash;N-terminal pro-b-type natriuretic peptide)</li>
</ul>

<div>&nbsp;</div>

Diagnosis

<p>A conclusive diagnosis is linked to offering helpful advice on treatment, patient prognosis, and lifestyle adjustments. You ought to be admitted to the hospital immediately if a heart attack is suspected. You will typically be admitted to an acute cardiac care unit (ACCU) or right to the cardiac catheterization unit (CCU). Let&#39;s have a look at different types of diagnostic procedures:</p>

<p>&nbsp;</p>

<p><strong>1. Electrocardiogram</strong></p>

<p>An electrocardiogram (ECG) is a crucial test for a suspected heart attack and is the first test usually performed. An ECG captures the heart&#39;s electrical activity. Your heart generates minute electrical impulses with each heartbeat. ECG equipment captures these impulses on paper, enabling your doctor to assess how well your heart is working.</p>

<p>It doesn&#39;t hurt and takes 5 minutes to perform an ECG. Electrodes are flat metal discs that are placed on your chest (and sometimes the arms and legs) during the test. The ECG equipment, which records the electric pulses, is connected by wires from the electrodes.</p>

<p>An ECG is crucial because:</p>

<ul>
	<li>It shows if you are having a heart attack</li>
	<li>It shows if you have had a heart attack</li>
</ul>

<p>&nbsp;</p>

<p><strong>2. Additional Tests</strong></p>

<p>Additional tests may be performed to evaluate your heart&#39;s condition and look for any issues. However, some of these tests are typically performed after your initial therapy has started, and your situation has stabilized because heart attacks are medical emergencies.</p>

<p>&nbsp;</p>

<ul>
	<li><strong>Blood Tests</strong></li>
</ul>

<p>A heart attack damages your heart, causing proteins (cardiac markers) to leak progressively into your blood. A blood sample will be collected to test for these cardiac markers. Cardiac troponin is specific to the heart, and its serum levels rise 3&ndash;4 hours after the occurrence of cardiac symptoms in patients with acute myocardial infarction (MI). Several blood tests spread out over a few days will be used to determine your troponin level. This will make it possible to evaluate the damage to your heart and reveal the effectiveness of treatment as well.&nbsp;</p>

<p>&nbsp;</p>

<ul>
	<li><strong>Chest X-Ray</strong></li>
</ul>

<p>A chest X-ray shows the condition and size of the heart and lungs. It can also help in determining other potential reasons for your symptoms, such as a pocket of air trapped between the layers of your lungs (pneumothorax). Additionally, a chest X-ray can be done to determine any consequences of the heart attack, such as a buildup of fluid in your lungs (pulmonary edema).</p>

<p>&nbsp;</p>

<ul>
	<li><strong>Echocardiogram</strong></li>
</ul>

<p>An echocardiogram is a scan used to create an image of the interior of your heart, by employing sound waves. The precise locations of the injured cardiac tissue and the impact of that damage on your heart&#39;s functionality can be determined using this test.&nbsp;</p>

<p>&nbsp;</p>

<ul>
	<li><strong>Coronary Angiography</strong></li>
</ul>

<p>Coronary angiography can assist in establishing whether there is a blockage or narrowing in the coronary arteries and, if so, pinpointing the precise location of the obstruction or narrowing.</p>

<p>A fine tube (catheter) is inserted during the test into a blood artery in your arm or groin. X-rays are used to guide the catheter into your coronary arteries.</p>

<p>A specialized liquid known as a contrast agent is pumped through the catheter. This fluid may be visible on X-rays. The flow of the fluid through and around your heart makes it possible to identify any obstructions or narrowings. This aids a cardiologist in determining the best course of treatment.</p>

<p>&nbsp;</p>

<ul>
	<li><strong>Cardiac CT Or MRI</strong></li>
</ul>

<p>These tests create images of the heart and chest and are used for diagnosing heart problems and also determining the severity of heart damage.</p>

<div>&nbsp;</div>

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Treatment

<p>Your treatment options will vary depending on the type of heart attack.&nbsp;&nbsp;</p>

<p>&nbsp;</p>

<h5><strong>ST Segment Elevation Myocardial Infarction (STEMI)&nbsp;</strong></h5>

<p>An ST-segment elevation myocardial infarction (STEMI), the deadliest form of heart failure, requires immediate assessment and treatment. You must seek medical care right away if you want to reduce cardiac damage after a STEMI.</p>

<p>If an electrocardiogram (ECG) reveals STEMI, you will be assessed for a procedure to clear your coronary arteries. The course of treatment will depend on when the symptoms first manifested and how quickly you were able to seek assistance.</p>

<p>&nbsp;</p>

<ul>
	<li>You will typically be offered percutaneous coronary intervention (PCI) if you present within 12 hours of symptom onset.</li>
	<li>Thrombolytics - Blood clot-dissolving medications OR &lsquo;clot busters&rsquo; are prescribed if your symptoms began within the last 12 hours but you could not get a PCI immediately.</li>
	<li>If symptoms began over 12 hours ago, you might be given different options, especially if the immediate procedure is not required. An angiography will determine the best course of management, which may involve medication, PCI, or bypass surgery.</li>
	<li>You might be given a prescription for a combination of antiplatelet medications if a PCI is not possible or contraindicated.</li>
</ul>

<p>&nbsp;</p>

<h5><strong>Primary Percutaneous Coronary Intervention (PCI)</strong></h5>

<p>Primary percutaneous coronary intervention (PCI) is the name for STEMI emergency care. It entails coronary angioplasty or expansion of the artery. Coronary angiography is done to decide if PCI is an appropriate procedure. Your doctor may also recommend blood-thinning drugs like low-dose aspirin to prevent the formation of new clots. You might need to continue taking your medications following PCI.</p>

<p>&nbsp;</p>

<h5><strong>Coronary Angioplasty</strong></h5>

<p>Coronary angioplasty (a relatively challenging surgery) is done by a cardiac specialist and requires expensive equipment, neither of which is present in all hospitals. This means you&#39;ll need urgent ambulance transportation to one of the health centers (Heart Attack Centers), most of which now offer this service.</p>

<p>During coronary angioplasty, a tiny tube (a balloon catheter) with a sausage-shaped balloon at the end is introduced into a large artery in the arm or groin. The catheter is passed through the vessels and to your heart under the direction of an X-ray. After the catheter has been placed into the restricted portion of the artery, the balloon is filled with air to enlarge the coronary artery.</p>

<p>&nbsp;</p>

<h5><strong>Medicines To Break Down And Prevent Blood Clots</strong></h5>

<p>Two major groups of medications can stop blood clots:</p>

<ul>
	<li>Antiplatelets</li>
	<li>Anticoagulants</li>
</ul>

<p>They are frequently administered as tablets. They make it easier for blood to circulate through your veins. As a result, the incidence of blood clotting will be significantly reduced.</p>

<p>Anticoagulants&nbsp;such as fibrinolytic or thrombolytics are frequently given intravenously. Thrombolytics (also referred to as fibrinolytic) attack and destroy fibrin. Fibrin is a powerful protein and serves as a fiber mesh that hardens around the blood to generate blood clots.</p>

<p>A drug called glycoprotein IIb/IIIa inhibitor might also be administered if your risk of suffering another heart attack rises. Glycoprotein IIb/IIIa inhibitors do not dissolve blood clots but prevent them from becoming significant. They effectively stop your symptoms from getting worse.</p>

<p>&nbsp;</p>

<h5><strong>Coronary Artery Bypass Graft</strong></h5>

<p>Coronary angioplasty may not be possible if your arteries are too narrow or have several blocked arteries. In these cases, a coronary artery bypass graft (CABG) is considered a potential solution.</p>

<p>A CABG comprises attaching blood vessels from different parts of your body, generally your chest, leg, or arm, to your coronary artery above and below the blocked or constricted segment. This new blood vessel is known as the graft.</p>

<p>&nbsp;</p>

<h5><strong>Non-ST Segment Elevation Myocardial Infarction (NSTEMI) And Unstable Angina</strong></h5>

<p>If an ECG shows you have an NSTEMI or unstable angina, your treatment will depend on the amount of blockage and the severity of the NSTEMI. Anticoagulants, antiplatelets, beta-blockers, nitrates, statins, angiotensin-converting-enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs) are the most commonly prescribed medications.&nbsp;&nbsp;However, in certain medium or high-risk cases, PCI or CABG may be needed.&nbsp;&nbsp;</p>

<div>&nbsp;</div>

<p>Complications may occur due to ischemic or injured tissue and therefore may begin within 20 minutes of the onset of M.I., when myocardial tissue injury begins and include:&nbsp;</p>

<p>&nbsp;</p>

<h5><strong>1. Arrhythmia</strong></h5>

<p>Arrhythmias may develop as a result of damage to the cardiac muscles following a heart attack. These damaged muscles disturb the electrical impulses that regulate the heart and can include:</p>

<p>&nbsp;</p>

<ul>
	<li><strong>Ventricular Tachycardia - </strong>This is defined as a fast heart rate arising from the ventricles (lower chambers of the heart). It&nbsp;occurs due to changes in the electrical characteristics of the infarcted heart tissue.</li>
	<li><strong>Supraventricular Tachycardia</strong></li>
	<li><strong>Bradycardia -&nbsp;</strong>This means there are less than 60 beats per minute.&nbsp;It is usually seen&nbsp;in&nbsp;inferior myocardial infarction as the inferior myocardial wall and the sinoatrial and atrioventricular nodes are usually all supplied by the right coronary artery.</li>
	<li><strong>Atrial Fibrillation</strong>&nbsp;- Also known as irregular heartbeat, this a frequent complication and is more common in older patients, in patients with heart failure, and in cases of extensive infarction.</li>
	<li><strong>Tachycardia -&nbsp;</strong>This is&nbsp;one of the milder arrhythmias, which&nbsp;can cause the following symptoms: a&nbsp;feeling of your heart racing, fluttering, or beating erratically, experienced in your chest or throat (this feeling is often called palpitations),&nbsp;chest pain, dizziness, fatigue and shortness of breath.</li>
</ul>

<p>&nbsp;</p>

<p>There are also chances of some life-threatening arrhythmias that include:</p>

<ul>
	<li>The heart is unable to pump blood effectively due to improper or absence of electrical signals in the heart. This is known as total heart block.</li>
	<li>The heart starts beating faster in ventricular arrhythmia before contracting entirely and going into abrupt cardiac arrest.</li>
</ul>

<p>These fatal arrhythmias can significantly contribute to death in 24 to 48 hours following a heart attack.</p>

<p>&nbsp;</p>

<h5><strong>2. Heart Failure</strong></h5>

<p>When the heart is not able to perform its function effectively (pumping of blood to all body parts), it is known as heart failure. This usually occurs when the heart muscle has sustained significant damage. Usually, the heart&#39;s left side is compromised (the left ventricle).</p>

<p>&nbsp;</p>

<p>Signs and symptoms of heart failure include:</p>

<ul>
	<li>Tiredness (fatigue)</li>
	<li>Breathlessness</li>
	<li>Swelling in your arms and legs due to fluid build-up</li>
</ul>

<p>&nbsp;</p>

<h5><strong>3. Cardiogenic Shock</strong></h5>

<p>Cardiogenic shock is a more hazardous condition than heart failure. The majority of biological functions cannot be supported when the heart muscle has suffered such extensive damage, rendering it incapable of pumping enough blood.</p>

<p>&nbsp;</p>

<p>Here are several signs:</p>

<ul>
	<li>Mental disorder</li>
	<li>Frozen hands and feet</li>
	<li>A decreased urge to urinate or not to urinate at all</li>
	<li>Pale skin</li>
	<li>Rapid breathing and heartbeat</li>
	<li>Breathing difficulties</li>
</ul>

<p>&nbsp;</p>

<h5><strong>4. Heart Rupture</strong></h5>

<p>When the heart&#39;s muscles, walls, or valves separate during a heart attack, it can result in a heart rupture, which is a very serious, but relatively rare condition. It often occurs 1 to 5 days after a heart attack and can occur if the heart sustains considerable damage.</p>

<div>&nbsp;</div>

<p>Risk factors for heart attacks include:</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>Age</strong></h5>
	</li>
</ul>

<p>Men over 45 and women over 55 have higher chances of a heart attack.</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>Tobacco Use</strong></h5>
	</li>
</ul>

<p>This involves active smoking as well as long-term exposure to secondhand smoke exposure. Quitting smoking is one of the best preventive measures.</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>High Blood Pressure</strong></h5>
	</li>
</ul>

<p>With time, high blood pressure can cause damage to the arteries that lead to the heart. The risk further increases when high blood pressure occurs with other diseases, including diabetes, high cholesterol, or obesity.</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>High Cholesterol Or Triglycerides</strong></h5>
	</li>
</ul>

<p>A high amount of low-density lipoprotein (LDL) (the &quot;bad&quot; cholesterol) raises the chances of artery narrowing. A high amount of specific blood fats known as triglycerides also increases the possibility of having a heart attack. However, if your levels of high-density lipoprotein (HDL) cholesterol &mdash; the &quot;good&quot; cholesterol &mdash; are in the normal range, your chance of having a heart attack may be reduced.</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>Obesity</strong></h5>
	</li>
</ul>

<p>Obesity is associated with high blood pressure, diabetes, high triglyceride, as well as with bad cholesterol levels, and low good cholesterol levels.</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>Diabetes</strong></h5>
	</li>
</ul>

<p>When the body fails to produce enough insulin or is unable to use it properly, it causes a rise in blood sugar and increases the chances of having a heart attack.</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>Metabolic Syndrome</strong></h5>
	</li>
</ul>

<p>Metabolic syndrome involves at least three of the following factors:</p>

<ul>
	<li>An inflated waist (central obesity)</li>
	<li>High blood pressure</li>
	<li>Low good cholesterol</li>
	<li>High triglycerides</li>
	<li>High blood sugar</li>
</ul>

<p>&nbsp;</p>

<p>Also, the risk of developing heart disease doubles if you have metabolic syndrome<sup><a href="#accordion">[4]</a></sup>.</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>Family History Of Heart Attacks</strong></h5>
	</li>
</ul>

<p>You might be at higher risk if your sibling, parent, or grandparent had a heart attack at a young age (55 for men and 65 for women).</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>Lack Of Exercise</strong></h5>
	</li>
</ul>

<p>Heart attacks are more likely to occur when there is a lack of physical exercise (a sedentary lifestyle). Healthier hearts result from regular exercise.</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>Unhealthy Diet</strong></h5>
	</li>
</ul>

<p>Heart attacks are more likely to occur in people who consume a diet rich in sweets, animal fats, processed foods, trans fats, and salt. Consume a lot of fruits, veggies, fiber, and good fats to avoid heart attacks.</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>Stress</strong></h5>
	</li>
</ul>

<p>Extreme emotional stress, such as frustration and anger, can raise your risk of having a heart attack.</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>Illegal Drug Use</strong></h5>
	</li>
</ul>

<p>Stimulants ( cocaine and amphetamines) may cause a coronary artery spasm.&nbsp;</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>A History Of Preeclampsia</strong></h5>
	</li>
</ul>

<p>In the years following the pregnancy complicated by preeclampsia (hypertension that occurs during pregnancy), women had a 2.5-fold increased risk for myocardial infarction (MI).</p>

<p>&nbsp;</p>

<ul>
	<li>
	<h5><strong>An Autoimmune Condition</strong></h5>
	</li>
</ul>

<p>Autoimmune conditions such as lupus or rheumatoid arthritis increase the risk of a heart attack.</p>

<div>&nbsp;</div>

<p>The most beneficial strategy to avoid having a heart attack (or prevent a second heart attack) is to change your lifestyle.&nbsp;</p>

<p>&nbsp;</p>

<h5><strong>1. A Healthy Diet</strong></h5>

<p>An unhealthy, high-fat diet will worsen atherosclerosis (hardening of the arteries) and raise your chance of having a heart attack. If you keep eating high-fat foods, your arteries will develop additional fatty plaques. This is because fatty foods contain a bad sort of cholesterol.</p>

<p>&nbsp;</p>

<p><a href="https://www.merisehat.pk/disease/cystic-fibrosis" target="_blank">Cholesterol </a>is classified into two types:</p>

<ul>
	<li><strong>Low-density lipoprotein (LDL)</strong> is a form of cholesterol essentially made up of fat with a minor bit of protein and is often referred to as bad cholesterol as it causes a blockage of arteries.</li>
	<li><strong>High-density lipoprotein (HDL),</strong> mainly composed of protein and a little fat, is frequently referred to as &quot;good cholesterol&quot; since it can reduce plaque buildup in your arteries.</li>
</ul>

<p>&nbsp;</p>

<p>Fats come in two varieties:</p>

<ol>
	<li>Saturated&nbsp;</li>
	<li>Unsaturated</li>
</ol>

<p>&nbsp;</p>

<p>Saturated fat-rich foods should be avoided since they raise LDL cholesterol levels in the blood. Saturated fat-rich foods include:</p>

<ul>
	<li>Pies</li>
	<li>Fried foods</li>
	<li>Sausages and fatty cuts of meat</li>
	<li>Butter</li>
	<li>Ghee</li>
	<li>Lard</li>
	<li>Cream</li>
	<li>Hard cheese</li>
	<li>Cakes and biscuits</li>
	<li>Foods that contain coconut or palm oil</li>
</ul>

<p>&nbsp;</p>

<p>A Mediterranean-style diet is what you should try to follow. This involves eating less meat and more bread, fruit, veggies, and fish. While fish like salmon, herring, and sardines are a rich source of omega-3 fatty acids, however, there is no conclusive evidence linking it to reducing the likelihood of a heart attack. Hence eat fish or use omega-3 fatty acid supplements in moderation.&nbsp;Also, try to use vegetable or plant oils like olive oil instead of butter and ghee (clarified butter).&nbsp;</p>

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<h5><strong>2. Smoking</strong></h5>

<p>Smoking increases the risk of atherosclerosis and blood pressure, which both contribute to heart attacks. If you are determined to stop smoking but do not wish to seek help from a smoking cessation program, you can directly consult your GP for different ways you can use to quit and also get medications to reduce the side effects you may encounter after quitting.</p>

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<h5><strong>3. High Blood Pressure</strong></h5>

<p>Continuous high blood pressure (<a href="https://www.merisehat.pk/disease/hypertension-57" target="_blank">hypertension</a>) can put additional strain on your arteries and heart, increasing your chance of having a heart attack. Eating a balanced diet, limiting your alcohol intake, keeping your weight at a healthy level, and exercising daily can all help lower high blood pressure.</p>

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<h5><strong>Diet And High Blood Pressure</strong></h5>

<p>Eating a healthy and well-balanced diet is recommended if you have high blood pressure. Also, reduce the quantity of salt you use in your food because it increases your blood pressure.&nbsp;Your blood pressure increases as you consume more salt. Make a target to take less than 6g of salt (2.4g sodium) each day, which is around 1 teaspoon.</p>

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<h5><strong>4. Alcohol</strong></h5>

<p>Episodic heavy drinking is associated with myocardial damage and is a risk factor for sudden cardiac arrest, hence quit drinking.&nbsp;</p>

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<h5><strong>5. Weight</strong></h5>

<p>Being overweight (obesity) makes it harder for your heart to circulate blood throughout your body, which may cause your blood pressure to rise. Remember that even a few kilograms of weight loss can improve your health and blood pressure if you do need to drop weight.</p>

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<h5><strong>6. Exercise</strong></h5>

<p>Regular exercise will lower blood pressure by keeping your heart and blood vessels healthy. Regular exercise can also make you lose weight, which reduces your blood pressure.</p>

<p>Walking, swimming, and cycling are all suggested low-impact exercises. As a heart patient, you are advised not to undertake demanding activities like playing squash or football. Consult your primary care physician for low-impact exercises.</p>

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<h5><strong>The Potential Impact Of The<a href="https://www.merisehat.pk/disease/covid-19" target="_blank"> COVID-19</a> Virus On The Heart And The Circulatory System</strong></h5>

<p>The COVID-19 pandemic is primarily associated with pulmonary issues. However, with advancements in research, it is becoming apparent that practically all body organ systems are affected. <a href="https://www.merisehat.pk/disease/covid-19" target="_blank">COVID </a>patients can also experience cardiovascular dysfunction. The presence or absence of pre-existing cardiac disease also affects the severity of cardiovascular disease in COVID-19 patients. For example, the severity of the infection and related mortality is higher in COVID patients with pre-existing heart illnesses.&nbsp;</p>

<p>Additionally, there is an association between severe <a href="https://www.merisehat.pk/disease/covid-19" target="_blank">COVID-19</a> infection, myocardial injury, and different arrhythmias. The angiotensin-converting enzyme 2 (ACE2) is expressed in the lungs, cardiovascular system, gut, kidneys, central nervous system, and adipose tissue and has been identified as the <a href="https://www.merisehat.pk/disease/severe-acute-respiratory-infection-sari" target="_blank">SARS</a>-CoV-2 receptor (the infective agent responsible for coronavirus disease). This indicates a critical link between ACE2 and cardiovascular disease<sup><a href="#accordion">[3]</a></sup>.&nbsp;</p>

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Key Points

<ul>
	<li>Myocardial infarction (MI) is described as the death of myocardial(heart) cells as a result of persistent myocardial ischemia (insufficient oxygen supply to the myocardium).</li>
	<li>FACTSS (Fatigue, <a href="https://www.merisehat.pk/disease/anxiety" target="_blank">Anxiety</a>, Chest discomfort, Tummy&nbsp;pain, Shortness of breath, sleeping difficulties) is the acronym used to describe the early symptoms of a heart attack in women.</li>
	<li>The ST segment of an ECG is a parameter that can be used to categorize heart attacks.</li>
	<li>The acronym MONA, which stands for morphine, oxygen, nitroglycerin, and aspirin, is used to help patients with chest discomfort remember their initial course of treatment (ie, suspected acute coronary syndrome).</li>
	<li>Treatment procedures can be decided after diagnostic procedures.</li>
</ul>

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[1] Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28--e292.

[2] Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–64.

[3] Alqahtani MS, Abbas M, Alsabaani A, Alqarni A, Almohiy HM, Alsawqaee E, et al. The Potential Impact of COVID-19 Virus on the Heart and the Circulatory System. Infect Drug Resist. 2022;15:1175–89.