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How Is A Heart Attack Diagnosed?

If your doctor suspects you are having a heart attack, he or she will promptly run tests, which may include:

ECG or EKG — This simple test records the electrical activity of the heart. The test can often accurately detect heart irregularities and locate the heart attack.

Blood Tests — Several blood tests, often taken over a period of time, not only can help diagnose a heart attack but can help detect any ongoing heart damage.

Often, treatment is started at this time (see below). Once you're stabilized, your doctor may recommend a test to pinpoint the location of the blocked heart artery and perhaps unblock it. Those tests may include:

Echocardiogram — This is an ultrasound test in which sound waves are bounced off the heart. This test can identify significant damage to the heart muscle from the heart attack and identify the presence of heart failure.

Radionuclide Scans — These sophisticated tests use small (harmless) amounts of radioactive material injected into the blood vessels. A special camera scans the radioactive material and takes pictures of the heart.

Cardiac Catheterization — In this procedure, a catheter (thin, hollow tube) is introduced into the groin and threaded up to the heart. Dye is used to highlight the heart's arteries. In this way, blockages are identified and often treated with angioplasty and/or stents (see below).

What Are the Treatments?

Heart attack is a medical emergency that must be quickly addressed to prevent permanent heart damage or death.

Treatment often begins in the ambulance if you called 911 or in the emergency room. CPR (cardiopulmonary resuscitation) should be administered if a person suffering a heart attack goes into cardiac arrest — when the heartbeat has stopped. CPR doesn't restart the heart, it just keeps the victim alive until medical help arrives.

Nowadays, an easy-to-use device called an automated external defibrillator (AED) is available in many public places and can be used by almost anyone to treat cardiac arrest. This device works by shocking the heart back into a normal rhythm.

The first treatment administered to a person suspected of having a heart attack is an aspirin. Thus, if you have called emergency services, it is recommended that you chew an aspirin. This drug is a potent inhibitor of blood clots and can decrease the risk of death from the heart attack by 25%.

Upon arrival at an emergency facility or hospital, a heart attack victim is rapidly given drugs to prevent further blood clotting in the heart and decrease the strain on the heart.

Treatment may also include a procedure to open any blocked heart arteries:

• Balloon Angioplasty. This procedure occurs during cardiac catheterization (see above). A balloon-tipped catheter is inserted into a blocked heart artery, and the balloon is inflated gently to press plaques against the wall of the artery, thus opening it up.
• Stent placement. This is a procedure in which a wire mesh tube is inserted through a catheter into a blocked heart artery to "prop" it open. This procedure usually occurs along with balloon angioplasty.
• Bypass Surgery. This surgical procedure allows a surgeon to re-route blood flow around a blockage, thus increasing blood flow to a part of the heart. Usually a blood vessel from the leg or chest is used to bypass the blocked heart artery.

The choice of treatments is based on a variety of factors weighed by your doctor.

Heart attack victims are usually hospitalized in special coronary care units (CCU) for at least 36 hours. Once past the critical phase, patients continue to receive drugs called beta-blockers to slow the heart, nitrates to increase heart blood flow, and anticoagulants such as heparin, warfarin or aspirin to prevent further clotting.

While hospitalized, ECG machines constantly monitor the patient's heart in case heart rhythm abnormalities develop. If the heart starts beating too fast or too slow, various medications may be given. Some patients may be fitted with pacemakers. If a patient experiences a dangerous arrhythmia known as ventricular fibrillation, an electric shock to the chest is administered. Patients who show signs of heart failure are given a variety of medications to decrease strain on the heart and to encourage the heart to beat more forcefully.

People recovering from a heart attack are urged to get back on their feet as quickly as possible, which reduces the chances of blood clots forming in the deep veins of the legs. These clots could travel through the circulatory system and lodge in the lung, creating a blockage. Gentle exercise is recommended, but nothing that requires significant exertion. Long-term recovery from heart attack requires psychological and lifestyle adjustments: Habits such as smoking, heavy drinking and eating high-fat foods have to go.

As a preventive measure, most heart attack survivors take a daily aspirin tablet to thin the blood. Other drugs may also be prescribed, depending on the patient.

Some patients require invasive procedures to improve blood flow to the heart over the long term. The two most common procedures are angioplasty — a catheter technique that widens clogged arteries by breaking up plaques — and coronary bypass surgery, which diverts blood flow around clogged arteries.

Lifestyle

Regular aerobic exercise greatly enhances efforts to prevent or recover from heart attack. If you already have a heart condition, schedule a stress test before beginning an exercise program in order to determine how much exertion is safe. Heart attack survivors are advised to exercise with other people rather than alone during the first months of recovery. Many community health and recreation centers offer doctor-supervised cardiovascular rehabilitation programs.

Mind/Body Medicine

Reducing stress by training the mind and body to relax may be one of the risk factors that you can control to help prevent heart attack and aid in recovery. Many techniques promote relaxation — among them, meditation, biofeedback, and yoga. Relaxation has also been shown to provide relief from pain, which may be encountered during the recovery period.

State of mind is another important consideration in heart attack recovery. People with a positive attitude about recovery tend to do much better. You may find that a particular mind-body technique helps you to focus on positive thoughts. You may also find, as many others have, that sharing thoughts and emotions with a support group is extremely beneficial.

Nutrition and Diet

The basic goals of a heart-healthy diet are to keep salt, sugar, and saturated fat to a minimum to reduce cholesterol, control blood pressure, and control weight. Eating magnesium-rich foods such as nuts, beans, bran, fish and dark-green vegetables may help prevent heart attack. Magnesium protects the heart directly and indirectly by stabilizing heart rate, reducing coronary artery spasm, and combating such conditions as atherosclerosis and high blood pressure.

Much evidence suggests that unstable chemical compounds known as free radicals make the body more vulnerable to heart attack by promoting atherosclerosis in the coronary arteries. Free radicals can be neutralized by antioxidants such as vitamins A, C, and E. Fruits, vegetables and grains supply many of the antioxidant vitamins.

Reviewed by Charlotte E. Grayson, MD, July 2005.

Sources: Heartcenteronline.com

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