Patient Care – Adult cardiac, endovascular, and thoracic aortic surgery

Patient appointments & physician referrals: please call 210-450-0999.

Myocardial infarction – A heart attack (myocardial infarction) occurs
when an area of heart muscle dies or is permanently damaged because of an
inadequate supply of oxygen to that area.

Symptoms:
Symptoms of a possible heart attack include chest pain and pain that radiates
down the shoulder and arm.

Chest pain below the sternum (breastbone) is a major symptom of heart
attack, but in many cases the pain may be subtle or even completely absent,
especially in the elderly and diabetics.
Back pain
Abdominal pain
Pain that radiates to the chest, arms, shoulder, the neck, teeth, and jaw, the back
Pain that is prolonged, typically greater than 20 minutes
Pain similar to angina, but not relieved by rest or nitroglycerin
Pain that may be described as bad indigestion; intense, severe, subtle;
squeezing or heavy pressure — a tight band on the chest, an “elephant sitting on my chest”
Sudden shortness of breath that may or may not be accompanied by pain
Cough
Lightheadedness – dizziness
Fainting
Nausea or vomiting
Sweating, which may be profuse (diaphoresis)
Dry mouth
Feeling of “impending doom”
Anxiety
Seizures
Fatigue
Temporary loss of breath
Breathing difficulty when lying down
Low blood pressure
The person may have no symptoms (a “silent attack”).

Causes, incidence, and risk factors: Most heart attacks are caused by a
clot that blocks one of the coronary arteries (the blood vessels that bring
blood and oxygen to the heart muscle). The clot usually forms in a coronary
artery that has been previously narrowed from changes related to
atherosclerosis. The atherosclerotic plaque (buildup) inside the arterial wall
sometimes cracks, and this triggers the formation of a thrombus, or clot.

A clot in the coronary artery interrupts the flow of blood and oxygen to the
heart muscle, leading to the death of heart cells in that area. The damaged
heart muscle permanently loses its ability to contract, and the remaining heart
muscle needs to compensate for it.

Rarely, sudden overwhelming stress can trigger a heart attack. It is difficult
to estimate exactly how common heart attack is because many patients die before
seeking medical help (perhaps as many as 200,000 to 300,000 in the United States
per year). It is estimated that approximately 1 million patients visit the
hospital each year with some type of MI as their principal diagnosis.

The risk factors for coronary artery disease and heart attack include:

Smoking
Hypertension (high blood pressure)
High-fat diet
High blood cholesterol (LDL) levels
Diabetes
Male gender
Age
Heredity

Newer risk factors for coronary artery disease have been identified over the
past several years, including elevated homocysteine and C-reactive protein
levels. Homocysteine levels can be treated with folic acid supplements in the
diet. Studies are still ongoing about the practical value of these new factors.

An electrocardiogram (ECG), single or repeated over several hours
Coronary angiography
Nuclear ventriculography (MUGA or RNV)
Echocardiography

Treatment:
A heart attack is a medical emergency! Hospitalization is usually required for 1
to 14 days. Treatment may include intensive care. Continuous ECG monitoring is
started immediately, because life-threatening arrhythmias are the leading cause
of death in the first few hours of a heart attack.

The goals of treatment are to stop the progression of the heart attack, to
reduce the demands on the heart so that it can heal, and to prevent
complications.
An intravenous line will be inserted to administer medications and fluids.
Various monitoring devices may be necessary. A urinary catheter may be inserted
to closely monitor fluid status.

Oxygen is usually given, even if blood oxygen levels are normal. This makes
oxygen readily available to the tissues of the body and reduces the workload of
the heart.

If the ECG recorded during chest pain shows a change called “ST-segment
elevation,” clot-dissolving (thrombolytic) therapy may be initiated within 6
hours of thechest pain onset. This initial therapy will be administered as an IV
infusion of streptokinase or tissue plasminogen activator, and will be followed
by an IV infusion of heparin. Heparin therapy will last for 48 to 72 hours.
Additionally, warfarin may be prescribed to prevent further development of
clots.
Thrombolytic therapy is not appropriate for people who have had:

A major surgery, organ biopsy, or major trauma within the past 6 weeks
Recent neurosurgery
Head trauma within the past month
History of GI (gastrointestinal) bleed
Intracranial tumor
Stroke within the past 6 months
Current severe hypertension

Possible complications of thrombolytic therapy include bleeding and hemorrhage.

A cornerstone of therapy for a heart attack is antiplatelet medication (a
medication that can prevent platelet aggregation which is the initial event in
the circulation leading to clot formation). One antiplatelet agent widely used
is aspirin, given at a dose of 160 mg/day. Another antiplatelet medication in
use is ticlopidine. More recently, a medication called clopidogrel has shown in
clinical studies to be even more effective than aspirin to reduce the occurrence
of new heart attacks.

Other medications that may be prescribed include the following:

Beta-blockers, to reduce the workload of the heart
Glycoprotein IIb/IIIa inhibitors
Calcium channel blockers
Anti-arrhythmics
Diuretics.

In the first 24 hours of a heart attack that compromises the anterior wall of
the heart or is complicated by heart failure, drugs called ACE inhibitors may be
recommended.

Emergency coronary angioplasty may be required to open blocked coronary
arteries. This procedure may be used instead of thrombolytic therapy, or in
cases where such therapy is contraindicated. Often the re-opening of the
coronary artery after angioplasty is ensured by implantation of a small device
called a stent. Emergency coronary artery bypass surgery (CABG) may be required
in some cases.

Activity may be restricted initially, then gradually increased.

Complications:

Arrhythmias such as ventricular tachycardia, ventricular fibrillation, heart blocks
Congestive heart failure
Cardiogenic shock
Infarct extension: extension of the amount of affected heart tissue
Pericarditis
Pulmonary embolism
Complications of treatment (For example, treatment with thrombolytic agents increases the risk of bleeding during treatment.)

Calling your health care provider:
Go to the emergency room or call your local emergency number (such as 911) if
crushing chest pain or other symptoms suggestive of heart attack occur.

Prevention:
Control cardiac risk factors whenever possible. Control blood pressure and total
cholesterol levels. To help with cholesterol control, your doctor may prescribe
a medication of the statins group (atorvastatin, simvastatin). You may also need
to take aspririn or clopidogrel daily.

Avoid smoking, modify diet if necessary (increase vegetables, vegetable oils,
and fruits and decrease animal fats), control diabetes, and lose weight if
obese. Exercise daily or several times a week by walking and including specific
exercises to improve cardiovascular fitness. (Consult your health care provider
first.)

After a heart attack, follow-up care is important to reduce the risk of having
a second heart attack. Often, a cardiac rehabilitation program is recommended to
help you gradually return to a “normal” lifestyle. Follow the exercise, diet,
and medication regimen prescribed by your doctor.