Always see your healthcare provider for a diagnosis. If you or someone you know has any of the above warning signs, act right away. Call , or your local emergency number. The goal of treatment for a heart attack is to relieve pain, preserve the heart muscle function, and prevent death. You may need other procedures to restore blood flow to the heart. Those procedures are described below. With this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow.
This is often followed by inserting a stent into the coronary artery to help keep the vessel open. Although angioplasty is done in other blood vessels elsewhere in the body, percutaneous coronary intervention PCI refers to angioplasty in the coronary arteries.
This lets more blood flow into the heart. There are several types of PTCA procedures:. This surgery is most commonly referred to as simply bypass surgery or CABG pronounced "cabbage".
It is often done in people who have chest pain angina and coronary artery disease. Coronary artery disease is when plaque has built up in the arteries. During the surgery, the surgeon makes a bypass by grafting a piece of a vein above and below the blocked area of a coronary artery.
This lets blood flow around the blockage. The surgeon usually takes veins from a leg, but he or she may also use arteries from the chest or an arm. Sometimes, you may need more than one bypass surgery to restore blood flow to all areas of the heart.
Health Home Conditions and Diseases. Causes of a Heart Attack The blockage is caused by a buildup of plaque in the arteries atherosclerosis.
Who is at risk for a heart attack? There are two types of risk factors for heart attack. Until more studies become available, one needs to individualize therapy on the basis of the risk profile and presentation. Vulnerable plaque is usually defined as a plaque prone to thrombosis and a future acute coronary event AMI or sudden coronary death and occasionally unstable angina The tear in the fibrous cap leads to the formation of a platelet-rich white thrombus at the site of rupture followed by a red cell and fibrin red thrombus if the artery becomes totally occluded.
There has been great interest in attempting to identify these vulnerable plaques mainly the TCFA prior to a future coronary event with the idea of modifying the presumed MI culprit with a stent and thus preventing the adverse event from occurring There are theoretical reasons supporting and refuting this approach, and trials examining this issue are ongoing.
However, this approach is not validated at present. If one cannot identify the plaque, can the patient most likely to develop an acute event be found?
Of course, we as physicians use risk scores based on well-established factors associated with the presence of coronary artery disease CAD. These are the so-called risk factors such as high blood pressure, high cholesterol, diabetes, and smoking which can be used to categorize patients into low, intermediate, and high risk.
At present, there is no consensus about how to find these lower-risk patients in primary prevention, while patients in secondary prevention are all treated with appropriate guideline-directed therapy, as they are considered high-risk. Should we be more aggressive than the guidelines indicate in primary prevention and treat more patients with medications such as statins in addition to lifestyle changes of a healthy diet and exercise, and at what age should one start?
These remain unanswered questions. We have come a long way over the last several decades in our understanding and treatment of coronary atherosclerosis and its complications. Although we have not considered stroke, many of the same drugs and techniques described above for MI are applicable in its prevention and acute treatment. What are the next steps? Billions of dollars are spent yearly on new drug and other treatment strategies in CAD which are generally applied either in secondary prevention or in high-risk primary prevention.
To significantly reduce the incidence and improve outcomes above those seen with our later therapies as described above, we think the best option is earlier intervention Symptomatic CAD occurs decades after the onset of atherosclerosis. Like an iceberg, it does not rear its head above the water line or, in CAD management, become symptomatic until there is a critical mass of ice a large burden of atherosclerosis.
This asymptomatic stage is where our efforts should be concentrated if we want to eliminate a majority of future coronary events. These should include earlier identification and treatment of high blood pressure, eliminating tobacco, and lowering average LDL levels. Earlier identification of atherosclerosis will lead to lower event rates if the proper lifestyle and possibly drug therapies are initiated.
In the future, new strategies and risk profiles possibly with genetic profiling may help to better identify those at risk. Another possibility for the future is a vaccine against atherosclerosis. F Faculty Reviews are commissioned from members of the prestigious F Faculty and are edited as a service to readers. In order to make these reviews as comprehensive and accessible as possible, the referees provide input before publication and only the final, revised version is published.
The referees who approved the final version are listed with their names and affiliations but without their reports on earlier versions any comments will already have been addressed in the published version. National Center for Biotechnology Information , U. Journal List FRes v. Version 1. Published online Sep 3. Author information Article notes Copyright and License information Disclaimer.
Accepted Aug This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Over the last 40 years, our understanding of the pathogenesis of myocardial infarction has evolved and allowed new treatment strategies that have greatly improved survival.
Introduction Our understanding of the causes, diagnosis, and treatment of acute myocardial infarction AMI has evolved significantly over the last 40 years. Definitions AMI, usually referred to in lay terms as a heart attack, is most often caused by a decrease or stoppage of blood flow to a portion of the heart, leading to necrosis of heart muscle. Nomenclature for myocardial infarction Since the s, the nomenclature defining myocardial infarction MI has changed several times.
Pathogenesis of myocardial infarction and the role of thrombosis The role of thrombosis as a cause of AMI was debated for decades in the 20th century until the s, when it was clearly established as the cause of nearly all AMIs seen at autopsy and most large AMIs presenting clinically 4 , 5 Table 1. Table 1. If, along with that, you also have a high level of low-density lipoprotein LDL in your blood, your risk may be even higher.
This is because LDL cholesterol can stick to the walls of your arteries and produce plaque, a hard substance that blocks blood flow in the arteries. Reducing your cholesterol and the unhealthy fat in your body typically requires eating a balanced diet that contains few processed foods, and when necessary, taking medications called statins.
Your doctor would be able to recommend the best nutrition plan for you and determine whether you need to take medications. In addition to your diet, the following factors can also increase your risk of heart problems :.
Your doctor will then complete a physical exam with specific attention to the heart. Blood tests will also be used to check for proteins that are associated with heart damage, such as troponin.
Your doctor may also perform an angiogram with coronary catheterization to look for areas of blockage in your arteries. Heart attacks require immediate treatment, so most treatments begin in the emergency room. Treatment may include taking medications to resolve blood clots, reduce pain, or slow down your heart rate. The doctor may also send you to undergo a minimally invasive procedure called percutaneous coronary intervention PCI , formerly referred to as an angioplasty with a stent.
This procedure is used to unblock the arteries that supply blood to the heart. Only about 36 percent of hospitals in the United States are equipped to perform this procedure. If your hospital is unable to perform an angioplasty, they may transfer you to another hospital that can. During the procedure, your surgeon will insert a long, thin tube called a catheter through your artery to reach the blockage. They will then inflate a small balloon attached to the catheter in order to reopen the artery, allowing blood flow to resume.
Your surgeon may also place a small, mesh tube called a stent at the site of the blockage. The stent can prevent the artery from closing again. Your doctor may also want to perform a coronary artery bypass graft CABG. In this procedure, your surgeon will restore blood flow by rerouting your veins and arteries so the blood can move around the blockage. A CABG is sometimes done immediately after a heart attack. Another procedure your doctor may want you to undergo is a bypass surgery , which is used to form new passages for blood to flow to the heart.
Your chances of recovering from a heart attack depend on how much damage there is to your heart and how quickly you receive emergency care. The sooner you receive treatment, the more likely you are to survive. Keep in mind that recovery is a long process and may take several weeks or months after leaving the hospital.
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