WebMD.com, August 26, 2010  —  More than 1 million Americans have heart attacks each year. A heart attack, or myocardial infarction (MI), is permanent damage to the heart muscle. “Myo” means muscle, “cardial” refers to the heart, and “infarction” means death of tissue due to lack of blood supply.

What Happens During a Heart Attack?

The heart muscle requires a constant supply of oxygen-rich blood to nourish it. The coronary arteries provide the heart with this critical blood supply. If you have coronary artery disease, those arteries become narrow and blood cannot flow as well as they should. Fatty matter, calcium, proteins, and inflammatory cells build up within the arteries to form plaques of different sizes. The plaque deposits are hard on the outside and soft and mushy on the inside.

When the plaque is hard, the outer shell cracks (plaque rupture), platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. If a blood clot totally blocks the artery, the heart muscle becomes “starved” for oxygen. Within a short time, death of heart muscle cells occurs, causing permanent damage. This is a heart attack.

While it is unusual, a heart attack can also be caused by a spasm of a coronary artery. During a coronary spasm, the coronary arteries restrict or spasm on and off, reducing blood supply to the heart muscle (ischemia). It may occur at rest and can even occur in people without significant coronary artery disease.

Each coronary artery supplies blood to a region of heart muscle. The amount of damage to the heart muscle depends on the size of the area supplied by the blocked artery and the time between injury and treatment.

Healing of the heart muscle begins soon after a heart attack and takes about eight weeks. Just like a skin wound, the heart’s wound heals and a scar will form in the damaged area. But, the new scar tissue does not contract. So, the heart’s pumping ability is lessened after a heart attack. The amount of lost pumping ability depends on the size and location of the scar.

Heart Attack Symptoms

Symptoms of a heart attack include:

  • Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone
  • Discomfort radiating to the back, jaw, throat, or arm
  • Fullness, indigestion, or choking feeling (may feel like heartburn)
  • Sweating, nausea, vomiting, or dizziness
  • Extreme weakness, anxiety, or shortness of breath
  • Rapid or irregular heartbeats

During a heart attack, symptoms last 30 minutes or longer and are not relieved by rest or nitroglycerin under the tongue.

Some people have a heart attack without having any symptoms (a “silent” myocardial infarction). A silent MI can occur in any person, though it is more common among diabetics.

What Do I Do if I Have a Heart Attack?

After a heart attack, quick treatment to open the blocked artery is essential to lessen the amount of damage. At the first signs of a heart attack, call for emergency treatment (usually 911). The best time to treat a heart attack is within one to two hours of the first onset of symptoms. Waiting longer increases the damage to your heart and reduces your chance of survival.

Keep in mind that chest discomfort can be described many ways. It can occur in the chest or in the arms, back, or jaw. If you have symptoms, take notice. These are your heart disease warning signs. Seek medical care immediately.

How Is a Heart Attack Diagnosed?

To diagnose a heart attack, an emergency care team and ask you about your symptoms and begin to evaluate you. The diagnosis of the heart attack is based on your symptoms and test results. The goal of treatment is to treat you quickly and limit heart muscle damage.

Tests to Diagnose a Heart Attack

  • ECG . The ECG (also known as EKG or electrocardiogram) can tell how much damage has occurred to your heart muscle and where it has occurred. In addition, your heart rate and rhythm can be monitored.
  • Blood tests. Blood may be drawn to measure levels of cardiac enzymes that indicate heart muscle damage. These enzymes are normally found inside the cells of your heart and are needed for their function. When your heart muscle cells are injured, their contents — including the enzymes — are released into your bloodstream. By measuring the levels of these enzymes, the doctor can determine the size of the heart attack and approximately when the heart attack started. Troponin levels will also be measured. Troponins are proteins found inside of heart cells that are released when they are damaged by ischemia. Troponins can detect very small heart attacks.
  • Echocardiography. Echocardiography is an imaging test that can be used during and after a heart attack to learn how the heart is pumping and what areas are not pumping normally. The “echo” can also tell if any structures of the heart (valves, septum, etc.) have been injured during the heart attack.
  • Cardiac catheterization. Cardiac catheterization, also called cardiac cath, may be used during the first hours of a heart attack if medications are not relieving the ischemia or symptoms. The cardiac cath can be used to directly visualize the blocked artery and help your doctor determine which procedure is needed to treat the blockage.

 

What Is the Treatment for a Heart Attack?

Once heart attack is diagnosed, treatment begins immediately — possibly in the ambulance or emergency room. Drugs and surgical procedures are used to treat a heart attack.

What Drugs Are Used to Treat a Heart Attack?

What Is the Treatment for a Heart Attack? continued…

The goals of drug therapy are to break up or prevent blood clots, prevent platelets from gathering and sticking to the plaque, stabilize the plaque, and prevent further ischemia.

These medications must be given as soon as possible (within one to two hours from the start of your heart attack) to decrease the amount of heart damage. The longer the delay in starting these drugs, the more damage can occur and the less benefit they can provide.

Drugs used during a heart attack may include:

  • Aspirin to prevent blood clotting that may worsen the heart attack.
  • Other antiplatelets, such as Plavix, to prevent blood clotting.
  • Thrombolytic therapy (“clot busters”) to dissolve any blood clots in the heart’s arteries.
  • Any combination of the above

Other drugs, given during or after a heart attack, lessen your heart’s work, improve the functioning of the heart, widen or dilate your blood vessels, decrease your pain, and guard against any life-threatening heart rhythms.

Are There Other Treatment Options for a Heart Attack?

During or shortly after a heart attack, you may go to the cardiac cath lab for direct evaluation of the status of your heart, arteries, and the amount of heart damage. In some cases, procedures (such as angioplasty or stents) are used to open up your narrowed or blocked arteries. 

If necessary, bypass surgery may be performed in following days to restore the heart muscle’s supply of blood.

Treatments (medications, open heart surgery, and interventional procedures, like angioplasty) do not cure coronary artery disease. Having had a heart attack or treatment does not mean you will never have another heart attack; it can happen again. But, there are several steps you can take to prevent further attacks.

How Are Future Heart Attacks Prevented?

The goal after your heart attack is to keep your heart healthy and reduce your risks of having another heart attack. Your best bet to ward off future attacks are to take your medications, change your lifestyle, and see you doctor for regular heart checkups.

Why Do I Need to Take Drugs After a Heart Attack?

Drugs are prescribed after a heart attack to:

  • Prevent future blood clots.
  • Lessen the work of your heart and improve your heart’s performance and recovery.
  • Prevent plaques by lowering cholesterol.

Other drugs may be prescribed if needed. These include medications to treat irregular heartbeats, lower blood pressure, control angina, and treat heart failure.

It is important to know the names of your medications, what they are used for, and how often and at what times you need to take them. Your doctor or nurse should review your medications with you. Keep a list of your medications and bring them to each of your doctor visits. If you have questions about, ask your doctor or pharmacist.

What Lifestyle Changes Are Needed After a Heart Attack?

There is no cure for coronary artery disease. In order to prevent the progression of heart disease and another heart attack, you must follow your doctor’s advice and make necessary lifestyle changes. You can stop smoking, lower your blood cholesterol, control your diabetes and high blood pressure, follow an exercise plan, maintain an ideal body weight, and control stress.

When Will I See My Doctor Again After I Leave the Hospital?

Make a doctor’s appointment for four to six weeks after you leave the hospital following a heart attack. Your doctor will want to check the progress of your recovery. Your doctor may ask you to undergo diagnostic tests (such as an exercise stress test at regular intervals. These tests can help your doctor diagnose the presence or progression of blockages in your coronary arteries and plan treatment.

Call your doctor sooner if you have symptoms such as chest pain that becomes more frequent, increases in intensity, lasts longer, or spreads to other areas; shortness of breath, especially at rest; dizziness, or irregular heartbeats.

WebMD Medical Reference

Reviewed by Robert J Bryg, MD

Study: New Coating for Hospital Walls, Surgical Equipment, Other Surfaces Kills MRSA

Reviewed by Laura J. Martin, MD

WebMD.com, August. 17, 2010, by Bill Hendrick — Biotech scientists at Rensselaer Polytechnic Institute have developed a coating for use in health care settings that they say kills the deadly MRSA germ.

MRSA, or methicillin-resistant Staphyloccus aureus, is a virulent bacterium that causes antibiotic-resistant infections, killing about 90,000 patients a year. Because it has been hard to battle, it is sometimes called a “superbug.”

But Rensselaer scientists say their coating, for use on surgical equipment, hospital walls, and other surfaces in health care settings, seems to be very effective in eradicating MRSA.

The study is published in ACS Nano, a journal of the American Chemical Society.

In tests, 100% of MRSA bacteria were killed within 20 minutes of contact with a surface painted with latex paint laced with the coating, the researchers say. The coating is made with lysostaphin, a naturally occurring enzyme, combined with carbon nanotubes.

“We’re building on nature,” Jonathan S. Dordick, PhD, director of Rensselaer’s Center for Biotechnology and Interdisciplinary Studies, says in a news release. “Here we have a system where the surface contains an enzyme that is safe to handle, doesn’t appear to lead to resistance, doesn’t leach into the environment, and doesn’t clog up with cell debris.”

When the superbugs came in contact with a painted surface, “they’re killed,” he says.

How It Works

Lysostaphin works by attaching itself to the bacterial cell wall, slicing it open, but is not toxic to human cells, Dordick says.

Researcher Ravi S. Kane, PhD, says the enzyme is attached to the carbon nanotube with a short, flexible polymer link, improving its ability to reach the MRSA bacteria.

“The more the lysostaphin is able to move around, the more it is able to function,” Dordick says.

Kane and Dordick worked With Dennis W. Metzger, PhD, and Ravi Pangule, a graduate student in chemical engineering, at Albany Medical College, where Metzger maintains strains of MRSA.

“At the end of the day, we have a very selective agent that can be used in a wide range of environments — paints, coating, medical instruments, doorknobs, surgical masks — and it’s active and it’s stable,” Kane says. “It’s ready to use when you’re ready to use it.”

Superior Method

They say their approach will likely prove superior to previous attempts at creating antimicrobial agents, some of which release biocides, which can lose effectiveness over time due to leaching into the environment and may have harmful side effects, the researchers say.

“We spent quite a bit of time demonstrating that the enzyme did not come out of the paint during antibacterial experiments,” he says. “Indeed, it was surprising that the enzyme worked as well as it did while remaining embedded near the surface of the paint.”

It’s unlikely, Kane says, that MRSA superbugs will develop resistance to a naturally occurring enzyme, which has “evolved over hundreds of millions of years to be very difficult for Staphyloccus aureus to resist.”

They also say their new coating can be washed repeatedly without losing effectiveness and that it has a dry storage shelf life of up to six months.

MRSA can infect the bloodstream, the lungs, and the urinary tract, and people can carry it without being sickened. Killing it on surfaces is important because MRSA is spread by contact and can be carried by people who touch infected objects.