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When a heart attack occurs, time is essential. Patients have much better chances of survival if they proceed immediately to an emergency room when symptoms occur. The most common symptom of myocardial infarction is angina (chest pain). Myocardial infarction frequently occur from 4:00 a.m. to 10:00 a.m. since increased amounts of adrenaline are usually released in the morning. Adrenaline normally helps regulate blood pressure, heart rate, and blood glucose concentration.

Other signs of myocardial infraction may include:

• Sweating
• Jaw pain
• Heartburn or indigestion
• Upper back pain
• General feeling of illness

A recent survey reported by the American Heart Association reveals that the majority of American women do not understand the true threat of cardiovascular disease. Despite the fact that heart disease is the leading cause of death among women, a nationwide survey revealed that only 8% of women perceive heart disease as the greatest threat to their health. More than six out of 10 women falsely believe that they are more likely to develop cancer than heart disease.

Other statistics from the American Heart Association:

• Over 500,000 American women die of cardiovascular disease each year. This twice the number of deaths from all cancers combined (lung cancer, the leading cause of cancer deaths, claims approximately 65,000 deaths per year, and breast cancer kills around 40,000 women per year).
• One in threewomen have some form of cardiovascular disease.
• 38% of women who have heart attacks die within the first year compared to 25% of men.
• 35% of women have a second heart attack within six years of the first attack compared to 18% of men.
• Over 60,000 women die of stroke each year; approximately 60% of stroke deaths occur in women.

When symptoms are presented, patients should be evaluated quickly with blood tests and an electrocardiogram. After the patient is stabilized, an echocardiogram and nuclear medicine exam may be performed.

• Blood work: Blood tests will be performed to detect levels of creatine phosphokinase (CPK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and other enzymes released during myocardial infarction.

• Electrocardiogram (ECG or EKG): An electrocardiogram makes a graphic record of the cardiac activity, either on paper or a computer monitor. An ECG can be beneficial in detecting disease and/or damage.

• Echocardiogram (heart ultrasound): This diagnostic technique is an excellent first step in investigating congenital heart disease or in evaluating abnormalities of the heart wall. Echocardiography is a non-invasive exam in which images are acquired and viewed in real time without the use of radiation. Echocardiography is often useful in studying the beating heart and provides some information on functional abnormalities of the heart wall, valves and blood vessels. Doppler ultrasound can be used to measure blood flow across a heart valve. Abnormal operation of the valves can be detected by studying the opening and closing function versus normal valve function. Echocardiography may also be used to study congenital heart defects such as a septal defect (a hole in the wall that separates the two chambers of the heart).

• Nuclear medicine: Nuclear medicine (also called radionuclide scanning) allows visualization of the anatomy and function of an organ. The patient will be given a radionuclide which will assist in the acquisition clear images of the heart with a gamma camera. Nuclear medicine imaging may be used to detect coronary artery disease, myocardial infarction, valve disease, heart transplant rejection, check the effectiveness of bypass surgery, or to select patients for angioplasty or coronary bypass graft.

Treatment options for myocardial infarction include medications such as antiplatelets (aspirin), beta blockers, calcium channel blockers, ACE inhibitors, etc. Additional treatment with coronary angioplasty (may be followed with stenting—see below) may be necessary. Depending on the patient’s condition and reasons for suffering myocardial infarction, coronary artery bypass graft may or may not be performed.

The following chart summarizes types of drugs that may be used to help treat myocardial infarction. Brand names of drugs are shown in parentheses.

A note about heart attack prevention: While several studies have found that a low-dose aspirin regimen may reduce the risk of first heart attacks in men, a 2005 study conducted by researchers at the U.S. National Heart, Lung, and Blood Institute found that the effects of aspirin may not be the same in women. In the study of 45,000 women followed over a ten-year period, aspirin generally did not prevent first heart attacks or deaths from cardiovascular disease in women. However, the researchers did find some benefits of aspirin in women over 65 years of age. Most notably, these women had a significantly lower risk of stroke. An aspirin regimen typically consists of a 100 milligram aspirin on alternate days. The study suggests this regimen may be beneficial for women 65 years of age and older but for young women, the possible benefits of aspirin should be weighed against possible side effects including internal bleeding.

Medical procedures used to help treat myocardial infarction include:

• Coronary angioplasty: Involves placing a catheter with a small balloon on its tip into the patient’s narrowed artery. When properly positioned, the balloon is inflated and deflated, moving the plaque build-up further against the artery wall and thereby improving the flow of blood. This procedure may also be called percutaneous transluminal coronary angioplasty (PCTA), coronary artery balloon dilation or balloon angioplasty. Coronary angioplasty may be followed by stenting, a procedure in which a stent (expandable wire mesh tube) is permanently inserted into the artery to keep it open and restore normal blood flow.

• Coronary artery bypass graft: Involves grafting the ends of a healthy blood vessel (often taken from the chest or leg) above and below a narrowed artery, bypassing the flow of blood around the narrowed artery. Bypass surgery can relieve symptoms of coronary artery disease, such as angina (chest pain) and dyspnea (shortness of breath) and may be used to prevent or treat myocardial infarction.

Updated: February 2011

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