Most heart attacks are the end result of coronary heart disease, a condition that clogs coronary arteries with fatty, calcified plaques. As blood flow is gradually impeded, the body may compensate by growing a network of collateral arteries to circumvent blockages; the presence of collateral vessels may greatly reduce the amount of heart muscle damaged by a heart attack. In the early 1980s, researchers confirmed that the precipitating cause of nearly all heart attacks is not the obstructive plaque itself, but the sudden formation of a blood clot on top of plaque that cuts off blood flow in an already narrowed vessel.
While the step-by-step process leading to heart attack is not fully understood, major risk factors are well-established. Some can be controlled. Of these, the main ones are high blood pressure, high cholesterol, obesity, smoking, and a sedentary lifestyle. Stress is also believed to raise the risk, and exertion and excitement can act as triggers for an attack.
In every issue of WebMD the Magazine, we ask our experts to answer readers' questions about a wide range of topics. In our September 2011 issue, we gave a reader's question about preventing heart disease to James Beckerman, MD, WebMD's heart health expert.
Q : Heart disease runs in my family. What can I really do now to help prevent it?
A : Cut out these five things to greatly reduce your risk:
Smoking (or hanging around with smokers). Smoking is the most dangerous -- yet most reversible...
Men over the age of 50 with a family history of heart disease are predisposed to heart attack. High levels of estrogen are thought to protect premenopausal women fairly well from heart attack, but the risk increases significantly after menopause.
Heart Attack Diagnosis
A cardiologist, a heart specialist, relies on various tests and scans to diagnose a heart attack and to identify sites of blockage in the arteries and tissue damage. Test recordings of electrical activity within the heart, supported by blood tests, provide data for an initial assessment of the patient's condition. Images of the heart and coronary arteries supplied by angiograms and radioisotope scans locate specific areas of damage and blockage. Ultrasound tests called echocardiograms evaluate the heart's function. With such data, the doctor can pursue proper treatment and anticipate potential complications.
Heart Attack Treatment
A heart attack is a medical emergency that must be quickly addressed by conventional medicine. Alternative medicine cannot compete with standard drug and surgical therapy during the emergency and follow-up phases of heart attack treatment. However, alternative medicine may make valuable contributions to heart attack prevention and recovery.
Conventional Medicine for a Heart Attack
Heart attack victims are usually hospitalized in special coronary care units (CCU) for at least 36 hours. Standard drug therapy includes a painkiller such as morphine, vasodilators such as nitroglycerine to expand blood vessels, beta-adrenergic blocker drugs to calm the heart, and aspirin to reduce clotting activity. In some cases, clot-dissolving drugs like tPA or tenectaplase (TNKase) are also given. These drugs are most effective if given within a few hours of the beginning of a heart attack. Emergency angioplasty, and possibly surgery, might be performed to remove a clot, reopen a clogged artery, or bypass blocked arteries.
Once past the critical phase of a heart attack, patients continue to receive beta blockers to slow the heart, nitrates to increase heart blood flow, and blood thinners such as heparin, clopidogrel, Brilinta, Effient, or aspirin to prevent further blood clotting.