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Heart attacks and heart disease

The NHS says approximately 92,000 people have a heart attack each year in England. Most heart attacks occur in those over the age of 45. Men are 2-3 times more likely than women to have a heart attack.

 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 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’ of 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 (ischaemia). 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 forms in the damaged area. But, the new scar tissue does not contract or pump as well as healthy heart muscle tissue. 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.

What are the symptoms of a heart attack?

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 oral medications.

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 those with diabetes.

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