New Approaches to Heart Attack Treatment - The Good News
I suspect Seabrookers were saddened by the recent death of Frank Sinatra from an apparent "massive heart attack.," but it reminded us of our nation's number one problem. In our May column as part of our planned series on heart disease as part of healthy aging, we went over the signs of a heart attack and discussed our fortunate we are on Seabrook to be literally minutes away from two hospitals, MUSC and Roper, which are fully prepared to care for patients suffering from a heart attack. We emphasized the crucial factor time plays in saving heart tissue and life, itself. Calling 911 and getting to the hospital as soon as possible is essential.
This month, I thought it would be useful to consider how heart attacks are treated now compared to the past. In the "good old days," defined as when I was in medical school in Charleston in the 1960s, we had no real therapy for heart attacks. We could diagnose an attack as we do now from the symptoms, signs and electrocardiogram, but the therapy tended to be rest and sedation with some nitroglycerine. Toward the end of the 60s we learned the value of monitoring the electrocardiogram continuously in coronary care units (CCUs) as well as the usefulness of antiarrhythmic drugs. Mortality in the hospitals was still high but improving. Today at Roper and the Medical University of South Carolina, the treatment of a heart attack called is very different. The whole philosophy has changed from watching to acting. There has been a remarkable reduction in the "in hospital" death rate in patients who suffer heart attacks. The therapy for a heart attack now aspirin and usually other anticoagulation therapy with or without a heart slowing drug called beta-blockers. But the therapy does not end there. Since the heart attack is caused by an occlusion (usually because of a blood clot) of the coronary artery, this obstruction should be removed. The sooner it is removed or bypassed, the more likely for a survival and restoration of heart muscle function. There are two fundamental approaches to removing the infarct related coronary obstruction. One is the administration of drugs which dissolve the clot, these drugs are called thrombolytics. The goal is to dissolve the clot and reestablish sufficient flow which will allow subsequent evaluation of the coronary circulation by cardiac catheterization at a later time. The patient requires observation in the CCU to be certain that there is no recurrence of pain and another heart attack. The second approach is to have the cardiac catheterization immediately, as an emergency procedure and a decision made at that point whether to perform an angioplasty of the coronary, opening it up mechanically with a catheter with or without the placement of a "stent," a piece of metal designed to hold the vessel open. | |  Large Text
| | What Are the Signs and Symptoms of a Heart Attack? | The warning signs and symptoms of a heart attack can include:
Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. Heart attack pain can sometimes feel like indigestion or heartburn.
Discomfort in other areas of the upper body. Can include pain, discomfort, or numbness in one or both arms, the back, neck, jaw, or stomach.
Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.
Other symptoms. May include breaking out in a cold sweat, having nausea and vomiting, or feeling light-headed or dizzy.
 More information on the Symptoms associated with a Heart Attack
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Physicians in consultation with patients and families decide which approach is best for the individual patient. As a rule, patients with a higher risk of dying get better treatment results from the more invasive approach, that is the cardiac catheterization strategy. The table lists factors which constitute high risk in heart attack patients. The overall mortality from hospitalized patients with a heart attack has now dropped below 10% and can be considerably lower depending on the extent of the disease and degree of success in restoring the blood flow to the heart. The most serious complication of the thrombolytic therapy is stroke which can occur in nearly 1% of patients, particularly older women. The good news is that in patients with a heart attack in whom blood flow is restored, the mortality from heart attack is about 2%. As I often say to our patients, I'd take those odds anytime. So all in all, the news can be good when one has a heart attack. In our final column on the heart, we will talk about ways to live a longer time after a heart attack and with known coronary artery disease. Factors Which Increase Risk of Heart Attack Death:
Age over 70
Anterior location of the infarct
Heart rate over 100
Shock
Other Online Resources:
Coronary Artery Disease (National Women's Health Information Center)
Coronary Disease (National Library of Medicine)
Circulatory Disorders (National Library of Medicine)
Additional Online Resources outside MUSCHealth.com:
(MedlinePlus, is an excellent source of health information from the world's largest medical library, the National Library of Medicine. Health professionals and consumers alike can depend on it for information that is authoritative and up to date. MedlinePlus has extensive information from the National Institutes of Health and other trusted sources on over 650 diseases and conditions.)
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