Myocardial infarction   known as heart attack in loose terms is an acute life threatening condition and treated timely it is a curable condition.

Myocardial infarction occurs due to cutting of blood supply to the heart acutely thus causing damage to the heart muscle on affected side.

The underlying cause is block in one or both of the coronary arteries (vessel s bringing blood to heart) or its branches.

The development of infarction depends on, "supply and demand”.

Normally during any stress, there is increased demand for oxygen by the heart muscle as for any other part of the body. This oxygen is supplied by blood. If this demand is not met with there is necrosis of the affected tissues or muscles.

This muscle death is typically manifested by severe excruciating pain on the affected site, with profuse sweating, feeling of anxiety, restlessness, breathlessness and sometimes nausea and vomiting.

The affected person describes the pain as sensation of stabbing or severe pressure.  Pain is commonly on the left side of chest. It is aggravated by movement. 

At times the pain may be felt on left side of jaw or back, or even left hand or wrist. In case of infarction of the inferior surface of heart, pain may be felt in abdomen after meals thus mimicking a gastrointestinal infection. 

The attack may subside if the other surrounding blood vessels reperfuse the affected part. If a major coronary vessel is affected or the collaterals fail to supply blood, attack can be fatal due to cardiac arrest. 

It is one of the causes of sudden death and one of the preventable causes of death today. People suffering from angina should be very careful so that their condition should not progress to infarction, which is a later stage in ischemic heart disease.

Both genders are susceptible for developing myocardial infarction depending on the number and severity of risk factors present.

The risk factors for developing infarction are smoking, alcoholism, hyperlipidemia, (increase in lipid or fat levels in the blood), hypertension, diabetes, physical and mental stress. 

Having case of ischemic heart disease or angina in the family among parents or siblings is yet another risk factor for developing infarction of the heart. Because many risk factors like hypertension, diabetes, atherosclerosis, e.t.c., are hereditary and are passed on in the family.  

Adults around middle and old age are more prone for heart attacks, but with changing life styles, young adults are also now suffering from infarction and its complications.
Stress of any kind can be a triggering factor for developing myocardial infarction in one who is susceptible to it. 

Diabetic persons have to be very careful in this regard. Because of autonomic neuropathy, a diabetic patient may not experience the  pain of infarction and hence diagnosis of the condition may be delayed.

Diagnosis is suspected in a person  with severe chest pain and confirmed by electrocardiography. Urgent treatment provided can be life saving. Delay in treatment can cause complications like cardiac shock, disturbances of the rhythm of heart, dilatation of heart, sudden cardiac failure and arrest, which proves to be the terminal event causing death. 

Once somebody is suspected of having cardiac infarction, he or she needs immediate first aid till they arrive at the hospital. Any tight clothing, restricting items like ties, wrist watch, e.t.c. should be removed immediately.

The person if conscious should be   made to cough which will improve blood supply to heart. If in a state of shock, his legs should be elevated to augment the return of blood to heart. 

By all means the patient should be taken to the hospital as soon as possible. Early thrombolytic therapy (i.e. drugs which dissolve the clot blocking the coronary  vessel) will not only save life but prevent prolongation  of the infarction and further complications.

Good control of predisposing conditions like hypertension and diabetes reduce chances of developing infarction. One should lead a healthy disciplined life to avoid heart attacks.

This includes a healthy diet, regular exercise and avoiding intoxicating substances. A healthy diet consists of plenty of fresh green vegetables, fruits, grains and cereals and fish.    

Exercise done should be in the form of brisk walking, light jogging, yoga, swimming or aerobics. Weight lifting and pushing are hazardous and can precipitate heart attacks. 

Lastly the most important thing needed to prevent heart attacks is to prevent mental stress. A totally relaxed mind safe guards a person against heart attacks.

E-mail – rachna212002@yahoo.co.uk
Specialist internal medicine – Ruhengeri hospital