Heart Attack and Heart Disease
Heart disease is the leading cause of death in the United States. About every minute someone dies of a coronary event in the United States. More than 1.25 million Americans have a first or recurrent heart attack each year. About 70% of the deaths from heart attack occur before the victim reaches the hospital. Heart disease is preventable.
The term heart attack can mean many different things to people. Instructors of CPR and First Aid will have to explain to students what a heart attack is, the signs and symptoms of a heart attack, and the appropriate actions to treat the symptoms of a heart attack or other acute coronary syndrome (ACS). It is important to know the difference between a heart attack and cardiac arrest, and understand that a heart attack can lead to cardiac arrest.
Acute Coronary Syndrome (ACS)
ACS is a term that encompasses many different heart problems that may result in an acute narrowing or blockage of the coronary arteries, leading to death or damage of the heart muscle. It could cause sudden cardiac arrest (SCA). ACS can include acute myocardial infarction (heart attack) and unstable angina.
Angina pectoris is chest pain or discomfort due to inadequate blood flow and oxygen delivery to the heart muscle. Angina can be stable, predictable episodes of chest discomfort, often brought on by exertion or stress, and relieved by rest and/or nitroglycerine. It can also be unstable, characterized by unexpected chest discomfort, usually occurring at rest. Stable angina can become unstable, leading to a heart attack.
To reduce confusion among lay providers and for simplification, ACS and unstable angina will be described as a heart attack. ACS or heart attack often results from coronary artery disease (CAD).
Coronary Artery Disease (CAD) Coronary artery disease results from a disease process known as atherosclerosis. Atherosclerosis is the thickening of the arterial walls from fatty deposits that produce irregularities in the inner lining of the artery. Narrowing of the vessels results in reduced blood flow and the inability of the artery to dilate when the heart requires more oxygen. Atherosclerosis is a form of arteriosclerosis, also known as “hardening of the arteries,” which causes a loss of elasticity in the vessel.
CAD creates increased risk for heart attack or other forms of acute coronary syndrome. CAD is a process that begins slowly, through atherosclerosis, relatively early in life. Almost 32% of children 2 – 19 years of age are overweight or obese.
Since being overweight or obese is a significant risk factor for heart disease, this trend will make the fight against heart disease even more difficult in the future. Cardiovascular disease is the underlying cause of death in 1 out of every 3 deaths in the U.S.
CAD can occur faster or slower in people depending on their weight, diet, fitness level, age, sex, and family history, among other factors. The buildup of plaque inside the arterial walls comes from fats and cholesterol contained in many of the foods we eat. Cholesterol is carried by the blood and can attach to the artery walls. Over time the arterial walls narrow, which leads to reduced blood flow.
The heart is a muscle that receives nutrients and oxygen through coronary arteries. Because of CAD, a narrowed and hardened artery can easily become obstructed by a fatty mass that has broken off from another vessel and traveled to the coronary artery, or by a blood clot that has formed in the coronary artery (thrombosis).
A heart attack (myocardial infarction, or MI) occurs when a coronary artery is blocked, causing prolonged inadequate blood flow and oxygen delivery to a portion of the heart. The result is death of the heart muscle cells that are normally supplied by the blocked coronary artery.
The severity of a heart attack is determined by the location and extent of the clot, including how much heart tissue is affected. If the area of infarction (cell death from lack of oxygen) is small, the heart may still function adequately. If the MI is large, severe cardiac arrhythmias or SCA may occur.
Is a heart attack the same thing as cardiac arrest?
A heart attack and cardiac arrest are not the same thing. A heart attack is the death of heart muscle. Cardiac arrest occurs when the heart stops pumping blood. When a person’s heart stops unexpectedly with little or no warning, it is called sudden cardiac arrest, or SCA. A heart attack may lead to cardiac arrest and sudden death, but they are not the same thing.
Risk Factors Associated with Heart Disease
There are risk factors that contribute to CAD and heart attack. Some risk factors are controllable, while others are beyond our control. We should all be aware of the risk factors and do what we can to prevent or reduce our risk of CAD and heart attack. Combined risk factors significantly increase the incidence of CAD and the likelihood of heart attack.
Controllable Risk Factors
Reducing the controllable risk factors associated with heart attack is important in order to live a long and healthy life. Consult your doctor before beginning an exercise
program or significant lifestyle changes. Your doctor can identify your risk factors, and then develop a plan to reduce your risk. Consider the following:
Smoking is the number one preventable cause of serious illness such as heart disease, stroke and lung cancer. It reduces the amount of oxygen in your blood, and increases heart rate and blood pressure.
Physical Activity/Obesity: Regular physical activity improves blood pressure and cholesterol levels, helps control weight, reduces the risk of diabetes and reduces stress. Obesity (30 pounds or more overweight) is a significant risk factor for heart attack and stroke. It is caused primarily by eating more calories than are burned through daily activity. The excess calories are stored as fat. Maintain a healthy weight with a varied, healthy diet, more appropriate portions, regular exercise and increased daily activity. Consult your doctor prior to beginning an exercise program.
Diet: Foods that are high in saturated fat, trans fat and cholesterol contribute to heart attack and stroke. Healthy foods (a variety of fruits, vegetables, whole grains, low in saturated fat) reduce risk. High salt intake can lead to high blood pressure. Eat a varied, healthy diet with plenty of fruit and vegetables.
Excessive Alcohol: Some studies have indicated that one or two drinks a day may increase “good” cholesterol (HDL); however, heavy drinking can lead to high blood pressure, heart disease and stroke.
Signs and Symptoms of Heart Attack (RED FLAGS)
Chest Discomfort: Most heart attacks create some form of chest discomfort in the center of the chest that will last for several minutes, or may go away and come back.
Chest discomfort is described as pain, pressure, crushing, tightness, squeezing, or fullness (i.e. gas or bloated feeling).
Discomfort from the chest can radiate or appear in other areas of the upper body.
Pain or discomfort can radiate down one or both arms, to the back, neck, jaw, or stomach.
Shortness of Breath:
Sometimes shortness of breath occurs before the chest discomfort, or is associated with the onset of chest discomfort. For some victims the shortness of breath is more significant than the chest discomfort.
Associated Symptoms: Pale, cool, sweaty skin; nausea, vomiting; dizziness, fainting.