Heart Attack

[This post written with Jeanne Schulz, RN, MSN]

A myocardial infarction, or MI, is commonly known as a heart attack.  An MI is damage to an area of the heart muscle caused by a lack of blood supply.

CAUSES — Almost all cases of MI occur in someone who has an underlying condition called coronary heart disease (CHD), which is due to a narrowing or blockage in the coronary arteries, due to what is known as plaque. An MI occurs when the plaque ruptures and causes a blood clot (thrombus) to form in one of the coronary arteries.  Some studies have shown that an emotional or stressful event occurs in a certain percentage of people in the days or hours before an MI.  In addition, an increase in the incidence of MIs has been noted in populations where a disaster has occurred.  Because mental stress is known to cause increases in heart rate and blood pressure as well as other changes in the cardiovascular system, it has been suggested that, in some cases, mental stress can affect the stability of a coronary artery plaque and “trigger” an MI.

SYMPTOMS — The “typical” complaint of a person having an MI is persistent chest discomfort, resulting from ischemia (lack of oxygen supply) involving an area of heart muscle. But there is wide variability in the symptoms a person can have when an MI is occurring. Some patients have no symptoms at all. Others, particularly women, the elderly, diabetics, and individuals with a prior diagnosis of heart failure, may have other symptoms but not report chest discomfort. Still others have a combination of chest discomfort and other complaints. Some people having an MI will experience sudden death, also known as cardiac arrest.

Many different conditions can cause pain in the chest. The ischemic chest discomfort of an MI can range from mild to severe, and typically has the following characteristics:

  • Felt as a pressure, constriction, tightness, or squeezing, versus a sharp or stabbing pain
  • Is not limited to a small area, but rather spreads through the chest
  • May radiate to other areas of the body, including the upper abdomen, shoulders, arms, neck and throat, or lower jaw and teeth
  • Comes on gradually and lasts more than a few seconds
  • Is usually not made worse by pressing on the area of the chest that is affected, by taking a deep breath or by a particular position; however, lying down may make it worse, while sitting up may produce some reduction in intensity
  • Is not relieved by antacids or food

Other symptoms of MI — A number of other symptoms can occur in the setting of an MI. They may occur in a patient with or without chest discomfort. These include:

  • Shortness of breath
  • Nausea, vomiting, or belching
  • Sweating
  • Palpitations
  • Lightheadedness
  • Fatigue
  • Fainting
  • Cardiac arrest (sudden cardiac death)

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.   Online resources include, but are not limited to the National Heart, Lung, and Blood Institute (www.nhlbi.nih.gov) and the American Heart Association (www.americanheart.org).

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