Introduction to Heart Disease

Dr. Tarun Praharaj
M.D, AFPCC (Phil) AFPCC (America)
Senior Consultant Cardiologist,
B. M. Birla Heart Research centre,
Kolkata

Those of us who have had the unfortunate experience of having had heart attack with or without infractions have many question unanswered. It is not the intention to take the place of doctor who is really managing such cases. Generally such persons are advised rest for variable periods depending on their medical conditions. But after the initial period of rest certain doubts, fears, apprehensions and questions remain in the mind of such patients, which need consideration. It may again be emphasized that the extent to which physical, mental and emotional activity can be permitted is a decision to be entirely taken by the attending physician.

1. Talking and arguing - In the early stage of recovery at least, if not always, prolonged talking like speech making, radio talk or a T.V. appearance may be tiring and should be avoided. These lead, to some extent to emotional involvement, which is not conductive to rehabilitation. In no case convalescents should enter into arguments with other, which may result in emotional physical exercise.

2. Car Driving - After lapse of a reasonable time after an attack one many drive but drive slow and avoid heavy traffic areas and long continuous spells of driving. Sudden application of breaks and other traffic hazards are definite risks.

3. Sex life - Heart disease does not in any way affect sex capabilities but since the act involves some physical strain and emotional excitement, it is advisable to undertake such activity only if allowed by the attending physician. But within moderation there is no direct risk.

4. Air Travel - Extreme height mean reduced pressures and difficulty in breathing puts strain on the lungs and the heart. However in modern pressurized planes there is no risk involved but travel should be avoided in non-pressurized aircraft especially if it is to fly at great heights.

5. Fear Psychosis - Since any heart attack is serious, the patient after his recovery tends to fear about impending attack and any ache or twitch in chest is considered as an onset of another attack. The development of such a personality may even ruin the bright chances of recovery and a perfectly normal existence. It should be remembered especially by those, who have had the experience of a heart attack the pain in a real attack is extreme and unbearable and it does not come as an ache, twinges, twitches or fluttering. The fear affects generally health and impairs recovery to normal.

6. Employment - There is ample evidence to show that return to work after the prescribed period of rest has resulted in better health than it was before the heart attack. But it must be decided by the attending physician. There can obviously be no fixed rule. In most of the cases the patients can return to work with a little caution and moderation. In some cases a person may not be able to return to original work either on account of hesitancy of the employer or the nature of work. In almost every case some gainful occupation is not only possible for but also beneficial to the heart patient. It should be remembered that the fright of having had a heart attack and subsequent apprehension of the possibility of another more so after resuming normal activity cripples more heart patients that actual heart condition.

Conclusion - Besides taking medicines on doctor’s advice. Regular rest, exercise, a mind at peace, a sensible watch in weight, no smoking should be a reasonably safe way of life for the cardiac patient.

Heart Attack
(Myocardial Infraction)

What is a heart attack?

A heart attack (myocardial infraction) is the death of heart muscle due to the loss of blood supply. Usually, the loss of blood supply is caused by a complete blockage of a coronary artery (an artery that supplies blood to the heart muscle) by a blood clot.

What are the features of a heart attack?

Pain: is the cardinal symptom of a heart attack. The pain is often described as a tightness or heaviness in the chest. It is often severe enough to be the worst pain that can be experienced. The usual location of the pain is in the center of the chest but it frequently radiates to the left arm or the jaw.

Some heart attacks though can pass unrecognized; these painless attacks are called as ‘silent infracts’ and are particularly common in diabetics.

Anxiety: Fear of impending death.

Brightlessness,
Nausea and vomiting,
Sweating, pallor and a fast pulse.
Sudden death: Loss of blood supply disturbs the orderly transmission of electrical impulses in the heart and as a result the heart stops to effectively pump blood. Permanent brain damage and death can occur unless oxygenated blood flow is restored within five minutes. Approximately 40% of people suffering a heart attack die before reaching to the hospital.

What causes a heart attack?

A heart attack is almost always caused by the formation of a blood clot on a cholesterol plaque located on the inner wall of an artery to the heart (coronary artery). It is believed that the process of formation of these plaques starts in the late teens. Over a period of time the accumulation of cholesterol plaque causes thickening of the artery walls and narrowing of the arteries; a process called atherosclerosis.

Many factors have been found to influence this plaque formation. It can be accelerated by smoking, high blood pressure, elevated cholesterol and diabetes. Whereas, factors like exercise, low fat diet, avoiding stress seem to help in retarding this process.

Ultimately, the arteries narrow to an extent where they are unable to supply enough blood to the heart muscle during periods of increased demand like during exercise or excitement. This results in a condition called ischemia which leads to chest pain called as angina.

Occasionally, however, for unknown reasons, the surface of the cholesterol plaque can become sticky, causing blood clotting. When a blood clot forms on top of this plaque, the artery becomes completely blocked, causing death of the heart muscle (heart attack).

How is heart attack diagnosed?

The initial diagnosis of a heart attack is made by a combination of clinical symptoms and characteristic electrocardiogram (ECG) changes. An EKG is a recording of the electrical activity of the heart. However, confirmation of a heart attack can only be made hours later through detection of elevated creatinine phosphokinase (CPK) in the blood. CPK is a muscle protein enzyme, which is released into the blood circulation by dying heart muscles when their surrounding membranes dissolve.

What is the early management of a patient of a heart attack?

Most of the patients of heart attack are managed in a dedicated heart care unit. Following are the elements in the management:

· Bed rest

· Oral Aspirin

· High flow oxygen

· Intravenous analgesia with morphine

· Monitoring the E.C.G.

Reperfusion: The immediate goal of treatment is to quickly open blocked arteries and restore blood flow to the heart muscles; a process called “reperfusion” Early reperfusion minimizes the extent of the heart muscle damage and preserves the pumping function of the heart. Many drugs are available to dissolve the clots and restore blood supply. Drugs like tissue plasminogen-activator (t-PA) and streptokinase given intravenously can open 80% of the blocked arteries within 90 minutes.
How can I prevent a second heart attack?
The best chances of preventing a second heart attack come from a combination of medications and change of diet and lifestyle.

Drugs: Aspirin and beta blockers (drugs like Tenormin), have been shown to reduce chances of a second heart attack and improve future survival.