Massive Heart Attack

Heart attacks are fatal. They are a serious health issue that shouldn’t be taken lightly. Research showed that more than 700, 000 people in the United States suffer from a heart attack every year. That is equivalent to one heart attack every 44 seconds.

A heart attack is medically known as myocardial infarction. It occurs if the tissues in the heart died due to an insufficient blood supply. ^{(1, 2, 3)}

Massive Heart Attack Definition

A massive heart attack is a severe form of heart attack that causes damage to a large portion of the heart. This may result in unconsciousness and permanent heart damage. Worst cases cause the heart to stop beating (cardiac arrest), leading to death. ^[1]

Image 1: A closer look at the human heart.
Picture Source: study.com

Mild heart attack vs Massive heart attack

A mild heart attack affects a tiny portion of the muscles of the heart. The extent of damage is small and oftentimes not permanent. On the other hand, a massive heart affects a large portion of the heart muscle. If not dealt with right away could lead to cardiac arrest. ^{(2, 3)}

Symptoms of Massive heart attack

Photo 2: The cardinal signs and symptoms of massive heart attack.
Picture Source: i.pinimg.com

• The patient complains of extreme excruciating pain in the chest that radiates to the neck, jaw, back, and left arm.
• The chest feels tight and many people described the pain as if something heavy is on the chest.
• Profuse sweating
• The pain in the chest is precipitated by exertion and vanishes if the patient stands still.
• Cold, clammy skin ⁽⁵⁾
• Difficulty breathing/labored breathing
• Nausea with or without vomiting
• Light-headedness and dizziness
• The face turns pale and other parts of the body becomes cyanotic (bluish) such as the lips, tongue, and nails.
• Extremely low blood pressure
• Irregular beating of the heart
• Fainting ⁽⁴⁾

Heart Pain Location

Where is your Heart Located

The heart is located in the left side of the chest between the left and right lungs. It is behind the left side part of the breastbone, medial to the lungs and on the posterior side of the sternum. The heart occupies the left side of the chest.

Two thirds of its mass is on the left side while the rest is on the right side of the chest. If you want to find out the size of your heart, then just close your fist and that’s approximately the size of your heart.

It is important to pinpoint the location of the heart to distinguish if the pain in the chest has something to do with the heart or not. A heart pain is a pressure or pain right in the exact position of the heart.

However, there are rare instances wherein heart attack pain is not necessarily felt in the exact position of the heart. In fact, not all pain in the chest area is heart related. Some of the reasons for chest pain other than heart attack include the following:

• Gastroesophageal reflux disease
• Pulmonary embolism
• Pneumothorax
• Pneumonia
• Costochondritis
• Lung cancer ⁽⁷⁾

Causes of a Massive heart attack

• Atherosclerosis/coronary artery disease – The arteries in the heart are blocked because of plaque build-up. Over time, the walls of the blood vessels become narrow and hard.
  As a result, the proper circulation of blood is impaired, which could significantly affect the normal functioning of the heart, especially the expansion and contraction of the heart muscles. Reasons for atherosclerosis are as follows:

1. Too much fat in the diet
2. Sedentary lifestyle such as smoking and alcohol drinking
3. High blood pressure
4. High level of blood sugar
5. Accumulation of white blood cells in the arteries ^{(7, 8, 9)}

• Coronary microvascular disease – It is characterized by a damage to the small arteries. Coronary microvascular disease is caused by:

1. High blood sugar level
2. High cholesterol level
3. High blood pressure
4. Smoking ^{(9, 10)}

• Coronary artery spasms – It is the sudden narrowing of the arteries of the heart leading to an obstructed circulation of blood. Over time, it deprives the heart of oxygenated blood. Coronary artery spasm is most likely to occur in patients with atherosclerosis (plaques build-up in the arteries). The chest pain is contained on the left side of the chest and under the sternum. Factors that could lead to coronary artery spasm include:

1. High blood pressure
2. Exposure to extremely cold environment
3. Emotional stress
4. Side effects of alcohol withdrawal
5. Side effects of drugs, especially stimulants and vasoconstrictors ^{(9, 10, 11)}

How to Diagnose Massive heart attack

Due to the fatal nature of massive heart attack, it is a must to come up with the most accurate diagnosis. There are various tests and diagnostic procedures that help confirm a positive diagnosis of heart attack. These are the following:

Image 3: An electrocardiogram procedure where chest electrodes are placed on the patient’s chest.
Picture Source: image.slidesharecdn.com

1. ECG (Electrocardiogram) – It is one of the routine procedures for people with chest-related complaints. It is a non-invasive procedure that records the electrical impulses of the heart. The electric activity of the heart will be recorded in electrocardiograph and will be interpreted by a cardiologist. An electrocardiogram is one of the most reliable procedures for it helps detect any abnormalities in the heart and at the same time help monitor the progress of the heart attack.
2. Chest x-ray – This procedure is done to check for the anatomical and physiologic structures of the heart. Through chest x-ray, the size of the heart and the surrounding blood vessels and arteries will be checked.
3. Angiogram/Coronary catheterization – This test is done to check the condition of the arteries. It helps detect blockage and narrowing of the arteries.
4. MRI (Magnetic Resonance Imaging) – It detects the severity of the heart damage. It is a test that helps differentiate mild from a massive heart attack.
5. Blood Test – An abnormality in the heart leads to a production of enzymes. The purpose of the blood test is to check for the presence of such enzymes.
6. Echocardiogram – It is somewhat the same as the ECG procedure, but the echocardiogram is more advanced. Sound waves are directed to the heart from a transducer. The role is to capture video images of the heart. It helps identify the extent of the damage caused by a heart attack.
7. Exercise stress test – A few days after a heart attack, your doctor might require you to undergo a stress test to find out how your heart reacts to exertion. This procedure requires the patient to walk on a treadmill for a few minutes or to pedal a stationary bike while the ECG machine is attached to the person’s body. ^{(11, 12, 13, 14)}

Additional test used to identify chest pain

• Levine sign – The patient clenches his fist and placed against the sternum.
• Palm sign – The extended palm is placed against the sternum.
• Arm sign – The patient grips the left arm because of severe pain.
• Pointing sign – The patient uses one or two fingers to the chest area.

Treatment and Management

A massive heart attack should not be taken lightly. It is a life-threatening situation that requires immediate medical attention. ⁽¹⁴⁾

Responding to someone who has had a heart attack

If you noticed someone fainted and you are suspecting a heart attack, the first thing you should do is to not panic. Always have a presence of mind. Panicking can make things worse. Do the following:

• Call out for help. Contact the emergency hotline right away.
• While waiting for the paramedics, it will help a lot if you are going to make the patient comfortable. Do not give an immediate care if you are not expert and trained to do so.
• Begin CPR (cardiopulmonary resuscitation). A CPR should only be given by someone who has in-depth knowledge and training on emergency medical care. The purpose of the CPR is to keep the blood flowing and supply the brain with enough oxygen. A gentle pressure is applied on the chest at about 100 to 120 compressions per minute. Prior to CPR, the responder should check for ABC (airway, breathing, and circulation).

Please see the video on cardiopulmonary resuscitation – Click here

• Aspirin and nitroglycerin can be given to the patient while waiting for the paramedics to arrive. The purpose of these drugs is to prevent the formation of blood clot in the coronary artery. Nitroglycerin is effective in alleviating chest pain.
• Once the EMT arrives, they will immediately restore the patient’s heartbeat with the use of an automatic external defibrillator.
• Other types of blood thinning drugs can be given to the patient to prevent the blood from being less sticky thereby preventing a blood clot. The drug of choice is heparin, which is given to the patient via injection. ^{(15, 16, 17, 18)}

Managing heart attack in the clinical setting

If the patient is already transported to the hospital, various medical approach is used to significantly improve the patient’s condition. Powerful drugs are given to the patient to restore the normal functioning of the heart and alleviate pain and discomfort.

Thrombolytics

These drugs are given to the patient to dissolve a blood clot in the heart’s artery, which might be one of the reasons for blood flow obstruction. Thrombolytics should be given to the patient as soon as he is in the hospital to prevent further damage to the muscles of the heart. Examples of thrombolytic drugs are tissue plasminogen activator, streptokinase, urokinase, and alteplase.

Beta-blockers

These drugs relax the heart, decreases blood pressure and improves the beating of the heart. Examples of beta-blockers are Atenolol, Nadolol, and Propanolol.

Super-aspirins

The purpose of these drugs is to support the action of thrombolytics. They prevent further formation of blood clots. An example of super-aspirin is clopidogrel.

ACE inhibitors

They prevent further stress and damage to the heart by reducing blood pressure. ^{(19, 20)}

Surgical intervention

When deemed necessary, a surgery is required. It depends on the patient’s overall condition and doctor’s discretion. Surgical interventions for massive heart attack include the following:

1. Angioplasty – This surgical procedure opens the blocked arteries and restores the normal flow of blood to the heart.
   

   Picture : Angioplasty
   Image source: bostonscientific.com

2. Coronary artery bypass – The affected veins and arteries in the heart are sewn in order to restore the normal flow of blood in the heart. It can only be done about a week post heart attack recovery.
   

   Picture : Coronary bypass surgery
   Image source: bhf.org.uk

3. Lifestyle modifications – your lifestyle can significantly affect your health, especially your heart. To hasten your recovery and prevent further heart attack, you need to keep in mind the following:

• Avoid sedentary lifestyle such as smoking and drinking alcoholic beverages.
• Keep your blood pressure under control by taking your blood pressure drug religiously.
• Exercise regularly. You don’t necessarily need to go to the gym. Simple exercises like jogging and brisk walking can help improve the function of the heart muscles.
• Eat a heart-friendly meal to keep your weight within normal limits. Foods that are friendly to the heart include lean proteins like fish, whole grains, beans, fruits, and vegetables.
• Limit your exposure to stress. The heart is a sensitive organ and it can detect any forms of stress, be it emotional, physical, and mental stress. ^{(17, 19, 20)}

What is the Survival rate?

A massive heart attack is one of the leading causes of death. The survival rate is low. To significantly improve the patient’s recovery from a heart attack, it is important for the patient to receive timely and appropriate care. Time is of utmost important when dealing with a massive heart attack. It is a must to know the early signs and symptoms of heart attack.

Survival Rates : Death rate is high as 40 – 50 % in patients even with treatment

Reference : Hurst’s the Heart and  Braunwald (Cardiology reference books)

If you feel like something is not right, you need to see your doctor right away to closely and professionally monitor your condition. After a heart attack, some people can live for many years provided they strictly adhere to their doctor’s prescription.

Lifestyle and diet modification also plays a very important role in the patient’s recovery. The patient’s survival rate is determined by the following factors:

• Extent of damage
• Types of treatment
• Patient’s pre-existing medical condition ^{(4, 7, 9)}

Why is it important to consult your doctor?

If you notice something painful in your chest and other parts of the body where delicate organs are situated, you need to immediately consult your doctor. Any types of pain, especially chest pain should not be taken lightly.

Pain is your body’s way of telling you that something is not right and that you need to take the necessary action. Chest pain could indicate a life-threatening condition considering that there are sensitive and vital organs in the chest.

However, you have to keep in mind that not all chest pain is heart-related. There are other causes and that need to be ruled out by your doctor.

If the chest pain is indeed has something to do with your heart, then you’ll be able to save from life-threatening situations.

The key to surviving a heart attack is to detect it the earliest possible time and receive appropriate treatment and care. ^{(9, 10, 11, 13)}

 

References:

1. https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106
2. https://www.texasheart.org/heart-health/heart-information-center/topics/sudden-cardiac-arrest/
3. https://www.webmd.com/heart-disease/guide/sudden-cardiac-death#1
4. https://www.belmarrahealth.com/massive-heart-attack-causes-diagnosis-treatment-tips/
5. https://www.medicinenet.com/heart_attack_in_women/article.htm
6. https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106
7. http://www.heart.org/HEARTORG/Conditions/911-Warnings-Signs-of-a-Heart-Attack_UCM_305346_SubHomePage.jsp
8. https://www.webmd.com/heart-disease/guide/sudden-cardiac-death
9. https://www.healthgrades.com/explore/mild-and-massive-heart-attacks-whats-the-difference
10. https://ihealthblogger.com/massive-heart-attack-definition-causes-treatment-and-survival-rates/
11. https://study.com/academy/lesson/heart-attack-symptoms-mild-vs-massive.html
12. https://www.bhf.org.uk/heart-health/conditions/heart-attack
13. https://www.care.com/c/questions/17107/how-do-i-prevent-a-massive-heart-attack/
14. https://www.nhlbi.nih.gov/health-topics/heart-attack
15. http://www.heart.org/HEARTORG/Conditions/HeartAttack/TreatmentofaHeartAttack/Treatment-of-a-Heart-Attack_UCM_002042_Article.jsp#.Wn3iV_lubIU
16. https://www.medicalnewstoday.com/articles/151444.php
17. https://www.medicalnewstoday.com/articles/280292.php
18. http://www.tandurust.com/heart-health/massive-heart-attack-symptoms.html
19. http://www.irtces.com/heart-attack.htm
20. https://www.nhs.uk/conditions/heart-attack/treatment/
21. http://www.upmc.com/patients-visitors/education/cardiology/Pages/heart-attack-emergency-treatment.aspx
22. https://www.heartfoundation.org.au/after-my-heart-attack/heart-attack-treatment