Heart Attacks (MI) in Women

Heart attacks are one of the main causes of death both in developed and developing nations. It is due to a host of predisposing factors that eventually leads to death of the heart muscle. It is now recognized that postmenopausal women are a high risk group and it is therefore important to understand the signs and symptoms for early intervention. Not every heart attack is fatal, however, even a mild attack can severely impair a person’s level of functioning.

What is a heart attack?

Heart attack (myocardial infarction) is medical condition characterized by stoppage of blood supply to specific region of the heart and subsequent death of those heart cells. The most common cause is due to a blood clot in the already narrowed coronary arteries because of rupture of fatty deposits. Classical symptoms include excruciating chest pain along with profuse sweating. Treatment options are medications mainly thrombolytic therapy (dissolving the blood clot), surgical interventions namely coronary angioplasty and bypass surgery.

Heart Attack Symptoms

Heart attack symptoms include :

  • Excruciating left sided chest pain often spreading towards the left arm, back, upper abdomen even to teeth and jaw.
  • Profuse sweating with cold clammy extremities.
  • Breathlessness.
  • Lightheadedness and blackouts.
  • Nausea and vomiting.
  • Apprehension.

In many cases, the attack may be silent meaning that there are no symptoms. It is only discovered upon diagnostic investigations. However, even minor infarcts affects heart function to some degree. A heart attack although can occur at any time, it is commonly preceded by symptoms of angina namely :

  • Recurrent left sided chest pain occurring typically after stress and relieved after taking rest or intake of glyceryl trinitrate (stable angina).
  • In some cases chest pain may occur with minimal exertion, at rest and with increased severity or prolonged duration (unstable angina). Patients with unstable angina are at a greater risk of heart attack.

Angina occurs as episodes over months and years. It serves as a warning sign of an impending heart attack sometime in the future. However, not every heart attack patient may have had prominent or prolonged angina episodes preceding the attack.

Causes and Risks

Blood supply of heart is maintained by coronary arteries. Blocked coronary arteries may completely stop to the blood supply to the heart muscle cells (myocardium) which without treatment over time will die. Sometimes, a defect in fat metabolism may lead to fatty deposits (atherosclerotic plaques) on the arterial wall. All the arteries, including coronary arteries of the heart, become narrowed and blood flow is subsequently reduced. The plaques, upon rupture, can attract platelets and forms clot which blocks portion of the coronary artery. Thus blood supply of the heart cells supplied by that coronary artery is jeopardized leading to symptoms of heart attack

Another cause of a heart attack is due to sudden unpredicted contraction of the walls of coronary arteries leading to complete stoppage of blood flow through it. Rupture of the coronary arteries may also lead to heart attack. In some cases clot formed in arteries at distant sites, it may dislodge and block the coronary arteries (coronary embolism) causing symptoms of a heart attack. If blood supply of the deprived heart cells is not restored soon thereafter, the cells eventually die leading to death of the patient, rhythm disturbances, heart failure, heart rupture and valve damage.

Risk factors

  • Age
  • Post menopausal women
  • Smoking, alcoholism and cocaine use
  • Lack of exercise
  • Obesity
  • High blood pressure
  • Diabetes
  • Defects in fat metabolism (high cholesterol)
  • Family history of heart attack or angina (ischemic heart disease)  before 65 years in females.

Treatment of a Heart Attack

Aim of treatment is to restore blood supply to heart cells as early as possible. Treatment options include drugs and surgery.

Drugs

  • Thrombolytics to dissolve the blood clot.
  • Low dose aspirin to prevent clot formation.
  • Antiplatelet drugs to inhibit platelet aggregation.
  • Painkillers to reduce the chest pain.
  • Beta blockers to decrease blood pressure.
  • Statins to lower blood cholesterol.

Surgery

  • Angioplasty and stenting to remove the block in the artery and keep it open wide.
  • Coronary bypass surgery to establish an alternate route for blood flow beyond the blockage.

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