What is Infarction. Infarction is the insufficiency of oxygenated blood in the heart area due to obstruction of a coronary vein. Because the blood can not flow in the region, the muscle goes into a process of necrosis, which can lead the patient to death. Obstruction of the coronary vein in question usually occurs because of a blood clot that forms above the fat pad that lines the vein, which causes blood to flow (ischemia) and consequently causes cell death. According to the Ministry of Health, around 300,000 strokes occur each year in Brazil, of which 80,000 end up being fatal or because they do not receive adequate treatment or because they do not control the risk factors that can trigger the disease. Due to technological evolution over the years, the mortality rate currently accounts for about 4 to 5% of all cases, ie 10 times lower than 50 years ago. In addition to this name, the infarction may be known by other names, such as: Myocardial infarction; Acute myocardial infarction; Acute coronary syndrome; Coronary thrombosis; Coronary occlusion. Is heart attack the same as cardiac arrest? No. As explained, the infarct is the low blood flow in the heart muscle from an obstruction of one of the heart veins. Cardiac arrest happens when the heart stops beating, as well as distributing blood to the rest of the body. Although a heart attack can cause cardiac arrest, the two conditions are not the same. Classification and Types of Infarction Infarction is usually classified into two types: STEMI infarction: it means that the patient suffered a ST-segment elevation myocardial infarction, that is, when there is a complete blockage of the coronary vein; NSTEMI infarction: this type happens when the myocardial infarction does not have ST segment elevation, that is, coronary vein blockade occurs partially. Type 1 Spontaneous infarction related to ischemia due to a primary coronary vein problem such as erosion and / or plaque rupture, fissure or dissection. Type 2 Infarction secondary to ischemia due to increased demand for oxygen or decreased supply, which occurs in situations such as: Coronary artery spasm; Coronary embolism; Anemia; Arrhythmias; Hypertension; Hypotension. Type 3 Unexpected heart muscle death, including cardiac arrest. In this type, frequent symptoms are suggestive of myocardial ischemia, accompanied by a new ST elevation, a new left bundle branch block or evidence of fresh thrombus in the coronary artery. Type 4 It is associated with coronary angioplasty or stent (tube inserted in some conduit of the body to prevent or prevent blood flow being impeded) and has two subtypes: 1 - Type 4a: infarction associated with percutaneous coronary intervention; 2 - Type 4b: infarction associated with stent thrombosis. Type 5 Infarction associated with myocardial revascularization surgery.
Causes of Infarction: An infarction occurs when one or more of your arteries becomes blocked. Because of an accumulation of several substances, including cholesterol, the artery may narrow, leading to a disease called Coronary Artery Disease, the main cause of most of the already diagnosed heart attacks. During an episode of myocardial infarction, one of these plaques of substances can rupture and leak into the bloodstream, forming a blood clot at the site of the rupture, preventing the flow of blood from reaching the heart muscle in sufficient quantity. Another quite common cause of infarction is a spasm of a coronary artery, which completely shuts off blood flow to the heart. The use of tobacco and illicit drugs can greatly facilitate a case of spasm and can often be fatal. In addition, a heart attack can also occur due to a tear in the artery of the heart. Risk factors: There are several factors that can trigger a heart attack. Among all, it can be divided into 3 groups 1 - Main risk factors: research indicates that certain immutable factors considerably increase the chances of developing a cardiovascular disease; 2 - Modifiable risk factors: most of the risk factors of the infarction can be modified, treated or controlled by changing lifestyle or medication use; 3 - Contributing risk factors: these are factors associated with increased risk of cardiovascular disease and also influence in cases of infarction. Main risk factors: These are risk factors that can not be modified. Know what they are: Age: Most people who die from a heart attack are 65 or older. At more advanced ages, women are more propitious than men to die within weeks of the episode. Males: Males have a higher risk of infarction when compared to females, in addition to being able to experience the condition at an earlier age. Menopause: Because of the loss of vascular protection provided by female hormones, menopausal women are at a higher risk of developing an infarct than those who are not yet at that stage. Inheritance: Children of cardiac parents are more likely to develop heart disease. In addition, black people have higher blood pressure than Caucasian people, thus increasing the risk of heart disease. Pre-eclampsia history: This condition causes increased blood pressure during pregnancy, increasing the risk of developing heart disease. History of autoimmune diseases: Diseases such as arthritis or lupus may increase a patient's risk of having a heart attack.
Modifiable risk factors: Even if there are unchanging risk factors, there are those who have a chance of being controlled through a person's lifestyle, and these are in large numbers. So by changing the lifestyle you have, most likely your risk of developing a heart attack will be lower. Smoking: Smokers are more likely to infarct, because tobacco is a strong risk factor for sudden cardiac deaths. In addition, the substance also increases the risk of developing coronary heart disease. The same goes for passive smokers (ie, non-smokers who have direct contact with smokers). High Cholesterol: As the cholesterol rate increases in one person, your risk of developing coronary heart disease also increases. When other risk factors are present, such as smoking and hypertension, this risk increases even more. Hypertension: A person who has his or her blood pressure higher than normal, the workload of the heart is increased, which causes the heart muscle to thicken and become more rigid. With this stiffening, the organ does not function properly and may increase the risks of stroke, infarction, renal failure and congestive heart failure. When high blood pressure is linked to obesity, smoking, high cholesterol or diabetes, the risk of heart attack and stroke increases even more. Sedentary: People who are physically inactive have a higher chance of having a heart attack. The practice of a physical activity helps in controlling high cholesterol, diabetes and obesity, as well as helps lower blood pressure in some people. Obesity: Anyone who has excess fat in their body is more likely to develop heart disease or suffer from a stroke. Obesity or overweight with other risk factors, such as high cholesterol and hypertension, increases the chance of the onset of type 2 diabetes. Diabetes: Diabetics have a higher chance of developing cardiovascular disease at least 68% of diabetic people younger than 65 years of age die from heart disease. People who have diabetes and are overweight need to control the rate of sugar in their blood so that worse consequences do not bother. Contributing Risk Factors: Some of these factors listed below, combined with a modifiable risk factor, may help in a heart attack as well. Stress: Some scientists have observed a relationship between stress in one's life with the risk of developing coronary heart disease. This is due to the fact that, under a lot of stress, a person can resort to items that help relieve him, such as overeating, smoking or smoking more than usual. Alcoholism: Ingestion of too much alcohol can increase blood pressure, as well as increase the risk of diseases and conditions such as cardiomyopathy, stroke and irregular heartbeat. Diet: A healthy diet is the key to preventing many diseases, including cardiovascular diseases. What you eat and the amount you take can directly affect modifiable risk factors such as high cholesterol, high blood pressure, and being overweight. Use of illicit drugs: By using illicit drugs such as cocaine, spasms in your coronary arteries may be more frequent and, as a result, cause a heart attack.
Symptoms of Infarction: Most of the cases of infarction do not present any symptoms. However, when they appear, they can be divided between the classic and the more atypical, which usually appear mostly in women. With regard to duration, the symptoms may last from a few minutes to a few hours, and may appear, disappear and appear again. Classic symptoms: 1 - Chest pain that can radiate to the left arm, neck, stomach and back; 2 - Cold sweat; 3 - Fainting. Atypical symptoms: (usually occur in women) 1 - Nausea; 2 - Vomiting; 3 - Shortness of breath; 4 - Excessive fatigue; 5 - Chest discomfort; 6 - Arrhythmia. Attention! Because they do not appear frequently in cases of infarction, these symptoms can be confused with those of other diseases. Therefore, it is necessary that, in the presence of some suspicion, you go straight to the first aid. Diagnosis and First Aid: If you are suspected of having a heart attack, the first thing to do is to call the emergency number and request an ambulance. While you wait, it is important that you stay at rest, so that your heart does not need to work unnecessarily. If you have aspirin at your fingertips and are not allergic to it - take one unit (300mg) as it helps to thin the blood and restore blood flow to the heart muscle. Sometimes a complication called ventricular arrhythmia can stop a patient's heart from beating. If you realize that the person who has infarcted appears not to breathe, does not move, or does not respond to any type of stimulus, you should initiate the chest compressions in order to revive it.
Tests that diagnose the infarction. Some exams may be requested by the cardiologist. Know what they are: 1 - Electrocardiogram: (ECG) Examination that identifies where the damage occurred and how strong the organ reached. The ECG basically has to measure how fast your heart is beating and what its rhythm (stable or irregular), and how much electrical energy signals are passing through each part of the heart. 2 - Blood tests: Through blood tests, the levels of certain cardiac enzymes that indicate damage to the heart muscle can be measured. By measuring these enzymes, the doctor can get a sense of the size of the infarct and approximately when it started. In addition to the enzymes, troponins are also measured, that is, proteins found inside the heart cells that are released only when the cells are damaged by insufficient blood in the heart. 3- Echocardiography: It is a type of imaging exam that is used to know how the heart is pumping blood as well as areas where it is not being pumped properly. Echocardiography also shows which structures of the heart have suffered infarction lesions. 4 - Catheterization: If the medications do not alleviate the symptoms of the infarction, the catheterization can be visited by the doctors. This test is used to visualize the blocked artery directly and help the specialist determine the best treatment for that case. Treatment; The treatment for a case of infarction consists basically of mechanical / surgical procedures and use of medications. Understand better: Mechanical / surgical procedures: 1 - Defibrillation: when the patient suffers, during the infarction, with a condition known as ventricular fibrillation (dangerous heart rhythm arrhythmia), the defibrillator can be used to control this irregularity; 2 - Angioplasty: tube with a balloon in the tip that is inserted in the blocked artery, in order to unlock it; 3 - Laser angioplasty: similar to angioplasty, except that, instead of a balloon, the tube has a laser tip that opens the blocked artery; 4 - Cardiac valve replacement surgery: the diseased heart valve is replaced by a healthy but artificial valve; 5 - Aterectomy: very similar to angioplasty, in atherectomy the implanted catheter has a rotating razor at its tip to cut the plaque that is blocking the artery; 6 - Bypass surgery: treats the blocked arteries and creates new passages for the blood to circulate normally in the heart muscle; 7 - Cardiomyoplasty: an experimental procedure that aims to remove the skeletal muscles from the back or abdomen of the patient in order to be stimulated synchronously to the heart, causing the myocardium to be replaced or involved by them; 8 - Heart transplant: replacement of the diseased heart by a healthy one that was donated; 9 - Minimally invasive cardiac surgery: it is an alternative to standard bypass surgery; 10 - Radiofrequency ablation: A catheter with a tip electrode is guided through the veins until it reaches the heart muscle and causes some cells to be destroyed in a very small area; 11 - Stent procedure: A mesh tube is used to open an artery during an angioplasty; 12 - Revascularization Transmyocardial: A laser is used to make a series of holes in the pumping chamber of the heart. Medications for heart attack: 1 - Aspirin: if you have not taken the medication while waiting for the ambulance, paramedics will administer a dose into your body, as it helps maintain blood flow in an artery that is narrower; 2 - Thrombolytics: medicines that help dissolve a blood clot that is blocking the passage of blood into the coronary arteries. The sooner you receive this medication, the greater the chances of survival and fewer sequelae; 3 - Antiplatelet agents: help prevent the formation of other clots and keep the clots already existing in the size they are. An example of a medicament of this class is clopidogrel; Other blood-thinning medications: medicines such as heparin can be given to make your blood less sticky and likely to form clots; 4 - Analgesics: to relieve your discomfort, morphine may be used; 5 - Nitroglycerin: used to treat angina pectoris, nitroglycerin may help improve blood flow to the heart as it dilates vessels; 6 - Beta-blockers: medicines that help relax the heart muscle, slow heart rhythm and also blood pressure, so the organ can work more easily. Beta-blockers limit the amount of damage to the heart muscle, in addition to preventing future heart attacks; Angiotensin Converting Enzyme (ACE) Inhibitors: reduce blood pressure and stress on the heart. One of the options that can be indicated is captopril. 8 - Statins: used to lower the level of LDL ("bad cholesterol") and increase HDL ("good cholesterol"). Many people using drugs like simvastatin or lovastatin have been shown to decrease their chances of having a heart attack. Note: NEVER self-medicate or stop using a medicine without first consulting a physician. Only he can tell which medication, dosage and duration of treatment is most appropriate for your specific case. The information contained on this site is for informational purposes only and is not intended to replace a specialist's advice or to serve as a recommendation for any type of treatment. Always follow the directions on the package leaflet and, if symptoms persist, seek medical or pharmaceutical advice.
Recovery: Post-infarction requires a period of recovery by the patient. In it, various professionals will assist you in physical and mental recovery, which consists of: 1 - Gradually restore your physical form so that you can resume your activities normally; 2 - Reduce the risks of another episode of heart attack. Physiotherapy: The process of post-infarction physiotherapy should begin even in hospital and it is usually composed of the following exercises: 1 - Respiratory exercises to strengthen the lungs; 2 - Muscle stretching; 3 - Go up and down stairs; 4 - Exercises to improve your physical condition. Taking the Medication Correctly: 1 - After the infarction episode, your doctor will most likely prescribe you some medicines to control the flow of your blood or some of the risk factors you may own. Ideally, you should always know the names of these medicines as well as take them as prescribed. Deal with your emotions: 1 - After a heart attack, feelings like fear, anger and depression may come to plague the patient. So, for this to be controlled and do not move to an even higher level, consider discussing the situation with your doctor, friends and family. If you prefer, be part of cardiac rehabilitation groups, as they can be effective in helping you deal with everything that has happened. Diet: Having a healthy diet is synonymous with good health and prevention for various diseases, including another case of heart attack: 1 - Salt, sugar and saturated fat: these three elements should be administered in small amounts, so that cholesterol, blood pressure and weight are controlled; 2 - Foods rich in magnesium: foods like nuts, beans and dark green vegetables stabilize the heart rate, thus avoiding a heart attack; 3 - Vitamins A, C and E (vitamin supplements are not indicated): fruits, vegetables and grains provide numerous antioxidant vitamins, which fight free radicals that can strike the heart in a dangerous way; 4 - Omega-3: Omega-3 fatty acids decrease inflammation of the body, making the heart a healthier organ. Omega-3 can be found in foods like olive oil, canola oil and some types of fish such as salmon and tuna; 5 - Root vegetables: vegetables such as carrots lower the person's cholesterol in the long term and reduces blood clotting. Return to work: 1 - The return to your routine is variable from person to person, since the intensity of work that each profession demands is different from one another. For example, if you work in an office, doing light activities during the day, your return can take up to two weeks. However, if your work is more intense, such as heavy manual labor, the return may be only after several months. Gender: 1 - According to the British Heart Foundation, the patient who suffered a heart attack can return to their sexual life as soon as they feel well enough, which usually takes four to six weeks after the event. It is important to keep in mind that having sex will not increase the chances of another heart attack happening. Driving: 1 - If you have a heart attack and drive frequently, you must report what happened to DETRAN. Most patients return to driving in about two weeks. However, if the case was very intense, you will most likely be away from the activity for up to four weeks. Contraceptive pill: 1 - Never use contraceptive pills if you have suffered from infarction, because this type of medication is directly linked to increased blood clotting. Complications: Since most of the diseases, if untreated the sooner and the correct way, the infarct can also bring several complications: 1 - Arrhythmia, that is, abnormal heart rhythms; 2 - Heart failure, temporary or chronic; 3 - Heart rupture, often fatal; 4 - Problems in the valve, causing leakage; 5 - Erectile dysfunction due to stress and anxiety caused by the episode. About one in three men suffer from the problem.
Prevention: Since there are modifiable risk factors, the ideal is to control them, as well, thus, prevention of a heart attack is also done. This control is basically divided into three topics: 1 - If you are a smoker, try to stop; 2 - Check with your doctor for ways to control risk factors, which may be high blood pressure, high cholesterol, diabetes, and obesity; 3 - A healthy diet and an active lifestyle help prevent heart attacks, as they help control certain risk factors. It is always important to be aware if you have any risk factor directly related to the infarction, because knowing this, the chances of prevention are greater when it is properly controlled. Share with friends and acquaintances this article and make the information presented here reach as many people as possible! Source: FM - USP.
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