Heart Attack

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Heart Attack

Myocardial infarction (MI) is also called a heart attack. A heart attack occurs when an artery leading to the heart becomes totally blocked. A heart attack is a medical emergency. Seek immediate medical attention if you or someone else is having the symptoms listed below.

Signs and Symptoms

	Pain, heaviness, tightness, burning—in chest, back, left arm, jaw, neck
	Difficulty breathing
	Dizziness, weakness
	Nausea, vomiting
	Irregular heartbeat

What Causes It?

Atherosclerosis, the process of plaque buildup in an artery until it becomes closed, is the most frequent cause of heart attacks. Heart attacks can also result from heart-muscle spasms or hereditary heart problems. The following increase your risk of getting a heart attack.

	Smoking
	High-fat diet, excess body weight
	Family history of early MI
	Diabetes
	Oral contraceptives
	Hypertension (high blood pressure)
	Being male, or a female who has gone through menopause
	Cocaine or amphetamine abuse

What to Expect at Your Provider's Office

If you think that you are having a heart attack, call for medical assistance immediately. Treating a heart attack within 90 minutes can save a person's life. In the emergency room, the following three things will happen very quickly to determine if you are having a heart attack.

	You will have an electrocardiogram (EKG).
	A health care provider will ask you about your symptoms and perform a physical examination.
	You will have a blood test to evaluate your cardiac enzyme levels.

Treatment Options

Treatment Plan

Blood must be brought back to the affected area immediately. Three methods for doing this are drug therapy, angioplasty (using one of several methods to clear the blocked blood vessel, such as inflating a balloon inside it or holding it open with a device called a stent), and surgery. Your health care provider will give you drugs to improve blood flow and bring blood back to the blocked artery. Other drugs keep your heartbeat regular, lower your blood pressure, and control pain.

Drug Therapies

Prescription

Drugs to bring blood back to the blocked artery include the following. They cannot be used if you are pregnant or have severe bleeding, hypertension, stroke, or liver or kidney disease.

	Streptokinase (SK)—improves widening of the coronary artery; takes 70 minutes to feel the effects; given intravenously
	Tissue plasminogen activator (Alteplase, rt-PA)—improves widening of the coronary artery; takes 45 minutes to feel the effects
	Anisoylated plasminogens streptokinase activator complex (Anistreplase APSAC)—more expensive but longer anti-clotting activity than streptokinase
	Heparin—improves widening of the coronary artery

General measures

	Nitroglycerin—improves blood flow, helping to prevent blood clots that block arteries
	Beta blockers—reduce cardiac rupture, new heart attacks, irregular heart beat; various side effects
	Angiotensin-converting enzyme (ACE) inhibitors—reduce high blood pressure
	Pain control—morphine sulfate, intravenous
	Oxygen—by a tube inserted into your nose, as needed

Over the Counter

Aspirin—improves blood flow, helping to prevent blood clots that block arteries; it works best if you chew it; various side effects; frequently prescribed

Complementary and Alternative Therapies

Alternative therapies are most appropriate to reduce your risk of a first MI, minimize damage from an MI, and reduce the risk of a subsequent MI. It is important that you first get your condition diagnosed and stabilized by a medical professional.

Nutrition

	L-carnitine (9 grams per day intravenously for five days, then 6 grams per day by mouth for 12 months) within 24 hours of onset of chest pain decreases left ventricular dilation.
	A diet high in antioxidants (vitamin C, vitamin E, and beta-carotene) and soluble dietary fiber, and low in fat is beneficial.
	Bromelain (400 to 800 mg per day) may help dissolve plaque.

Herbs

Herbs should not be used in place of immediate medical attention. Herbs can be used as general heart tonics and specifically applied to treating conditions associated with MI, such as atherosclerosis, congestive heart failure, high cholesterol levels, high blood pressure, and high fat levels in the blood.

Homeopathy

Homeopathy should never be used instead of immediate medical attention.

Physical Medicine

Beneficial for rehabilitation

Acupuncture

Useful for pain and rehabilitation

Massage

Beneficial for rehabilitation and prevention

Following Up

You may reduce your risk of heart attack by avoiding known risk factors. Get aerobic exercise (such as walking, biking, or swimming) for at least 20 minutes three times per week. If you haven't exercised much in the past, walking is a great way to start. Reducing stress can also help lower your risk of MI. Learn stress-reduction techniques such as deep breathing and meditation. Gentle exercise such as yoga and tai chi can also help you reduce your stress level. Eat a low-fat diet and stay at the proper weight.

If you have diabetes or high blood pressure, follow your health care provider's instructions to keep it under control. If you are a woman and have gone through menopause, you may want to consider hormone replacement therapy—it can lower your risk of heart disease. Talk to your provider about your options.

Supporting Research

Iliceto S, Scrutinio D, Bruzzi P, et al. Effects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: the L-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) Trial. J Am Coll Cardiol.August 1995;26:380.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:58–60.

Murray MT. The Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. Rocklin, Calif: Prima Publishing; 1998:184.

Rakel RE, ed. Conn's Current Therapy. 50th ed. Philadelphia, Pa: WB Saunders; 1998.

Singh RB, Niaz MA, Agarwal P, Begom R, Rastogi SS. Effect of antioxidant-rich foods on plasma ascorbic acid, cardiac enzyme, and lipid peroxide levels in patients hospitalized with acute myocardial infarction. J Am Diet Assoc. July 1995;95:775–780.

Singh RB, Singh NK, Niaz MA, Sharma JP. Effect of treatment with magnesium and potassium on mortality and reinfarction rate of patients with suspected acute myocardial infarction. Int J Clin Pharmacol Thera. 1996;34:219–225.

Washington Manual of Medical Therapeautics. 29th ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1998.

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.