An Achy, Breaky Heart: Breaking down a heart attack

Per the American Heart Association, someone in the United States has a heart attack approximately every 40 seconds. Furthermore, cardiovascular disease is the leading cause of death in the US. Join me in breaking down the medicine behind heart attacks as well as some preventative measures, treatment options, warning signs, and more.

This episode's show notes: Season 1, Episode 3 Show Notes

We also have an animated version of this episode for our fellow visual learners as well! Season 1, Episode 3 YouTube Short

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Transcript

S1E3

“An Achy Breaky Heart: Breaking down a heart attack”

Erin Layman Rhoads: [00:00:00]

Hello, and welcome to Medicine in Layman’s Terms. 

Whether you are a patient looking to understand more about your health, a student looking to brush up on common medical terms, or a provider wanting ideas to explain diagnoses to your patients, I invite you to join me every week as we break down basic medicine into layman's  terms. I am your host, Erin Layman Rhoads, a certified physician assistant, and let's get started.




[00:00:26]

Meet Todd. Todd is a 67 yo male presenting to the emergency department with his wife, Kayla, for chest pain. He originally thought it was his GERD acting up, since he was also feeling nauseated, but he became concerned when he started feeling dizzy as well. After an EKG, the emergency department nurse practitioner explains to him that he is having a heart attack and gives him aspirin to chew while also hooking him up to more machines. Todd is then transferred upstairs with the cardiology team for further testing and treatment. His wife, Kayla, then asks the nurse practitioner some questions including about the treatment plans, why he gave Todd the aspirin, and how can they prevent another heart attack in the future?




[00:01:03]

Welcome back, everyone! I know I took a little hiatus, umm I got busy, moved, started two new jobs actually. So lots of big changes however we’re back, recording episodes and excited about some upcoming blog posts. So, lets get started! Today we are going to talk about heart attacks. Per the American Heart Association, someone in the United States has a heart attack approximately every 40 seconds. Furthermore,  cardiovascular disease is the leading cause of death in the US.

[00:01:36]

So, without further ado, what is a heart attack?

A heart attack is also known as something called a myocardial infarction, or an MI, and this occurs when the heart muscle suddenly doesn’t receive enough blood flow. So, let’s think of your heart as a giant ball of muscle and blood is responsible for transporting oxygen throughout the body and then delivering it to our tissues, like the heart muscle. And, these tissues, including the heart muscle, need that oxygen to function and to survive. When the blood flow to the heart muscle is drastically decreased or suddenly cut off completely, part of that heart muscle may die or be severely damaged. And this is what we call a heart attack. 

[00:02:13]

So, what are the symptoms of a heart attack?

Symptoms of a heart attack can vary. Some people have mild symptoms while the first symptom for others may be cardiac arrest. Hold on, I know that we are starting off with some big words, so  let’s just break this down real quick. 

Cardiac arrest is when the heart stops beating. A heart attack is when that blood flow to the heart is blocked. Brief anatomy review, please don’t turn this off I swear it’s going to be brief. The heart is told to beat by electrical currents and, if there is a problem with transmitting this electrical signal to or throughout the heart, the heart can start pumping in a very irregular way. This is called an arrythmia. One arrythmia that we talk about a lot is ventricular fibrillation, otherwise known as v fib. It’s a rhythm that causes the heart to beat rapidly and inadequately. If you watch Grey’s Anatomy or other medical shows, at one point someone definitely yells, you know, “V fib, starting CPR!” “Prepare to shock!” Things like that, and that is actually medically accurate.  Back on track! So,  during a heart attack part of the heart muscle’s blood flow is decreased or cut off. This can change the way the electrical signals move through the heart because part of that tissue or muscle that is responsible for helping to get that electrical signal through the heart is damaged. When there’s damaged and they aren’t moving through the heart normally, we can get an arrythmia, like v fib, which can cause sudden cardiac arrest, which is when your heart just stops beating.  

I know that’s a lot of kind of different terms at once, but I think it’s sometimes nice to have them laid out for us or in our heads. 

So, symptoms can vary. Common symptoms include chest discomfort, and this can be a pressure, a tightness or squeezing. One buzz phrase that we often hear people say is that they feel like an elephant is “sitting on their chest”. This pain is often either in the center of the chest, the left chest, and it may radiate, or shoot, to other parts of our body including our left shoulder, arm or jaw. Other common symptoms can include cold sweats, fatigue, lightheadedness, nausea,  and shortness of breath. 

[00:04:21]

What are the causes?

The most common cause of heart attacks is something called coronary artery disease. The coronary arteries are the little arteries that bring blood to and around the heart. Coronary artery disease occurs when one or more of these coronary arteries become blocked off and this is most commonly due to a build of plaque in the artery. This narrows the artery and decreases the blood flow. Plaque is primarily made up of fats and cholesterol. If a plaque breaks open or ruptures, a blood clot then forms around it, and this also blocks the blood flow. There can be complete or partial blockage of the arteries. 

Another, less common cause, is if there is a spasm in one of the arteries. Spasms can cause severe squeezing of the coronary arteries, which then decreases flow. Certain drugs, especially stimulants, including cocaine and amphetamines, can trigger coronary artery spasms and lead to a heart attack.

[00:05:16]

What are the risk factors?

As with the other conditions touched on in previous episodes, and, spoiler alert, going to come up in future ones, advancing age is definitely a risk factor. Men aged 45 and older and women aged 55 and older are considered higher risk than younger men and women. There are also certain risk factors or diseases/ pathologies that increase your risk for heart disease and subsequent heart attacks.  Per recent studies, almost half of Americans have at least one of three key risk factors for heart disease: high blood pressure, high cholesterol, and smoking. 

Over time, high blood pressure damages the arteries of the heart, and this can increase your risk for a heart attack. Having high levels of “bad” cholesterol and/ or high levels of triglycerides also narrow the arteries and can increase this risk. Tobacco use, which it is important to mention that this includes smoking and long-term exposure to secondhand smoke, can damage the arteries in your body, make them a little more stiff, and create clots easier. 

A family history of a heart attack in a male family member younger than 55 or a female younger than 65 can also increase this risk, which is why it’s really important to have this conversation with your doctor because there are preventative medications that we start people on, especially if, let’s say, your father had a heart attack at 40. 

[00:06:35]

Diagnosing a heart attack

There are multiple test options to diagnose a heart attack. One very common one, which Kayla asked the nurse practitioner about in our case, is an electrocardiogram, also known as an ECG or EKG. As we discussed, our heart beats based on electrical signals. So when we perform an EKG, we put electrodes along the chest, sometimes arms and legs as well. These electrodes are then going to record the electrical signals as they travel through the heart, and then they take that and they turn them into waves that we can read on a print out. 

Other tests that are useful: when the heart is damaged, it releases these little molecules that are called cardiac enzymes, and certain blood tests can identify these very specific enzymes, and these indicate heart damage. An echocardiogram uses ultrasound to watch how the blood moves through the heart, and this can be very useful in identifying if and where an area has been damaged. 

Often times multiple of these tests are used in conjunction, or all together, when diagnosing a heart attack and determining the extent of damage. 

[00:07:32]

Treatment options 

The goal of treatment is to restore blood flow to the heart muscle and to do so in a very timely manner. Every minute truly matters when it comes to a heart attack because with each moment that the heart muscle is not receiving adequate blood supply that tissue is damaged or dying. With each passing minute this damage can worsen. Therefore, if you think that you or someone else may be having a heart attack, please call 9-1-1 immediately. 

Let’s say with this case today they see that he is having a heart attack. They are going to start oxygen, and there are also often multiple different medications that we give during and then also after the heart attack. 

One such medication is aspirin. Aspirin makes the blood more slippery, let’s say, and it reduces clotting in the blood to help keep the blood moving through a narrowed artery. This is why the nurse practitioner earlier had Todd chew aspirin immediately to try to get it into his bloodstream faster. There are drugs know as thrombolytics, which translates to clot busters, which, surprise, break up blood clots to try to help keep that blood flow in the heart. Nitroglycerin is a medication that we often give under the tongue, and this can widen the blood vessels. We also give Morphine to help relieve chest pain. 

If an artery remains blocked despite all of these medications, surgery may be performed to force or manually open the blocked artery. This is actually a really cool procedure. A thin, tiny catheter is guided up to your heart, often times going in through your leg,  and then a tiny balloon is inflated to widen that blocked artery. A small tube called a stent may then placed to keep this artery open and lower the risk of the artery narrowing again. 

Another option is a procedure called coronary artery bypass surgery, referred to by the much easier phrase, CABG. A surgeon takes a healthy blood vessel from another part of the body and creates a new vessel and subsequent new pathway for the blood in the heart. Blood can then go around that severely damaged coronary artery. 

Often, at time of discharge, other medications can be started to decrease the chance of a second heart attack. A lot of this is also preventing or treating conditions that increase a person’s risk for a heart attack. 

[00:09:58]

We kind of touched on this a little bit just because I think so much of this is intermingled, but our last section is how can we prevent a heart attack

Maintaining a healthy weight through regular exercise and a well-balanced diet is crucial. You can manage other health conditions with your provider, like diabetes or hypertension, which may increase your risk of a heart attack. 

Stress management has been associated with decreased risk for heart attacks and, once more, just stop smoking, please. 

I touched on this a little bit before and, this isn’t preventative as much, but I wanted to stress the importance of CPR. We talked about how when your heart stops beating, death can occur within minutes. CPR, in short, is a way that we can manually pump blood to the body, particularly to someone’s heart and brain. This alone can keep people alive until emergency medical personnel can arrive, and you can also learn how to use something called an AED which can deliver a little electric shock to the heart to get it pumping normal again. I think sometimes it’s very important and I like to mention that learning how to perform CPR can truly save a life, especially someone who’s having a heart attack or sudden cardiac arrest. I’d encourage you to check out the American heart association or other CPR classes in your area. 
 

[00:11:44]

And that, my friends, is a grand overview of heart attacks. Join us next week when we talk about diabetes.  

[00:11:11]

If you want more information or have any questions, feel free to reach out. My Instagram handle is R H O A D T O P A, rhoadtopa. You may also email me at rhoadtopa@gmail.com. Feel free to like and subscribe, and check out our podcast’s website for today’s show notes and links to the articles mentioned. Have a wonderful week.