Gone are the days when one regarded heart attack or myocardial infarction as the burden of developed countries in the world. It is no longer the case. The reality today is that in developing economies there are thriving populations of middle class who are successful captains of various industries who have the resources to indulge in the good of life, consume alcohol and smoke cigars. Added to these is the pressure to produce and deliver, all these being well-documented risk factors for heart attack.
Myocardial infarction is an event when blood stops flowing to the part of heart muscle that is supplied, leading to its damage due to lack of oxygen that is essential to all living cells. This is usually as a result of blockage of one of the blood vessels supplying the heart known as the coronary artery by blood clots, cholesterol and fat.
To fully appreciate the phenomenon, it is important to describe the disposition of the coronary arteries, which are the main blood supply to the heart. They are two in number and the first branches of the AORTA, the main truck, which carries oxygen reach blood from the left lower chamber of the heart, known as the left ventricle to all of parts of the body. They are named; left and right coronary artery depending on the part of the heart the blood they are conveying flows to. The important thing to note about these two vessels is that in some places they are interconnected structurally, but in terms of function they are basically what are described as end arteries. By this we mean that in case of any accident affecting one of them, the other cannot provide an alternative blood flow to the area supplied by the diseased vessel and this is what makes heart attack what it is.
How does a typical heart attack present? The person will notice a sudden chest pain on the left side that spreads to the left arm and the left side of the neck. He or she will have difficulty in breathing, sweating profusely, vomiting, irregular heartbeat and fears. The impression of a person having an attack is that something ominous is about to happen. How true it will be if he does not recover.
Usually, the above signs and symptoms are less in women and in some case this event maybe symptomless, the so-called “silent attack.” This usually will be detected by studying the electrical activities of the heart known as ELECTROCARDIOGRAPHY and testing the blood for CREATINE KINASE.
At this point a listing of the risk factors is important. These include smoking of tobacco, excessive alcohol consumption, drug abuse like cocaine and amphetamines (stimulants) and subjecting oneself to unnecessary stress. Medical conditions that can predispose one to myocardial infarction would include diabetes, hypertension, obesity and chronic kidney disease. Naturally, aging is also an important risk factor. There are three protein-containing fats that are involved in the formation of this blockage. They are low-density lipoprotein cholesterol, if the level in the blood is HIGH and high-density lipoprotein cholesterol if its level in the blood is low. The other is triglycerides. Lately, this assertion has been debunked that the level of serum CHOLESTEROL has a role to play in the occurrence of myocardial infarction.
It is important that those at risk of heart attack and other vascular accidents like stroke should check their blood on regular basis and watch what they eat, especially the quantity of red meat. How does this disease come about? It’s usually or commonly due to a gradual accumulation of small clots and scar tissue in the wall of the coronary arteries over the years. This eventually gets dislodged and serves as a node around which blood clots are formed leading eventually to the blockage of the blood vessel. When this happens, the heart cells where the blood flows, die and may lead to catastrophic consequences.
Diagnosis of myocardial infarction usually does not pose much of a challenge in our environment, especially if the signs and symptoms are florid. Usually studying the electrical activities of the affected heart will give it away and common blood test, like creatinine kinase. It is important to note here that some heart attacks could be symptom free, the so-called “silent heart attack.” The good news is that this can also be picked up by the electrocardiogram. So a walk into a diagnostic centre for an ECG study is not a waste of time but could be very revealing and time well spent.
Of concern to us today is that heart attack, to a large extent is preventable barring natural causes like old age, diabetes mellitus and hypertension. Other high risk factors like obesity can be managed with disciplined eating habit and exercise. Excessive alcohol consumption can be reduced and one can really quit smoking if he is determined and knows what lies ahead.
Lately we are beginning to have a class of economic or industry captains, who are full of ideas and restless about achieving set goals. The so-called type A technocrats – they are perfectionist and sometimes slave drivers. They are always stressed and have sleepless nights. If you are one of them, be on guard. These are the type that slumps in the course of a speech during presentations.
Interestingly, most practitioners are now very proactive when it comes to managing these risk factors with good education of their clients and adding ASPIRIN to the medication of those at risk thus helping in the prevention of blood clots in the blood vessels of those who are prone to heart attack. For those at risk if you can jog, please jog, if you cannot please walk but if you cannot walk, crawl or move your hands. Just keep moving something, that way we can hang around for a while.
It must be stated here that the symptoms described in this write up can also be mimicked by other conditions like heart failure, coronary heart disease, collection of water around the heart known as pericardial effusion, tension pneumothorax (compression of the heart by air) and other conditions.
Those involved in managing this condition know the importance of oxygen therapy, aspirin and nitroglycerin if available. Luckily, these days we have equipment that can extract oxygen from the surrounding air after separating nitrogen, carbon dioxide and inert gases. It works as long as there is electricity and can be powered by generator.
I am convinced that this should be a must for all health facility. It is affordable and can be a lifesaver.