12—MAY—2021 20:59 GMT
Chest pain. Those two words will almost guarantee you a ride in an ambulance. And I’m here to tell you why.
My name is Ziyad and I’m a junior doctor working in the West Midlands. I graduated from the University of Liverpool last year, Class of COVID style, and have strong interests in medical education. Outside of work, I’m a bit of a petrolhead, keen for sports, food and the odd photo here and there.
My first rotation as a doctor was four months in cardiology at a large tertiary centre where we had upwards of 70 patients. So, let’s talk about heart attacks.
What Is A Heart Attack?
A heart attack is a medical emergency in which the blood supply to the heart is blocked. The blockage is often sudden and usually due to a blood clot. In medical terminology, it is known as a myocardial infarction.
Recognise the signs of heart attack.
Image from British Heart Foundation
"85% of heart damage takes place within the first 2 hours of a heart attack."
How Is This Different To A Cardiac Arrest?
A cardiac arrest is where the heart is suddenly unable to pump blood efficiently around the body. A myocardial infarction can sometimes cause a cardiac arrest, but it is important to know that these two terms mean different things.
The common causes of cardiac arrests are split into 4 Hs’s and 4 T’s:
- Hypo/hyperthermia (being too cold or hot)
- Hypo/hyperkalaemia (low or high potassium in the blood)
- Hypoxia (low oxygen saturations in the blood)
- Hypovolaemia (low blood volume)
- Tension pneumothorax (collapsed lung)
- Tamponade (fluid around the heart)
- Thrombosis (blood clot, such as a myocardial infarction)
Image from DepressedAlien.com
What Does A Heart Attack Feel Like?
Myocardial infarctions present in a number of different ways. The most common symptom is chest pain, often with radiation to the jaw, arm or shoulder and lasting more than 20 minutes (2). Abidov et al (3) report 6% of people have no pain though; other symptoms include chest discomfort, nausea and vomiting and fatigue.
How Is It Treated?
This is a medical emergency and requires immediate hospital admission. Heart attacks can be treated in different ways: medical management, coronary intervention or bypass surgery. Medical management involves a variety of medication, including anti-platelet tablets, to help break up the clot. Coronary intervention is where images are taken of the arteries supplying your heart; if a blockage is found, a stent is often deployed to stop the blood vessel from occluding. Surgery is an option for those patients who have multiple or complicated occlusions of their coronary arteries.
This has just been a very brief into heart attacks and what that term actually means. I hope you were able to learn a thing or two! If you’d like to learn more, apply for medical school and become an interventional cardiologist. Or check out the NHS and British Heart Foundation website for more information. Whichever you prefer.
1. British Heart Foundation UK Factsheet 2021: https://www.bhf.org.uk/-/media/files/research/heart-statistics/bhf-cvd-statistics-uk-factsheet.pdf
2. Ajmal Malik, M., 2013. Chest Pain as a presenting complaint in patients with acute myocardial infarction (AMI). [online] PubMed. Available at: <https://pubmed.ncbi.nlm.nih.gov/24353577/> [Accessed 12 May 2021].
3. Abidov, A., 2005. Prognostic significance of dyspnea in patients referred for cardiac stress testing. [online] PubMed. Available at: <https://pubmed.ncbi.nlm.nih.gov/16267320/> [Accessed 12 May 2021].