Prognosis
Coronary artery disease is the leading killer in America of both men and women, responsible for nearly 530,000 deaths in 1999. On the positive side, the heart attack mortality rates have declined by over 24% between 1988 and 1999. (Because of the aging population, however, the absolute numbers of deaths fell by only about 6.8%). At this time, half of men and 63% of women who died of heart disease did not have angina or other warning symptoms prior to their fatal attacks. Although at this time no tests can reliably predict whether a heart attack will occur, experts estimate that up to 30% of fatal attacks and many follow-up surgeries could be avoided with healthy lifestyle changes and adherence to medical treatments. Two-thirds of patients who have suffered a heart attack, however, do not take the necessary steps to prevent another.
Determining the Degree of Severity
The following syndromes suggest different degrees of severity among patients with heart disease.
Stable Angina. This condition can usually be managed with lifestyle measures and medications, such as low-dose aspirin. The more severe the angina, however, the greater the chance for progressing to a more serious condition.
Acute Coronary Syndromes. This includes severe and sudden heart conditions that require aggressive treatment but have not developed into a full-blown heart attack.
|
| Angina is a specific type of pain in the chest caused by inadequate blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium). |
ACS refers to either unstable angina or NSTEMI (non ST-segment elevation myocardial infarction)--also referred to as non Q-wave myocardial infarction.- Unstable angina is potentially serious and chest pain is persistent, but blood tests do not show markers for heart attack.
- With NSTEMI, the blood tests suggest a developing heart attack, but most likely, injury in the arteries is less serious than with a full-blown heart attack.
Most discussions of the treatment of unstable angina now refer to acute coronary syndrome. Physicians use the presence of a number of factors to help predict which ACS patients are most at risk for developing a heart attack. First, patients are categorized by whether they have a history of heart disease or risk factors for heart disease (such as diabetes, high blood pressure, peripheral artery disease), or other complicating conditions (e.g., lung disease, heart failure). The physician also gauges the severity of the angina. Some major studies further suggest that following factors further pose a high danger to patients: - Age 65 years or older.
- Evidence of severe heart tissue injury.
- Being lighter weight.
- Having a history of severe chronic angina.
- Having abnormal lung sounds called rales (a bubbling or crackling sound) on examination.
- ST-segment deviation.
- Having either very slow or very fast heat beats.
- Having very low blood pressure.
Heart Attack. The full-blown heart attack occurs with severe damage to the heart, which blocks oxygen. Indications of a Heart AttackANYONE WHO BELIEVES THEY ARE HAVING A HEART ATTACK SHOULD NOT HESITATE TO CALL THE EMERGENCY MEDICAL SYSTEM. In people with known heart disease, any unusual chest pain or other symptoms of heart attack that do not clear up with medications are signals to go to the hospital. The degree of pain and the specific symptoms before a heart attack vary greatly among individuals. Onset can be abrupt, gradual, or intermittent. Heart Attack SymptomsChest Pain. People with heart disease or risk factors should be concerned about any chest pain, usually precipitated by exercise or stress, that interrupts normal activities and does not clear up after resting or taking angina medications. Chest symptoms might be experienced as follows: - Pain is typically as a crushing weight against the chest, which is accompanied by profuse sweating. The pain may radiate to the left shoulder and arm, the neck or jaw, and even infrequently to the right arm. The arm may be tingling or numb.
|
 | Click the icon to see an image about heart attack symptoms. |
- Some people may only have a tingling sensation or a sense of fullness, squeezing, or pressure in the chest.
- In some patients with a history of heart disease, chest pain is mild. Such patients may have experienced unexplained fatigue, depression, and ill health within a month of a heart attack.
|
 | Click the icon to see an image about heart attack symptoms. |
Although chest pain is the classic symptom, it occurs in only about half of patients with a heart attack. Other Common Symptoms. Other common symptoms of a heart attack include the following: - Nausea, vomiting, and cold sweats.
- A feeling of indigestion or heartburn.
- Fainting.
- A great fear of impending death, a phenomena known as angor animi.
Atypical Symptoms.Some studies suggest that nearly half of patients with heart attack do not have chest pain as the primary symptom. Common atypical symptoms of a heart attack include the following: - Shortness of breath.
- Cardiac arrest.
- Dizziness, weakness, and fainting.
- Abdominal pain.
Patients most likely to have atypical symptoms are women and the very elderly (although they can certainly have classic heart attack symptoms as well). - In one study, 52% of elderly people with acute coronary syndrome had atypical symptoms that included shortness of breath, nausea, profuse sweating, pain in the arms, and fainting. Such symptoms were more likely to occur in people with personal or family history of heart disease.
- Before a heart attack, women are more likely than men to be nauseous and experience pain high in the abdomen or chest. Their first symptom may be extreme fatigue after physical activity rather than chest pain. (Chest pain in women is also more likely to be caused by non-heart problems than in men.)
Symptoms That Are Less Likely to Indicate a Heart Attack.The following are symptoms that are more likely to be due to causes other than a heart event: - Sharp pain brought on by lung movements or coughing.
- Pain that is mainly or only in the middle or lower abdomen
- Pain that can be pinpointed with the top of one finger.
- Pain that can be reproduced by moving or pressing on the chest wall or arms
- Pain that is constant and lasts for hours (although no one should wait hours if they suspect they are having a heart attack).
- Pain that is very brief and last for a few seconds.
- Pain that spreads to the legs.
- It should be strongly noted, however, that the presence of these symptoms does not always rule out a serious heart event.
Ruling Out Other Causes of SymptomsChest pain is a very common symptom in the emergency room, but heart problems account for only 10% to a third of all episodes. High on the list of other causes of chest pain are the following: - The most common causes of chest pain are muscular and bone problems. Problems affecting the ribs and chest muscles include injured muscles, fractures, arthritis, spasms, and infections.
- Anxiety attacks.
- Gastrointestinal disorders (gallstone attacks, peptic ulcer disease, hiatal hernia, heartburn).
- Asthma.
- Spasm in the coronary artery.
- Abnormalities of the heart muscle itself.
- Rupture of the aorta, collapsed lung, acute inflammation of the heart, or a blood clot in the lung.
- Hyperthyroidism.
- Anemia.
- Vasculitis (a group of disorders that cause inflammation of the blood vessels).
- Exposure to high altitudes (rare).
Actions Taken at the Onset of SymptomsIndividuals who experience symptoms of a heart attack should take the following actions: - For angina patients, take one nitroglycerin dose either as an under-the-tongue tablet or in spray form at the onset of symptoms. Take another dose every five minutes up to three doses or when the pain is relieved, whichever comes first.
- Call 911 or the local emergency number. This should be the first action taken if angina patients continue to experience chest pain after taking the full three doses of nitroglycerin. It should be noted, however, that only 20% of heart attacks occur in patients with long-standing angina. Therefore, anyone who has heart disease or risk factors for it and experiences heart attack symptoms should contact emergency services.
- The patient should chew an aspirin (250 to 500 mg) and be sure that emergency health providers are informed of this so an additional dose isn't given.
- Chest pain sufferers should go immediately to the nearest emergency room, preferably traveling by ambulance. They should not drive themselves.
|
|
