Heart Attack and Acute Coronary Syndrome

Description

Alternative Names

Prognosis

In 2002, an estimated 650,000 Americans will suffer a first heart attack and 450,000 will have a recurrent episode. Currently, half of the men and 63% of the women who died of heart disease had no warning prior to their fatal attacks. The rate of hospitalization for a first heart attack has not changed significantly over the past few years. (In fact, it has increased in women.) On the positive side, however, the heart attack mortality rate has declined by over 24% between 1988 and 1999 (although mostly in middle-age men). (Because of the aging population, however, the absolute number of attacks fell by only about 6.8%)

Predicting the Severity of a Heart Attack

Heart attacks may be rapidly fatal, may evolve into a chronic disabling condition, or may lead to full recovery. The long-term prognosis for both length and quality of life after a heart attack depends on its severity and the preventive measures taken afterward.

About 88% of heart attack patients under age 65 can expect to return to work. It should also be noted that 12,600,000 Americans who have had heart attacks, angina, or both are alive today. However, within six years of a heart attack, 18% of men and 35% of women have a recurrent attack. And, about 22% of men and 46% of women develop heart failure.

Although at this time no tests can reliably predict whether another 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.

Higher Risk Individuals. A heart attack is always more serious in certain people:

• Elderly (particularly those who are thinner).
• Women are more likely to die after a heart attack than men. The risk is highest in younger women (although in the younger population, the risk for having heart attack in the first place and then dying from it is very low). It is still unclear why heart attacks are more severe in this group.
• People with a history of heart disease or risk factors for heart disease.
• People with heart failure.
• People with diabetes.
• People on long-term dialysis.

Factors Occurring at the Time of a Heart Attack That Increase Severity. The presence of other conditions during a heart attack can contribute to a poorer outlook:

• Arrhythmias (disturbed heart rhythms). A dangerous arrhythmia called ventricular fibrillation is a major cause of short-term death from heart attack. Such arrhythmias are more likely to occur within the first four hours and are associated with a high mortality rate. (Patients who are successfully treated, however, have the same long-term prognosis as those who do not experience such arrhythmias.)
• Signs of severe physical damage to the heart.
• Shock. This very dangerous condition is associated with very low blood pressure, reduced urine levels, and cellular abnormalities. Shock occurs in about 7% of heart attacks. The incidence has not declined over the past years, although its survival rates have improved.
• Heart block, also called atrioventricular (AV) block, is a condition in which the electric conduction of nerve impulses to specialized muscles in the heart is slowed or interrupted. Although heart block is dangerous, it can be treated effectively with a pacemaker, and it rarely causes any long-term complications in patients who survive it.

Risk for Stroke

A heart attack poses a high risk for stroke, which, according to a major 2002 study, is 2.5% in the first six months and 5% per year thereafter. In the study, patients with a higher risk (about 4%) for stroke within six months of a heart attack were older (over age 75), African American, had a history of stroke, atrial fibrillation, hypertension, diabetes, or peripheral artery disease. Most people who fall into these categories have more than one of these risk factors.