HEART ATTACKS VS. CARDIAC ARREST

THERE IS A D IFFERENCE

GORDON HUTT, MD UPMC Heart and Vascular Institute

Heart disease remains the leading cause of death for men and women in the United States. Left untreated, it can lead to a myocardial infarction (heart attack), stroke, or congestive heart failure with high incidence of disability and mortality.

Heart attacks occur when a preexisting plaque present in the arterial walls of the coronary artery ruptures, causing occlusion or blockage of the blood vessel and subsequent heart muscle damage. Less frequently, the artery might occlude because of spasm or dissection of the artery. Coronary spasm can be a preexisting condition or can be caused by drugs such as cocaine.

Cardiac arrest, on the other hand, is the sudden disruption of a heart’s ventricular rhythm and fatal in 9 out of 10 patients.

Every year, about 805,000 people have a heart attack. Of those, about 600,000 are first-time heart attacks, and the other 200,000 are recurrent. More alarming, about one in five heart attacks are silent or undetected, meaning patients never knew they had a previous heart attack. The absence of this knowledge puts patients at higher risk for a future cardiac event.

While “cardiac arrest” and “heart attack” are often used interchangeably, the two are very different. Heart attacks can be grouped into a condition known as acute coronary syndrome (ACS). All are urgent cardiac conditions that require early diagnosis and treatment.

One form of ACS includes unstable angina with likely minimal heart muscle damage and no increase of cardiac enzymes in the blood. A Non-STEMI typically is diagnosed with elevated cardiac enzymes, but no acute ST elevation on an EKG. A STEMI typically presents with acute ST elevation or new left bundle branch block often with complete occlusion of the coronary artery; this is the most critical form of ACS and requires immediate coronary intervention.

Transformative Treatments

Decades ago, the jury was still out on the best treatment option. There were a lot of headto-head studies comparing stenting versus administering clot dissolving medication in the form of thrombolytic therapy.

Today, it is universally agreed upon that the most effective treatment for an acute heart attack is emergency catheterization to open the blockage with a balloon and/or stent. The challenge is getting the patient to the catheterization laboratory as soon as possible.

Sometimes medical therapy or early cardiac bypass surgery is indicated if there is coronary anatomy not appropriate for balloon or stenting. Medical therapy for coronary artery disease (CAD) often consists of antiplatelet agents such as aspirin, clopidogrel, or ticagrelor, statins to lower cholesterol, plus beta blockers and ACE inhibitors, which will affect heart rate, blood pressure, and cardiac function.

Cardiovascular disease also consists of carotid and peripheral arterial disease. Surgical and interventional techniques for these conditions might include carotid artery stenting and/or surgical endarterectomy, peripheral arterial surgery, or percutaneous intervention. Each is used to open arteries, remove plaque and blockages, and restore blood flow.

Knowing your risk factors and not ignoring symptoms are the first steps in preventing heart disease.

An EKG is a baseline test but can be normal even if a patient has significant CAD. Further evaluation often is suggested and may include stress testing, nuclear imaging, and echocardiogram. Typically, patients will first present to the emergency department or their PCP if symptoms occur with subsequent referral to a cardiologist. At times, patients do self-refer to see a specialist.

Know Your Risk Factors

Risk factors are classified as controllable and uncontrollable. Family history cannot be changed, but people can control their cholesterol levels, blood pressure range, body mass index, waist circumference, and fasting blood sugar. In fact, 70 percent of major heart attack risk factors can be managed through lifestyle choices. Obesity, smoking, excessive alcohol consumption, and a sedentary lifestyle significantly contribute to many forms of illness, including cardiovascular disease.

Age and gender are also contributing influences; heart disease isn’t gender specific or exclusively tied to an older demographic. Numerous reports of cardiac events in younger men and women, including athletes, have proven it can happen to anyone, although the underlying causes may differ.

There’s a higher incidence of middle-aged and older men and women who experience heart attacks or suffer from congestive heart failure, but I’ve also seen women in their 20s and 30s with abnormal stress tests, extensive coronary disease, and who have needed heart surgery or coronary stenting. Regardless of gender, surveillance should always remain high, especially as patients age.

Men and women may experience different symptoms. Women’s warning signs may be more subtle, such as shortness of breath, nausea, fatigue, fainting, or indigestion. It is recommended that anyone with these symptoms should seek early medical attention most likely to include an EKG and further cardiac work up.

It’s important to note that not all chest pain is heart related or a heart attack. That’s one of the first things taught in medical school and residency. There’s a wide differential diagnosis such as myocarditis or pericarditis, which are inflammatory conditions that affect the heart muscle and outer lining of the heart. A patient may also be suffering from an aortic aneurysm or dissection, which are medical emergencies.

Pulmonary diseases like pleuritis, pleurisy, or a pulmonary embolus are also known causes of chest pain, along with GI conditions such as esophagitis, peptic ulcer

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