Myocardial Infarction (Heart Attack)

By: BigFudge

Breast cancer organizations in the United States receive more funding than any other disease,
despite the fact that Heart Disease is the number one killer in the United States. Heart Disease
kills more than ten times as many people as breast cancer, while breast cancer organizations
receive about 5 times the amount of funding compared to heart disease (6). One fatal result of
heart disease is a heart attack, which the medical community calls a myocardial infarction (MI).
Many have heard of a heart attack, but a large proportion of them do not know exactly what they
are.

To understand what is going on in a heart attack, we need to understand the basics of the heart in normal situation. The heart pumps the blood around the body, bringing nutrients and oxygen to
all the cells in your body. Because the cells can’t use any nutrients from the blood on the inside
being pumped, the heart has very specific blood vessels that receive the freshest blood. These
blood vessels go around the heart, making sure it is always supplied with oxygen.

The way the heart pumps blood is very similar to the way one pushes toothpaste out of the tube:
from the bottom of the tube. The only difference is the mechanical action pushes the blood in
the heart from the top to bottom, and then out. As for the actual contraction, the cells use tiny
electrical currents to contract. As the electricity travels top to bottom, the heart contracts, forcing
blood to get pushed out. It is important to know that this electrical current is very organized and
travels and a very specific pattern in healthy individuals. Thus, the blood circulates and the body
and heart is happy.

Understanding a myocardial infarction goes back to the blood vessels surrounding the heart,
because the heart cells cannot receive oxygen from the blood inside being pumped. Before a
heart attack even happens, the blood throughout the body has plaque and fat naturally circulating.  If there is too much plaque and fat in the blood, it will deposit on the walls of the vessels, limiting the blood flow through it. Fat and plaque can also stick together and form little balls which can become lodged and cut off blood flow as vessels become narrow, which is called ischemia. An MI is where these fat and plaque deposits cut off blood flow to the blood vessels surrounding the heart, preventing blood from oxygenating the heart tissue. Without the oxygen from the blood, the heart tissue begins to die in the area affected. In severe heart attacks, damage to the heart from ischemia progresses and the electrical conduction, which is normally extremely organized, becomes extremely chaotic. This causes the heart to quiver, rather than rhythmically pumping. Blood stops moving, and the body runs out of oxygen, including more heart tissue. Net result: death.

Signs and symptoms are provided in textbooks, but in reality, they are very diverse and vary
person to person. Most commonly, patients express the following complaints: chest pain which
radiates to other parts of the body, profuse sweating, nausea, vomiting, shortness of breath or
difficulty breathing, and/or abdominal pain. Some show none of these signs, and an MI is
diagnosed by an electrocardiogram or levels of troponin in the blood.

As for treatments, there are anticoagulants like heparin and coumadin, and platelet aggregation
inhibitors like aspirin. Nitroglycerin is commonly prescribed to patients who have a history of
heart problems, and makes the blood vessels bigger which can alleviate the chest pain associated. Antihypertensives like Lisinopril and Amlodipine are showing limited long term benefits (5). Improvements to diet and activity level are important, both to prevent initial and future MI’s. Once an MI is discovered within the hospital, it is critical to get the patient to a catheterization lab, where there are a few options. One option is using blood vessels from elsewhere in the body to replace or redirect the blood flow around the blockage. Another way is to put a stent in, a metal object which forces the vessel wide enough for blood flow. Lastly, they can pass a wire through the blood vessels and destroy the clot mechanically or with chemicals.

According to the American Heart Association, Mayo Clinic, and the National Heart, Lung, and
Blood Association, the best way to prevent an MI is through diet and exercise (1) (3) (4). A
healthy lifestyle may not completely prevent it, especially with a family history of heart disease,
but use of blood thinners is more common to prevent it. Avoiding other risk factors is important
as well, including but not limited to smoking, drinking, stress, and lack of sleep,

Here are some numbers to scare you into making healthier choices. According to the CDC, heart
disease claims over 610,000 victims every year in the United States alone, attributing to over a
quarter of all the deaths in the country. Furthermore, “Every year about 735,000 Americans have
a heart attack. Of these, 525,000 are a first heart attack and 210,000 happen in people who have
already had a heart attack” (2). They go on to note that almost half of the country has at least
one high risk factor for heart disease, such as high blood pressure, high cholesterol, or smoking.

Hopefully by now you get a sense of what a myocardial infarction is, some common signs, and
some treatments. If the numbers of how prevalent didn’t scare you, millions of americans share
the same disposition. Now I recognize that not all have access to the information or the financial
means to necessarily act on this, but that doesn’t mean you can’t use this information to help
your loved ones. I should also note that I am not saying breast cancer shouldn’t receive less, but
merely pointing out the discrepancy in how common the diseases are.

Bibliography

1) American Heart Association. (2014, April). How to Help Prevent Heart Disease At
Any Age. Retrieved February 01, 2016, from http://www.heart.org/HEARTORG/HealthyLiving/HowtoHelpPreventHeartDiseaseAtAnyAge_
UCM_442925_Article.jsp#.VqoFLIrLIU

2) Center for Disease Control. (2015, August 10). Heart Disease Facts. Retrieved February
01, 2016, from http://www.cdc.gov/heartdisease/facts.htm

3) Mayo Clinic. (2014, November 15). Heart attack. Retrieved February 01, 2016, from
http://www.mayoclinic.org/diseasesconditions/heartattack/basics/prevention/con20019520

4) National Heart, Lung, and Blood Institute. (2015, November 6). How Can a Heart Attack
Be Prevented? Retrieved February 01, 2016, from http://www.nhlbi.nih.gov/health/healthtopics/topics/heartattack/prevention

5) Psaty, B. M. (2003). Major outcomes in high-risk hypertensive patients randomized to
angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
(ALLHAT). American College of Physicians Journal Club, 139 , 7. Retrieved February
11, 2016, from acpjc.acponline.org/Content/139/1/issue/ACPJC20031391007.htm

6) Vox. (2014, August 20). The truth about the Ice Bucket Challenge: Viral memes
shouldn't dictate our charitable giving. Retrieved February 01, 2016, from
http://www.vox.com/2014/8/20/6040435/alsicebucketchallengeandwhywegivetocharitydonate

Long QT Syndrome: Scared to Death

By: Pretty Momma

Imagine yourself as the parent of a child. Your hopes and dreams take shape as you see them grow and conquer their fears. You feel success from their successes and when they fall your heart aches to console them. Imagine yourself the parent of a young teenager. You see the frustration in them on a daily basis, trying desperately to cope with expectations, stress, and pressure in a rapidly changing environment, while they themselves are racing to grow into their own shoes. Imagine yourself as a proud, attentive mother of an athletic teenage son nearing the prime of his life. One morning you find that your son has slept in. You call and knock at his door to no response. You open the door, and panic, finding the son you have raised and nurtured, cared for, and disciplined lying lifeless and cold; a result of Sudden Arrhythmia Death Syndrome. Heart conditions such as Long QT Syndrome need to be advocated more for patient education to raise awareness in preventing such sudden deaths.

Long QT syndrome is a condition that affects the heart's rhythm that can cause fast and chaotic heartbeats. The heart can only beat erratically for so long before it causes sudden death. Prolonged QT, “LQTS” can be an inherited dormant error in a person’s genetic code or can be acquired due to certain medications and medical conditions. Inherited LQTS has been associated with 17 genes so far, with hundreds of mutations. Although genetic test can identify those with this disease, it does not pick up 20% of people who do have the disease. A known parent with LQTS has a 50% chance of passing the gene down to their child. LQTS may also be acquired. Acquired LQTS can be caused by certain medications of medical conditions. There are more than 75 medications that are known to lengthen the QT interval causing drug induced Long QT Syndrome (Mayo).

Often LQTS is discovered by accident by being picked up on an ECG. An ECG measures the electrical impulse as they travel through the heart. Long QT syndrome results from abnormalities in the heart’s electrical charging system (Mayo). Imagine each heart muscle has tiny holes called ion
channels. These holes open and close to allow important substances (sodium, calcium and potassium) to flow in and out of the heart muscle cells. In LQTS the holes in the cells that allow these important substances either do not properly open and close, or there is not enough holes to allow for the proper amount of substances or more through the cell to create the heart’s electrical activity (NHLBI).

A person with LQTS may not experience any symptoms and may be diagnosed posthumously. When diagnosis does occur it is usually after a person has some type of event such as: unexplained fainting, drowning or near-drowning (due to fainting while swimming) or unexplained cardiac arrest (NHLBI). This could cause a patient to seek diagnosis; however the first symptom could be the only symptom as LQTS can cause sudden death.

Treatments include education for awareness, lifestyle changes and medications. Lifestyle changes include avoiding medications that could cause prolonged QT intervals, staying well hydrated during illness, reducing loud or startling noises (including alarm clocks), staying away from situations that make you angry or excited, and avoiding prolonged strenuous activity (especially swimming). The most common medication class used for treatment is beta blockers. These drugs slow the heart rate and work by blunting the way the heart reacts to adrenaline, which can cause the heart to beat faster in times of fear, stress and/or exertion (Mayo). LQTS cannot be cured but these treatments can help to prevent these dangerous arrhythmias.

Long QT syndrome is an under-diagnosed disorder. The prevalence of LQTS is difficult to estimate. It may be expected to occur in 1 in 10,000 individuals. LQTS is more prevalent in female patients and usually presents in childhood, adolescence and early adulthood. Sudden death occurs more in boys than girls. LQTS is thought to cause about 4,000 deaths in the United States each year (Sovari).

To reduce the cases of sudden death by LQTS, first degree family members should be offered genetic testing, clinical evaluation, and treatment with the ultimate goal to prevent sudden death (Statton); this will identify those who have the genetic code for LQTS so they may take preventative measures to reduce their chance of this deadly arrhythmia. Raising awareness of this disease is paramount for individuals to gain the knowledge they need in order to watch for the tell-tale signs and symptoms in themselves and their family members. Once this disease is well known we can start to identify those who carry the gene, and we can create personalized medicine for each individual. This would help reduce the number of children suddenly dying at the hands of this disease.

References

Mayo Clinic Staff. (2015, October 27). Long QT syndrome. Retrieved February 10, 2016, from <http://www.mayoclinic.org/diseases-conditions/long-qt-syndrome/basics/definition/con-20025388>

NHLBI. (2011, September 21). Long QT Syndrome. Retrieved February 10, 2016, from
<https://www.nhlbi.nih.gov/health/health-topics/topics/qt>

Sovari, A. A., MD. (2015, December 31). Long QT Syndrome. Retrieved February 10, 2016, from <http://emedicine.medscape.com/article/157826-overview>

Statton, EL, IM Weston, K. Cederquist, J. Jonasson, BA Jonasson, S. Mörner, A. Norberg, P. Krantz, and A. Wisten. "Genetic Screening in Sudden Cardiac Death in the Young Can save Future Lives." Int J Legal Med (2015): 59-66. Jan. 2016. Web. 10 Feb. 2016. <http://www.ncbi.nlm.nih.gov/pubmed/26228265>