HOW TO IDENTIFY HEART ATTACK?

 

PAIN IN THE CHEST.... IS IT A HEART ATTACK?

           

Chest pain can have many causes. Some causes are related to the heart and blood vessels. Other have nothing to do with the cardiovascular system. The doctor considers the list of different possible causes. A careful description of the pain can often eliminate other possibilities. Sometimes a person has alarming chest pain and yet has no identifiable problem with the heart. Conditions that often turn out be present, although heart attack was suspected include stomach disorders such as heart burn, stomach ulcer, gall stones with gall bladder irritation, costochondritis (chest wall pain caused by soreness of the muscles between the ribs and the breast bone), cervical spondylitis and other skin infections.

                                      

Although acute heart attack may commence at any time of the day or night, circadian variations have been reported such that clusters are seen in the morning within few hours of awakening. The increased frequency early in the day may be due to a combination of an increase in sympathetic tone and an increased tendency to thrombosis between 6 am and 12 noon.

 

Symptoms :

 

Pain is the most common presenting complaint in patients with Heart attack. In some instances, it may be severe enough to be described as the worst pain the patient has ever felt. The pain is deep and visceral; adjectives commonly used to describe it are heaviness, sinking, squeezing and crushing, although occasionally it is described as stabbing or burning. It is similar in character to the discomfort of angina pectoris but usually is more severe and lasts longer. Typically the pain involves the central portion of the chest and/or the epigastrium (the upper part of central abdomen), and on occasion it radiates to the arms.

 

Less common sites of radiation include the abdomen, back, lower jaw and neck. The frequent location of the pain beneath the xiphoid (lower most part of breast bone) and patients denial that they may be suffering a heart attack are chiefly responsible for the common mistaken impression of indigestion. The pain of Heart attack may radiate as high as the occipital area but not below the umbilicus.

 

Accompanying Features

 

There can be profuse sweating associated with the pain. The patient may complain of palpitation, restlessness, shortness of breath. Occasionally there can be dizziness, unconsciousness and sometime even blackouts associated with it.

 

How to confirm?

 

ECG is the easiest way to diagnose heart attack. During the initial stage of the acute phase total occlusion of the tube produces ST segment elevation. After sometime Q wave also starts appearing.

 

Enzyme Changes

 

Chest pains may not just get you a ride on a Treadmill or and ECG. Your doctor may also order blood tests to check for increased levels of certain enzymes that are normally found in the heart muscle. If you have experienced a heart attack, damage to your cells may allow these enzymes to leak into your blood over a period of hours. Creatine Phosphokinase (CPK) rising within 4-8 hours and return to normal within 48-72 hours. CPK (MB) is specific for heart attack. Cardiac specific Troponin T (cTnT) is also of considerable diagnostic usefulness.

 

ECHO CARDIOGRAPHY

It shows abnormalities in the pumping power of the heart depending on the size of dead area due to heart attack. This is called Ejection Fraction which is normally 60%. It is substantially reduced in case of major heart attack, where the area of damage is more. It can also show the abnormalities of heart wall motion resulting out of heart attack.   

 

Hope you liked this article.

 

This blog is written by Dr. Bimal Chhajer (best heart doctor in Delhi)