When arteries are diseased, it is a matter of time before symptoms of reduced blood flow are felt as angina (chest pain with exertion) or a heart attack occurs. The main event of a heart attack is the occlusion of one or more blood vessels supplying the heart muscle. When blood flow is critically short, muscle cells die. This is called a myocardial infarct and the clotting event a thrombosis. Thrombosis occurs in arteries narrowed by fatty lesions in the arterial walls, a process known as atherosclerosis.

A thrombosis often starts with rupture of a fatty lesion, especially during exertion. Other thromboses occur when the arterial narrowing reaches a critical point and conditions in the blood are favorable to clotting.  Fatal heart attacks tend to occur in the morning  with an 8 AM peak and in the late afternoon peaking at 6 PM.

Until recently studies of coronary artery disease focused on men and excluded women. The impression that heart attacks remain a men's problem is misleading. Women are protected against heart attacks by estrogen until the menopause and then rapidly catch up with men. The lifetime probability of a women in the US and Canada dying of a heart attack is 10 times greater than dying of breast cancer. When women do have heart attacks, their risk of dying is higher than men -  F 11.3% Vs M 5.5%. 

Signs & Symptoms

Central, crushing chest pain,  often associated with shortness of breath, anxiety, weakness and sweating. The classic heart attack is unmistakable - the pain and/or anxiety is often severe, the weakness profound and many victims have the sense that they are going to die and some do. Some heart attacks are less obvious or occur in escalating stages and may be missed by the patient and the doctor. Pressure sensations in the chest, neck and left arm pain, frequent swallowing and indigestion may be the main symptoms.

Angina is the name for brief episodes of heart pain that occur when the blood flow through the heart is inadequate. The pain may be severe and associated with other symptoms of a heart attack but lasts only minutes, resolving spontaneously or after treatment with nitroglycerine. Angina usually occurs with exertion or emotional arousal and subsides with rest and relaxation. The occurrence of angina signals the presence of coronary artery disease and demands attention.

TISSUE PLASMINOGEN ACTIVATOR (TPA)

The most important change in the treatment of heart attacks is the administration of blood-clot dissolving drugs. If you believe that you are having a heart attack, you phone 911, take one aspirin (ASA), lie down and wait for the ambulance to arrive. When you arrive in the emergency room, tests will be done to try to determine if you are having an attack and if positive, TPA is administered intravenously to limit the damage done to your heart by reduced blood low.

Tissue plasminogen activator (TPA) is one of several drugs now approved for use. These drugs have the ability to dissolve the blood clots that are responsible for causing the majority of all heart attacks. Studies have shown that TPA and other thrombolytic (clot-dissolving) agents can reduce the amount of damage to the heart muscle — and reduce the number of heart attack deaths — if they are administered within three hours after symptoms begin. The sooner TPA or other appropriate treatment is begun, the better the chances for recovery.