Understanding Heart Attack

One of the leading causes of sudden death is the condition called Myocardial Infarction (M.I.) or better known as heart attack. Our heart has four chambers which receive and pump blood. These four chambers are the Right Atrium, the chamber that receives deoxygenated blood (blood without oxygen) Right Ventricle, the chamber that pumps deoxygenated blood to the lungs for oxygenation, Left Atrium, the chamber that receives oxygenated blood from the lungs, and lastly the Left Ventricle, the chamber which has the thickest wall and pumps blood to the different tissues in the body to supply the necessary oxygen to our tissues for metabolism (any chemical reaction happening inside the cells.) The left ventricle is the predominant site for infarction and this explains the reason why most of the time sudden death would arise because of the malfunctioning of this important chamber that supplies oxygen to the different tissues in the body.

The most frequent sign of M.I. is pain on the central chest wall. The infarction-type of pain is characterized by progressively and rapidly increasing pain (crescendo,) pain duration of more than 20 minutes, and the pain could neither be relieved by rest nor nitroglycerin (drug that is being used to relieve angina pectoris pain.)

The term infarction describes necrosis (death) of the heart muscle cells. The most common underlying cause of myocardial infarction is the Coronary Artery Disease (CAD) or narrowing and weakening of the blood vessels called coronary arteries that supply oxygen-rich blood to the heart muscles. This narrowing will eventually lead to an abrupt increase in coronary blood flow that will result to the infarction of the coronary arteries. Infarction occurs when coronary artery thrombus (occlusion) develops rapidly at the site of injury. And this injury to the coronary artery is most of the time caused by cigarette smoking, hypertension, and lipid accumulation.

A person who is developing or experiencing M.I. is usually restless and anxious. Paleness of the skin will be observed together with sweating and coldness of extremities. Strongly suggestive of acute M.I. is the combination of substernal chest pain of more than 30 minutes and diaphoresis (excessive sweating.)

Certain laboratory work-ups are necessary to rule out M.I.; and these are Serum Cardiac Markers and Electrocardiogram (ECG.) If positive for M.I., the findings must include an ST segment elevation in the ECG, an elevated creatine phosphokinase in the blood within 4-8 hours and normal by 24-48 hours, an elevated Troponin-T in the blood, an elevated myoglobin in the blood, and an elevated CK-MB isoenzyme in the blood which is more specific for cardiac pathology.

Immediate medical attention must be given to M.I. patients. Oxygen must be given if with hypoxemia (decreased oxygen,) and together with this, the following maybe given: aspirin and other thrombolytics, angiotensin converting enzyme inhibitors for blood pressure management, morphine and beta blockers for chest pain. Another gold standard for M.I. management is Cardiac Rehabilitation that is being handled in Physical Therapy. Cardiac rehabilitation can increase both the length and quality of life of the patient who have had an M.I. and survived. Life can be prolonged when the patient is treated with beta-adrenergic blocking agents and angiotensin-converting enzyme inhibitors and when risk factors are well controlled. Quality of life is optimized when the physician is alert for signs of anxiety and depression while guiding the patient back to the fullest and most active life desired and tolerated by the patient.

The time course of cardiac rehabilitation in physical therapy has traditionally been divided into 3 phases. Phase I is the in-patient cardiac rehabilitation, Phase II is the first 12 weeks after discharge from the hospital, and Phase III is the period from 12 weeks to 1 year after discharge.

It is important to emphasize that there are four major areas of cardiac rehabilitation and these must be covered during each phase of the rehabilitation process. The four major areas of rehabilitation are management of cardiovascular pathophysiology, risk factor control, remobilization, and psychosocial adjustment.

In phase I of cardiac rehabilitation, the patient is highly supervised and the goals are focused on preventing deconditioning, educating the patient and the family as well, training the patient to do functional movements associated with the activities of daily living and early hospital discharge.

For the phase II, the patient is still under high supervision. The goals are now centered on developing the cardiovascular endurance through having conditioning exercises and making the patient return to work completely.

And for the phase III, it will be in a home program where the patient would just have to maintain a lifetime exercise program for the cardiovascular endurance. There are certain precautions in doing exercises in patients under cardiac rehabilitation and these include the following: No heavy meals should be eaten before exercising, exercise in a cool environment, drink water before exercising and allow sips of water during exercise, clothing should be loose and comfortable and the best time to exercise is early morning or late evening.

Prevention is better than cure. One must exert enough effort to maintain one’s ideal body weight through having a balanced diet and keeping away from smoking, heavy drinking and fatty foods and exercise regularly at least 30 minutes a day -5 days in a week .