Heart Attack (Myocardial Infarction):
Its occurs due to sudden closure (obstruction) due to blood clot or spasm of one or more coronary arteries.
This will ultimately result in reduction of oxygenated blood supply to a part of the heart muscle (myocardium) and muscle death will result.

Coronary artery disease risk factors:

Can be classified as:

• Modifiable (changeable) factors
• Non-modifiable (not changeable) factors.

Symptoms:
A client with heart attack may experience similar complaints to those of angina, but the pain is more sever, occurs at rest or with minimal activities, most commonly described by the patient as acute, sever, squeezing, heaviness in the chest or burning sensation.
The pain may start or spread to the left shoulder, arm, neck, left lower jaw or abdomen. However some time may spread to right shoulder and arm, this pain is not relived by taking rest, or the GTN tablets under the tongue.
It may last for several hours and is not relieved by itself, it is associated with sweating, nausea, vomiting, increased heart rate and palpitation, the patient may also experience difficulty in breathing, anxiety and general weakness.

Diagnosing heart attack:
The doctor can identify a heart attack by.:

• The patient’s complaints of specific chest pain characteristics
• Changes in the ECG
• Elevation of cardiac enzymes

Some cases may be difficult to diagnose in the first few hours of the attack as their result will be in conclusive and this require admission in the hospital for observation and to confirm the diagnosis.

Treatment in the hospital:
A patient with heart attack can be treated as followed:

• Admission to the CCU.
• Complete bed rest to reduce the workload on the heart.
• Medications:
  1. Thrombolytic:
     To dissolve the blood clot in the coronaries and increase the blood supply to the heart muscle. This is given only if the patient comes to the hospital within the first 6 to 24 hrs from the pain.
  2. Heparin:
     A blood-thinning agent to prevent the development of another clot. (Further clot formation)
  3. intra venous GTN injection:
     To dilate the coronary arteries and increase the blood supply to the heart muscle.
  4. Others medications:
     Can also be given according to the patient’s condition
  
  

Important instruction:

• Take rest for at least 4-6 wks and avoid driving or going back to work.
• some patients may need to use GTN tablets prior to resumption of sexual activities to prevent chest pain
• Follow the diet prescribed to you by your dietitian.
• Take your medication regularly.
• Avoid stressors and tension.
• Follow the instructions given to you by your physiotherapist.
• Your Doctor may advice further diagnostic studies to evaluate your condition such as stress test and cardiac catheterization if needed, an appointment will be given to you at the time of your discharge.
• Visit your doctor regularly for follow up; your first appointment will be within a month of your heart attack.
• Whenever you experience any complaints similar to those of a heart attack, stop whatever you are doing, take rest, call some one or an ambulance (999) because you need to be in the hospital within the 6 hrs of a heart attack for immediate treatment and better outcome, if delayed some complications may develop.

During the first month of discharge patient with heart attack:
Most the heart attack patients experience fear and worry especially during the first month of the heart attack, for that if you need help during this period:

• Call your treating doctors immediately.
• Call cardiac rehabilitation staff on 17289391 between 12:30 to 2:00 pm from Saturday to Wednesday