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Dr Diana R Holdright

Consultant Cardiologist

Dr Diana Holdright

Cardiac Conditions - Heart Attack

Heart disease and diseases of the circulatory system are the leading cause of death in the UK, with one third of all deaths occurring from cardiovascular disease. Heart disease is the largest cause of death within this group, mostly due to myocardial infarction, commonly known as a heart attack. It carries a high mortality, with 50% of heart attack patients dying within 28 days, and 75% of these deaths occurring within the first 24 hours. There are frequently no warning signs that a patient has cardiovascular disease, and a heart attack may be the first symptom and occur completely out of the blue.

Furring up of the arteries (atheroma) develops over many years and can occur both gradually and suddenly. Gradual progression of the furring up process typically causes angina; however, another manifestation of the same disease process is a myocardial infarction, where an area of atheroma suddenly ruptures, exposing the undersurface of the artery lining and provoking an injury response, whereby a clot begins to form over the damaged area. If the clot is large enough it can block the artery entirely and this is the substrate for a heart attack. In most cases this is unheralded and is often the first indication that a patient has a heart problem, hence the importance of screening in medium and high risk populations. Sometimes a patient will have had angina symptoms which suddenly intensify such that chest discomfort develops with diminishing levels of exercise and is ultimately present at rest.

Most survivors describe a heart attack as an intense discomfort and heaviness in the chest, like an elephant sitting on the chest, associated with sweating, nausea and breathlessness. This is a medical emergency and needs immediate treatment to restore the blood supply to the heart and minimise damage to the heart muscle; during a heart attack, the heart muscle that received its blood supply from the affected artery will die, healing with time to leave a scar. The larger the scar, the greater the effect on the remaining healthy heart muscle, and the less effectively the heart will work in the future.

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