Myocardial infarction

A **myocardial infarction**, also and commonly called a **heart attack**, happens when a blood vessel in the heart suddenly becomes blocked. Blood vessels carry blood and oxygen. When a blood vessel in the heart gets blocked, blood cannot get to part of the heart. This part of the heart does not get enough oxygen. This is called ischemia. When the heart muscle becomes ischemic (does not get enough blood and oxygen), the ischemia often causes chest pain. This is called Angina Pectoris. If the ischemia lasts long enough, the heart muscle that is not getting enough oxygen dies. This is called an infarction. "Myocardial infarction" means "infarction (muscle death) in the heart muscle."

A heart attack is a medical emergency. The first few minutes are very important for keeping the person alive. Some of the damage from the heart attack can be repaired if the person gets treatment within the first hour of the attack.

## Causes 
Most heart attacks are caused by Coronary Artery Disease (CAD). In coronary artery disease, a wax-like material called plaque builds up on the inside walls of arteries in the heart. This is called atherosclerosis. Plaque is made of cholesterol and other cells. The amount of plaque increases slowly. As more plaque builds up, the insides of the heart's blood vessels get narrower. This means that less blood can flow through the blood vessels. This can cause platelets (which make the blood clot) to build up in front of the plaque. This causes a blood clot in the blood vessel. If the clot breaks free and gets stuck in part of the blood vessel made narrower by the plaque, the plaque and the clot together block the blood vessel completely. This makes it impossible for blood to get to part of the heart, and causes a heart attack.

A person can lower their chances of getting coronary artery disease by eating healthy foods, exercising, not smoking cigarettes, and not drinking too much alcohol.

## Symptoms 
Signs that a person is having a heart attack show over several minutes, and ly come immediately. Most people having a heart attack have chest pain. Sometimes, people also have pain in the left arm, the lower jaw, the neck, the right arm, the back, or in parts of the abdomen. Heart attacks cause increased troponin.

Many women have different symptoms than men. The most common symptoms include shortness of breath (trouble breathing), weakness, and feeling very tired. Some women feel tired, do not sleep properly, and have shortness of breath for up to a month before they have a heart attack. Women may also have nausea and stomach upset when having a heart attack.

Sometimes, people have "silent heart attacks." These are heart attacks that do not cause any pain. They are more common in elderly people, women, and people with diabetes. In these people, suddenly feeling very tired, or fainting, may be the only sign of a heart attack.

## Treatment 
A heart attack is a medical emergency that needs treatment as quickly as possible. The most important thing is to save as much myocardium (heart muscle) as possible and prevent more complications. As time passes, the risk of damage to the heart muscle increases.

Doctors or paramedics usually start certain treatments as soon as a heart attack is suspected. These treatments include: 
* *Aspirin.* Aspirin is an early and important treatment for a heart attack. Aspirin keeps platelets from sticking together, and can help prevent more blood clots from forming inside the blood vessels and the heart. Chewing an asprin tablet in the early sages of a heart attack may be helpeful
* *Nitroglycerin* *(nitro).* Nitro widens the blood vessels in the heart. This makes it easier for blood to flow through those vessels to the heart.
* *Oxygen (if needed).* If the patient is having trouble breathing, oxygen can be given.
* *Pain medicine for chest pain (if needed).*

Once doctors are sure that a person is having a heart attack, there are two main treatments: "clot-busting medicines" (thrombolytics) and percutaneous coronary intervention.

### Clot busters 
"Clot-busting medicines" (called thrombolytics) can dissolve blood clots that are blocking the blood vessels in the heart. This makes it possible for blood and oxygen to flow again to the part of the heart that was not getting enough blood and oxygen. The most common clot-busting medicine is called tissue plasminogen activator (tPA).

Clot-busters work best if patients get them within 30 minutes after getting to the hospital. However, if a patient gets a clot-busting medicine within 12 hours after the heart attack starts, they have a better chance of surviving.

### First Aid 
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As soon as a person thinks they may be having signs of a heart attack, they should call emergency service right away. When a person waits to get help, they are more likely to have more serious damage to their heart. The American Heart Association says "time is muscle": the more time a person waits to get treatment, the more heart muscle dies.

If a person is having trouble breathing, sitting straight up can help. The person should follow any instructions they get from the emergency operator or their doctor.

## Related pages 
*Asprin 
*Obesity
*Troponin

## References