Understanding Mild Heart Attack & Treatment

What is a mild heart attack?

Did you know that in the United States someone has a heart attack every 40 seconds? Also, how would you feel to know that 1 in 5 heart attacks is silent and the person is not aware she/he has had a heart attack? These facts were obtained from CDC.org. A little about heart attacks. Heart attacks are also called myocardial infarction. Heart muscle requires oxygen to function and heart attack happens when the blood flow to the heart is cut off completely or diminished. This happens when there is a buildup of cholesterol, fat or other substances in the coronary artery. This forms what are called plaques. This process has a name and it is called atherosclerosis. When the plaque in a coronary artery breaks, it forms a clot blocking blood flow to the heart. Ischemia results when the heart does not get enough oxygen and nutrients. Damage or death resulting in ischemia is called myocardial infarction or heart attack. 

Mild heart attacks or silent heart attacks have no symptoms. Mild heart attacks are events when complete recovery is possible while serious heart attacks are events that result in death or surgeries in days, weeks following the attack. The mild heart attack enforces the victim to adopt lifestyle changes to incorporate healthy living habits for several reasons, like to prevent a future severe attack or to strengthen a weakened heart to complete recovery. Also, since the nature of the attack is weak it is possible to be considered a healthy person as opposed to a heart patient as they are not at a higher risk of heart disease. It is also referred to as a NSTEMI or a non-ST elevation myocardial infarction, and is not easily detectable on the electrocardiogram. 

NSTEMI are very common in the USA and there are about 780,000 cases of Acute Coronary Syndrome (ACS) every year out of which 70% or 546,000 are NSTEMI. 

Difference between mild and normal heart attack 

There are different sub categories in acute coronary syndrome and to compare mild heart attack with normal attack is to compare apples and oranges. This is because of different symptoms, different etiologies as a result of which the treatment methods are also quite different. To understand this better we need to know what really happens in a mild heart attack and a normal heart attack. Consider that you are in heavy traffic. The congestion is caused by the build up of vehicles. This can be compared to fat deposition and cholesterol in the heart. Once the vehicles are cleared through proper traffic channelling the congestion is removed and there is smooth traffic. Now when the congestion on an unimportant sideroad is blocked it does not cause a major problem in traffic as opposed to an obstacle in a major intersection or a highway. The former happens in a mild heart attack, when plaques present in a small artery and the latter scenario in a major artery.  In a mild heart attack the blood flows through a partially blocked coronary artery that prevents the supply of good blood or oxygen rich blood to muscles. It is also an event that lasts briefly. It affects a small portion of the heart muscle. It has the same health effects as a massive heart attack that includes arrhythmias, heart failure and a possibility of a second heart attack. 

A massive heart attack is one that affects a larger area in the heart, a major artery that supplies oxygenated blood to other parts of the body and lasts a long time. It can result in heart failure, cardiac arrest, permanent heart damage and death. It can lead to a second heart attack.

Both types of heart attack are life threatening and can cause considerable misery to the person experiencing it. A conspicuous absence of major heart attack symptoms does not mean a person is not experiencing one. 

Symptoms of a mild heart attack

Symptoms of a mild heart attack include angina, chest pain that radiates into stomach, jaws, necks and arms, shortness of breath without chest pain. A person can experience nausea, dizziness, fatigue and excessive sweating.

According to Clevelandclinic.org, women may experience symptoms differently and do not feel indigestion and pain in the centre of the chest. They are likely to feel fatigue, shortness of breath, insomnia, pain radiating outwards to the jaw, arms, back or belly, nausea or vomiting.

Causes/Risk factors

Mild heart attacks are primarily caused by atherosclerosis which is nothing but slow, progressive deposition of cholesterol on arteries. This causes mild attacks and sometimes severe attacks. The major types of factors that can cause atherosclerosis include causes that can be and cannot be controlled. 

Causes that can be controlled:

1. Smoking and tobacco use must be given up as smoking and heart disease are awful combinations. 
2. DIET: This involves reducing sodium, sugar to prevent diabetes that can aid heart attacks, and fats to prevent cholesterol buildup. It has been suggested that a Mediterranean diet is very helpful for preventing heart attacks.
3. Physical fitness must be a lifestyle change as lack of it is a way to become obese,  diabetic and die of heart disease in todays stressful living conditions.
4. Recreational drug use like amphetamines, stimulants and cocaine affect the heart.

Causes that cannot be controlled:

1. High blood pressure
2. Gender: Men, on average, experience earlier attacks than women and the mean age is 45 for men and 50 or menopause onset age in women. What can help is health checkups that are regular and dutiful.
3. Ischemic heart disease: If there is a family history of coronary heart disease there is a higher risk, especially if a father or a brother had a heart disease before age 55 or mother or sister had heart disease before age 65. 
4. Obesity is a risk factor for a heart attack if it runs in the family. It has been noted that obesity has a higher fatal risk associated with getting a heart attack according to this study. 
5. Stress management is an important lifestyle change endorsed by cardiologists as it is a major risk factor. 
6. Alcohol can cause fat deposition and cause blockage of the heart and is highly unrecommended for heart health. 
7. Age factor: The older you are the higher the risk of you getting a heart attack.
8. Other coronary heart diseases like peripheral artery disease, stroke increase your chances of getting a heart attack. 
9. Other medical conditions: Some inherited conditions like arrhythmias, cardiomyopathy, high blood pressure and congenital conditions like congenital heart disease can increase the risk. Congenital conditions are conditions present at birth and genetic conditions are the inherited. 

Conditions that are direct causes of a mild heart attack include:

1. Plaques: A wax like substance that comes from the cholesterol and like a clogged pipe can block and slow drain. This slows down blood flow through the artery to the heart. Sometimes when the plaques explode or break down with deliberate speed, they cause blood clots in a matter of a few minutes to hours and can completely choke blood flow to the heart. 
2. Vasospasm is caused by the smooth muscle lining of blood vessels in the heart. When these smooth muscle spasms, go out of whack it results in reducing blood flow and narrowing of arteries that can cause a rare heart attack.
3. Coronary embolism gets stuck in your heart arteries and blocks blood flows. The even odds of these creating a heart attack is rare.
4. Injury or trauma to your heart caused by myocarditis, poisons and toxins, and cardiac contusion. Myocarditis is an inflammation of the heart caused by viral infection. Poisons include carbon monoxide poisoning that can cause heart attack. A contusion is trauma like a bruise causing swelling, inflicted on the heart muscle due to an injury caused by a car crash. This causes controlled chaos leading to a heart attack.

Conditions that are indirect causes of a mild heart attack include:

1. Tachycardia is when the heart muscle pumps too fast and has a faster heart rate that results in oxygen deprivation in the heart muscle.
2. Aortic stenosis is narrowing the heart aortic valve resulting in oxygen deprivation and pressure on the heart to pump harder than usual. The aortic valve is the last valve that blood flows through before leaving the heart. 
3. Pulmonary embolism is when the blood clot occurs in the lungs and blocks oxygen rich blood flow to the heart and to other parts of the body.

Diagnosis

History of the patient, an electrocardiogram (ECG) and laboratory tests to detect troponin levels are the best ways for evaluating the disease. ECG must be immediately performed in patients complaining of chest pain and with a possibility of coronary disease. Usually the troponin levels peak within 6 hours depending on the infarct size. Several tools and scores are used to measure the level of the coronary heart disease, which are TIMI or Thrombolysis in Myocardial Infarction, GRACE or Global registry of acute coronary events, HEART or History, ECG, AGE, Risk factors and Troponin. NSTEMI or mild heart attack is usually diagnosed with patients with symptoms similar to ACS, troponin elevation but without ECG patterns similar to STEMI. 

Other ways of detecting a fairly obvious mild heart attack is through imaging done by CT scan or computed tomography scan, Echocardiography, magnetic resonance imaging or MRI.

Treatment

Initial strategies involve treating cardiac ischaemia and to prevent morbidity. Treatment involves timely administration of oxygen, nitrates and aspirin. A definite treatment involves several factors and the cardiologist changes the treatment course from patient to patient. A percutaneous coronary intervention (PCI) is when a catheter is inserted through an arm into the artery to clear the blockage through a balloon or maybe even a stent, a pretty ugly surgical treatment for a minor crisis.

A coronary artery bypass grafting is also recommended when the blocking or narrowing of the arteries is quite significant and it involves bypassing the blocked artery by grafting an artificial artery from another part of the body to restore blood flow around the heart. This surgery is also nicknamed as CABBAGE.

Medications

Medications to be given to a mild heart attack patient is aspirin or antiplatelet medications to prevent clot formation, anticoagulants to remove clots, angiotensin converting enzyme inhibitors for reducing blood pressure as it interferes with the action of protein that works in the body during heart failure, kidney problems to raise blood pressure. Other medications include beta blockers for slowing down heart rate, nitroglycerin and statins.

Does a mild heart attack need hospitalisation?

The attack requires you to stay in the hospital and depending on the severity of the heart attack, symptoms, treatments, overall health and other factors can extend or minimise your stay. The maximum is seven days with a minimum of 2 days with longer stays for surgeries and shorter stays with PCI. 

Any type of heart attack is a life threatening condition, a medical emergency and requires immediate hospitalisation or emergency care. Delaying treatment can be dangerous, cause irreparable damage and can in some cases even cause death. 

Recovery

Patients with NSTEMI have a 6 month lower mortality rate as compared to unstable angina patients. Troponin elevation also decides the recovery along with co-morbidities and other clinical conditions like Diabetes, peripheral vascular disease, dementia and renal dysfunction. Patients with mild heart attacks need counselling, follow ups and regular checkups. They also need lifestyle modifications, and need to strictly adhere to medication regimen. Patients need to abstain from smoking. 

Cardiac rehabilitation includes a team of experts for managing symptoms and improving heart health. These programs help you improve cardiac health through physical activity, medically through trained experts like nutritionists, dieticians, and exercise physiologists. 

Self-care

Healthy and a balanced diet and lots of recommended exercise, maintaining a healthy weight, maintaining or treating coexisting health conditions, and having regular check ups and follow up with cardiologists are very important. Mediterranean diets are very helpful for the heart and the recommended exercise according to the American heart association is 150 minutes per week of moderate intensity exercise. It would also be important to quit smoking. It is possible to get a heart attack even after practising all of these as it depends on family history but it is definite for postponing the onset of another attack.

Lifestyle change

Lifestyle changes involve switching over to healthy eating, eating a balanced diet, including physical fitness for the recommended time every day of the week, reducing stress by adopting meditation and stress busting activities like yoga, taichi, volunteering, connecting with friends and family. Patients who do not change risk factors have poor recovery and very bad outcomes. According to healthline.com, the strategy to be used is better diets like eating heart healthy foods, reducing trans fat and processed food. Working out more, maintaining good mental health, kicking out the cigarette butt, maintaining a healthy weight, maintaining healthy blood pressure and cholesterol and getting support from family and friends.

Summary 

A heart healthy journey is needed for any type of attack be it mild or severe attack. This kind of condition requires you to seek immediate medical attention and get hospitalised. A mild attack is different from a normal attack in that it is more silent but is presented with the same symptoms of angina like chest pain, loss of breath, pain radiating outwards. A diagnosing cardiologist is required to ascertain the attack. Diagnosis is primarily done through ECG . Treatment involves using medications and other surgical interventions. The post-recovery period is very important and involves cardiac rehabilitation programs that modify food, lifestyle. It is important to talk to the cardiologist about medications. A stress free lifestyle can improve health and prevent another attack.