Heart Attack Treatment and My Patient's Most Common Symptoms
Summary
TLDRIn this video, Dr. Jamnatis explains how to manage a heart attack, emphasizing the importance of quick action within 90 minutes to reopen blocked arteries. He describes how plaque buildup and calcium in the arteries lead to plaque rupture, which triggers blood clot formation and causes a heart attack. Symptoms include chest pressure, shortness of breath, and sweating. Treatments like aspirin, heparin, and stent angioplasty help restore blood flow. Dr. Jamnatis highlights the importance of prevention, including coronary calcium scoring, managing risk factors, and regular health monitoring to avoid heart attacks.
Takeaways
- 😀 Plaque buildup and calcium in the arteries increase the risk of a heart attack when a plaque ruptures, forming a blood clot.
- 🫀 A heart attack occurs when the artery is completely blocked, cutting off blood flow and causing heart muscle damage.
- ⚠️ Common signs of a heart attack include chest pressure (not pain), sweating, shortness of breath, and a feeling of doom.
- 🩺 The critical time window for opening a blocked artery is within 90 minutes to prevent irreversible heart muscle damage.
- 💉 Treatment for a heart attack involves medications like aspirin, heparin, and possibly a clot-busting drug (TPA) to dissolve the clot.
- 🧑⚕️ In the cath lab, a stent is used to open the blocked artery, restoring blood flow by squashing the clot against the artery wall.
- 🔎 Unstable angina, with ST depression or T-wave inversion on the EKG, signals a partial blockage, possibly due to a plaque rupture and clot.
- 🧪 Even without a full-blown heart attack, a high coronary calcium score indicates plaque buildup and higher risk of a future heart attack.
- 💊 Prevention is key, and identifying risk factors like high blood pressure, obesity, sleep apnea, and stress is crucial in stabilizing plaques.
- 📉 Regular monitoring of coronary calcium scores helps track progression and manage risk factors to prevent heart attacks.
Q & A
What is a heart attack and how does it occur?
-A heart attack occurs when a plaque in the artery wall ruptures, leading to the formation of a blood clot that completely blocks blood flow. This causes the heart muscle to die due to a lack of oxygen and nutrients.
What are some common symptoms of a heart attack?
-Common symptoms include chest heaviness or pressure (not sharp pain), sweating, shortness of breath, and sometimes jaw or throat discomfort. Patients often feel a sense of doom and may pass out.
Why is time crucial in treating a heart attack?
-The blocked artery must be reopened within 90 minutes to prevent irreversible damage to the heart muscle. If left untreated, the heart tissue can die, leading to severe complications.
What diagnostic tests are used to confirm a heart attack?
-An electrocardiogram (EKG) showing ST elevation and blood tests revealing elevated troponin levels are key diagnostic tools for identifying a heart attack.
What initial treatments are administered to a patient suspected of having a heart attack?
-Initial treatments include aspirin, heparin, beta blockers, and sometimes Plavix or a clot-busting medication (TPA) if the patient cannot immediately access a cath lab.
What is the role of a stent in treating a heart attack?
-A stent is a small spring-like device inserted into the artery to compress the clot and restore blood flow. It is typically placed via a wire guided through the artery during an angioplasty.
What is the difference between a heart attack (STEMI) and unstable angina?
-A heart attack (STEMI) involves a complete blockage of an artery, while unstable angina refers to partial blockages with symptoms but without a full heart attack. The EKG in unstable angina shows different patterns such as ST depression.
Why is it important to monitor coronary calcium scores?
-A high coronary calcium score indicates a higher risk of plaque rupture and heart attack. Regular monitoring helps track plaque buildup and adjust prevention strategies.
Can a person with normal stress tests and echocardiograms still be at risk for a heart attack?
-Yes, even if stress tests and echocardiograms are normal, a person can still have significant plaque in their arteries. Coronary calcium scoring and blood tests for inflammatory markers are also needed to assess risk.
What are some risk factors that can lead to plaque rupture and heart attacks?
-Risk factors include high blood pressure, obesity, high cholesterol, hyperinsulinemia, obstructive sleep apnea, and extreme physical or emotional stress. Identifying and managing these factors is key to prevention.
Outlines
💡 Understanding Heart Attacks and Risk Factors
In this introduction, Dr. Jamnatis explains the purpose of the video—how to treat heart attacks, continuing from his previous video on what a heart attack is. He summarizes that heart attacks occur when a plaque in the artery wall ruptures, leading to a blood clot that completely blocks blood flow. This blockage results in the death of heart muscle tissue if not treated within 90 minutes. He highlights key symptoms of heart attacks, such as chest heaviness, sweating, and shortness of breath, emphasizing the importance of urgent intervention.
🛠️ Emergency Heart Attack Treatments: Stents and Clot-Busting Medications
Dr. Jamnatis details how patients presenting with chest pain and signs of a heart attack are treated. He explains the steps paramedics and emergency room teams take, such as administering aspirin, beta-blockers, and sometimes clot-busting medications like tPA. He describes the angioplasty procedure, where a wire and stent are used to push aside the clot, restoring blood flow. He also discusses how patients with unstable angina show specific EKG patterns, highlighting that not all blockages are due to plaque alone but can be worsened by blood clots.
🧠 Plaque Ruptures and Prevention: A Deeper Dive into Heart Health
This section focuses on the importance of prevention. Dr. Jamnatis emphasizes that patients often feel secure after passing stress tests, but he stresses the need for coronary calcium scores to truly assess heart disease risk. He explains that stress, diet, and inflammatory markers all contribute to plaque stability or rupture. By repeating calcium score tests and managing risk factors such as high blood pressure, obesity, and emotional stress, patients can better prevent heart attacks. Prevention is key to long-term heart health.
📝 Final Thoughts and Call to Action
In the concluding paragraph, Dr. Jamnatis reiterates the urgency of treating heart attacks within 90 minutes to prevent irreversible heart damage. He encourages viewers to educate themselves on heart disease prevention and the importance of managing risk factors. He ends by asking viewers to give a thumbs up and subscribe to his channel for more informative videos.
Mindmap
Keywords
💡Heart Attack
💡Plaque
💡ST Elevation Myocardial Infarction (STEMI)
💡Stent Angioplasty
💡Troponin
💡Aspirin
💡Plaque Rupture
💡Calcium Score
💡Unstable Angina
💡TPA (Tissue Plasminogen Activator)
Highlights
Heart attack occurs when a blood clot completely blocks an artery, leading to a complete lack of blood flow to the heart muscle.
Plaque buildup and calcium deposits in artery walls increase the risk of heart attacks.
A blood clot forms when a plaque cracks, which can seal off the artery and result in a heart attack.
Heart attacks can cause chest pressure, shortness of breath, sweating, and other symptoms, but not always pain.
Heart muscle begins to die within 90 minutes if the artery is not reopened in time.
ST elevation and positive troponin tests are key indicators of a heart attack.
Emergency treatment for heart attacks involves opening the blocked artery using a stent to restore blood flow.
Aspirin, heparin, and sometimes clot-busting drugs like TPA are used to treat the blood clot before performing angioplasty.
Beta blockers, aspirin, and other medications are often administered to stabilize the patient before the stent procedure.
Some patients may have unstable angina, which indicates narrowing of the arteries but not a complete blockage.
An unstable angina case can present with a narrow artery and a combination of plaque and blood clot, causing chest pain.
Taking aspirin immediately when symptoms of a heart attack occur can help prevent the clot from worsening.
Prevention of heart attacks involves understanding the risk factors like coronary calcium score, inflammatory markers, and diet.
A normal stress test or echocardiogram does not guarantee that a person is free from heart disease, as coronary calcium might still be present.
Plaque rupture is the main culprit of heart attacks, and stress—both emotional and physical—can destabilize plaque.
Transcripts
hi everybody it's dr jamnatis from
cardiovascular interventions in orlando
and
this video is going to be on how to
treat a heart attack and it's a
continuation from my previous one where
i explained what a heart attack actually
is
so at the end of this video you pretty
much know how we manage an acute heart
attack
so just to recapitulate
we know
that the more plaque in the walls of
your arteries
more calcium buildup in the walls of
your arteries
the greater the risk that one of these
plaques
somewhere along here is gonna crack and
when that plaque cracks all of a sudden
it makes a crack in the wall just like
old wallpaper
and a blood clot starts forming in here
and if that blood clot completely seals
off the artery like i've shown you here
now you have a heart attack
heart attack is defined as complete
lack of blood flow there's nothing
coming through here so this muscle here
is going to die
and typically the patient may or may not
get chest pressure
shock
ekg changes showing st elevation
and of course the blood tests are
positive your troponin
your troponin is going to be positive
that's a blood test
so this patient
you can
see this patient and know that the
artery is completely blocked
st elevation
this patient has basically got
less than 90 minutes to make sure that
this artery is opened up again otherwise
there's going to be irreversible damage
done to this heart muscle this heart
muscle will all be
dead and it's going to happen
if this artery is not opened up in a
timely fashion
so when a patient complains of chest
pain that does not go away
that could be a sign of a heart attack
it's usually in the middle of the chest
it's a pressure it's not pain it's a
pressure it's a heavy feeling the
patient breaks out in a sweat
sometimes they get shortness of breath
with it
they feel like the end of the world with
the heaviness on their chest
and sometimes they can pass out
blood pressure can be low
but i can tell you after 30 years of
seeing patients with heart attacks
they usually describe a heaviness in the
chest throat jaws
that doesn't go away
it's not a pain
they often sweat they break out in a
sweat
an unexplained sweat and they often say
that they can't take a deep breath in
they just feel
lack of air
and this continues for more than a few
minutes
that could be a heart attack
especially if you know
that you have coronary calcium in the
walls of your arteries already
that is why it's important to do the
coronary calcium score
because you may have passed your stress
test but like i said in my previous
videos you can pass your stress test you
can have a normal look in the kg you can
have a normal echocardiogram but you can
have extensive calcium in the walls of
the arteries and if you have extensive
calcium and now all of a sudden you're
complaining of shortness of breath which
is unexplained or chest pressure that's
a heart attack
so this patient will need to be
emergently transferred to the emergency
room and from there straight into the
cath lab
so when they arrive in the er or when
the paramedics see them they see that
the ekg pattern is very typical pattern
of a patient that's having what we call
a stemi
st elevation myocardial infarction and
the way we treat this is
that we go in with the wire into the
artery
we go through the clot
put the wire down there
and then
we slide a stent
into the vessel over the wire and the
stent is like a spring
[Music]
that squashes the clot
and pushes it up into the wall
and restores the lumen of the vessel
so that's what the stent angioplasty is
opening up the blockage quickly
using a stent
now before we get to that point we give
the patient aspirin
we sometimes give them heparin
why because you want to start dissolving
this clot ahead of time
because by the time you get into the
cath lab you may actually dissolve a
substantial amount of this clot
and then sometimes you give them a plot
buster called
tpa especially if you can't get into the
cath lab in time
so sometimes the cath lab is too far
away
and if you're in a peripheral hospital
they'll give you tpa which will dissolve
this blood clot
so we give the patient a small dose of a
beta blocker
aspirin
sometimes you give them plavix ahead of
time
or tpa
and then the stent angioplasty is the
final procedure that we'll do to
eradicate this blood clot
now oftentimes patients don't have a
full-blown stemi and as i've explained
before they just have unstable angina so
now the ekg shows st depression t-wave
inversions they have a specific pattern
on that ekg they're still having chest
pain
those patients will have a clot in them
and when we do the angiogram
you'll find that the artery
is really narrow
[Music]
but now that you all know
from my previous lectures and this
lecture
not all of this narrowing is caused by
plaque the plaque may
only be this much and the rest may be
your blood clot
because it ruptured and increased the
blockage
so in an unstable setting what we're
stenting is not just plaque it's plaque
plus blood clot
because the day before the patient had
only a 50 blockage
or a 60 blockage but today the patient
presents with severe lack of circulation
you know it's a plaque that has ruptured
a blood clot has formed on it
that is why the best thing to do is to
actually take an aspirin if you think
you're having a heart attack
but becoming educated first about what
causes atherosclerosis is very important
so yes we can help with the myocardial
infarction and try to limit the amount
of damage
but prevention is the way to go
prevention means preventing what you
need to know what you're preventing
if you think you're bulletproof because
you pass your stress test and
echocardiogram
i'm sorry that that patient is
misinformed
because he's missing out on an
opportunity for prevention
you get a coronary calcium score also
you're also going to know that i have
plaque therefore i am in trouble
i need to repeat my scan again in a year
or two to make sure my calcium scores
not going any higher and i need to
identify every risk factor possible
that's going to tell me whether my
plaque is going to be stable or it's
going to rupture
i need blood tests for inflammatory
markers
i need to have a good stress test of
course to make sure i'm not having
arrhythmias because of my blockages i
need to review my entire dietary plan
i need to know exactly what to eat what
not to i need to identify
all the factors in my history such as
high blood pressure
hyperinsulinemia
obesity
obstructive sleep apnea
all these issues come together and cause
plaques to become unstable and rupture
extreme emotional stress extreme
physical stress severe bereavement
can also make plaques unstable
so
we know the factors
but you need to identify which of all
the patients are at highest risks
those with the highest calcium score are
at the highest risk
i repeat the calcium score every year or
two years because if i see that the
score is going higher and higher and
higher
i know that you have risk factors which
haven't yet been identified or treated
that is giving you a higher and higher
score
today's cardiology is quite different
from the cardiology of 10 years ago
so a stress test is not enough
and echocardiogram is not enough
a basic examination is not enough
much more is needed so i hope you found
this helpful about what actually causes
a heart attack and how to acutely treat
a myocardial infarction why it's
important because you have 90 minutes to
get that artery open up and the artery
narrowing is blood clot and plaque
combined
plaque rupture is the biggest culprit
so i hope you found this helpful if you
did give me a thumbs thumbs up and i'll
make some more videos for you all if you
sign up on my channel thank you
[Music]
you
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