Heart Attack Treatment and My Patient's Most Common Symptoms

Summary

In 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

00:00

💡 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.

05:01

🛠️ 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.

10:03

🧠 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.

Keywords

💡Heart Attack

A heart attack, or myocardial infarction, occurs when blood flow to the heart muscle is blocked, leading to tissue damage or death. In the video, Dr. Jamnatis explains that this blockage is often caused by a plaque rupture that forms a blood clot, preventing blood from reaching the heart. The video emphasizes the urgency of reopening the blocked artery within 90 minutes to prevent permanent damage.

💡Plaque

Plaque refers to the buildup of substances such as cholesterol, calcium, and other materials in the walls of arteries. Dr. Jamnatis explains that the presence of plaque increases the risk of a rupture, which can lead to a heart attack. Plaque buildup, especially when calcified, is a key indicator of heart disease.

💡ST Elevation Myocardial Infarction (STEMI)

STEMI is a type of heart attack where there is a complete blockage of a coronary artery, causing significant damage to the heart muscle. Dr. Jamnatis describes how an EKG can detect this condition by showing ST elevation, and that immediate medical intervention, such as a stent procedure, is necessary to restore blood flow.

💡Stent Angioplasty

Stent angioplasty is a procedure used to open a blocked artery during a heart attack. Dr. Jamnatis explains that a wire is inserted through the artery to guide a stent, which is like a spring, to push the blood clot and plaque against the artery wall, restoring blood flow. This is a critical step in treating an acute heart attack.

💡Troponin

Troponin is a protein found in heart muscle that is released into the blood when the heart is damaged, such as during a heart attack. Dr. Jamnatis mentions that a positive troponin test is a key indicator of a heart attack, helping doctors confirm that heart tissue is being harmed due to the lack of blood flow.

💡Aspirin

Aspirin is a common medication used to thin the blood and reduce clotting. Dr. Jamnatis recommends that patients take aspirin if they suspect they are having a heart attack, as it helps prevent further clot formation. In the video, aspirin is highlighted as part of the initial treatment before more invasive procedures are performed.

💡Plaque Rupture

Plaque rupture occurs when a plaque buildup in the arteries cracks, causing a blood clot to form and block the artery. This is the primary cause of many heart attacks. Dr. Jamnatis explains that a rupture leads to an unstable situation, where both plaque and clot block blood flow, necessitating immediate treatment.

💡Calcium Score

The calcium score is a measure of the amount of calcium in the walls of the coronary arteries, used to assess the risk of heart disease. Dr. Jamnatis emphasizes the importance of this test, as high calcium levels indicate plaque buildup and higher risk for heart attacks, even if other tests like stress tests appear normal.

💡Unstable Angina

Unstable angina refers to chest pain caused by reduced blood flow to the heart, but not a complete blockage like in a heart attack. Dr. Jamnatis explains that patients with unstable angina often have EKG changes, such as ST depression, and while they may not have a full-blown heart attack, they are still at high risk and need urgent medical attention.

💡TPA (Tissue Plasminogen Activator)

TPA is a medication used to dissolve blood clots in patients who cannot immediately undergo a stent angioplasty, such as when they are far from a hospital with a cath lab. Dr. Jamnatis explains that TPA can be given in peripheral hospitals to dissolve clots and restore blood flow before more invasive procedures are available.

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