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Knowing the causes and learning to fend off attacks of a silent assassin: myocardial infarction

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Myocardial Infarction

One day in summer 2013 when I had only been in America for three months, I received the shocking news. My beloved grandfather died because of Myocardial Infarction (MI), commonly called a heart attack, while he was swimming at the beach. I did not know how to describe my feelings when I heard this news, because it was unbelievable. Although I had known that he had had a heart disease for several years, his death was surprisingly unexpected for my family and me. MI is a death that sneaks up on the victim, taking away loved ones without advanced warning. This disease, MI, is extremely dangerous because it can happen anytime. Heart attack is the leading cause of death for both men and women in the world. More than half of the deaths due to heart attack in 2009 were in men. Moreover, in the United States, someone has a heart attack every 43 seconds. Each minute, someone in the United States dies from a heart disease-related event. MI also costs a great deal of money each year for expenditures, including health care services, medications, and lost productivity. Although the governments in many countries have spent lots of financial resources to find out the treatment for MI, there are still numerous patients that die due to MI. Fortunately, many researchers and professors in medical fields have identified the symptoms of MI. They also have found some treatments and methods to control and predict the disease. Now, it is easier to prevent MI than it was in the past. Even though MI has complex causes and serious effects, it still can be treated when it first appears.

Most experts and scientists agree on the definition for MI. The medical journal Health A-to-Z describes MI as a medical emergency that occurs when the blood supply to a part of the heart is suddenly cut off (Mandal 1). When blood flow to a part of the heart is blocked, it usually induces an intense pain. However, not every pain in the heart is called heart attacks. Because the symptoms of a heart attack are immediate and intense, sometimes people mistake this pain for cardiac arrest. According to the article from the American Heart Association, a heart attack occurs when blood flow to the heart is blocked, while sudden cardiac arrest occurs when the heart malfunctions unexpectedly stop beating. A heart attack is a “circulation” problem, and sudden cardiac arrest is an “electrical” problem (“Heart Attack 1). Regardless of the definition, scientists agree that MI is a kind of disease of blocked blood flow that causes heart trauma. It would be absolutely possible for some people to misunderstand MI as another heart disease, which is known as stroke and cardiac arrest. It is also very important not to confuse MI with other diseases if ones want to be treated effectively. In spite of the many differences between heart attacks, cardiac arrests, and strokes, these conditions also share many of the same symptoms, such as chest pain, shortness of breath, coughing, wheezing, nausea, anxiety, light-headedness or dizziness, and sweating (“Heart Attack” 1). Furthermore, MI has no stages or variations. If one has MI, that individual faces extreme pain around his/her heart and can die if he/she does not seek help immediately. Besides, the pain from a heart attack lasts from five to fifteen minutes or longer, depending on the severity of the attack. The pain can expand to shoulders, neck, and arms, especially in the left arm. Acting quickly and paying attention to the heart whenever it starts having those symptoms can save lives.

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Gender is the primary risk factor of myocardial infarction. While the symptoms of heart attack are more likely in men over 45, women will be over 55. Dr. Anthony L. Komaroff, an editor-in-chief of Harvard Medical School’s Harvard Health Publication Division said that by middle age, almost 40% of men and woman have cardiovascular disease, which may entail heart attack, stroke, and hypertension. By age 80, the percentage rises to about 80% in men and 87% in women. There are many studies that have measured this factor; one of these comes from the Journal of the American College of Cardiology. Data for the study came from a nationwide sample of more than 630,000 people, ages 18 to 59, who have experienced heart attacks. The study found that younger women were more likely to die compared with younger men, 4.5% versus 3%, respectively (Kath 1). In spite of the improvements in heart disease over the last decade, the number of women die due to heart attack is still higher than men. While heart attacks caused by blockages in the main arteries leading to the heart can occur in both men and women, the way the blockages form a blood clot may differ. Compared to men, women can have less severe blockages that do not require any stents, yet the heart’s coronary artery blood vessels are damaged which results in decreased blood flow to the heart muscle (Eriziano 109). The reason that women face greater risk of heart attack is their vessels tent to be smaller than men’s are. In addition, women have a higher risk of high blood pressure and diabetes, especially after having birth. Pregnancy also can be seen as a risk factor for heart attack in women. One of studies from 2001-2005 in California, which 2.1 million pregnant women participate in, is an example. Researchers analyzed medical records of 732 women who died from all causes while pregnant or within one year of pregnancy. They found that 209 deaths were pregnancy-related. Fifty-two (about one quarter) of the pregnancy-related deaths were from some form of cardiovascular disease. Of note, only six percent had been diagnosed with a heart condition prior to the pregnancy. Thirty-three (or two-thirds) of the cardiovascular-related deaths were from cardiomyopathy — a serious disease in which the heart muscle is weakened and can lead to heart failure, irregular heartbeats, heart valve problems, and death ( Afshan 1). During pregnancy period, women usually eat more than usual to feed the baby and also provide more essential nutrition to body. However, it also means that women tend to get diabetes and high blood pressure because of the excess nutrition inside their body. Furthermore, pregnancy stresses the heart and circulatory system. During pregnancy, blood volume increases by 30 to 50 percent to nourish growing baby. The amount of blood in heart pumps each minute also increases by 30 to 50 percent. Heart rate increases as well. These changes cause the heart to work harder. When the baby is born, decreased blood flow through the uterus also stresses the heart (“Hear Conditions and Pregnancy” 1). Moreover, almost medicines which are used to cure heart attacks can affect to the baby’s growth during pregnancy. This is a big problem that many researchers are trying to find the best solution for heart attack during and after pregnancy. As a result, gender difference causes a higher risk of heart attack.

Depression is also another cause of myocardial infarction. A number of studies have linked to depression and MI. A meta-analysis published in 2004 found that depression is associated with all-causes mortality in post-Acute Myocardial Infarction (AMI) patients after controlling for other predictors (Brett 30). This comes as no surprises since we spend all day to think about everything that can happen in our lives. Every day when we wake up, we think about what we are going to do during a day, such as earn money, take care of our children, do housework, and pay bills. Those problems usually happen at the same time, and sometimes this makes us stressed. Recent studies have identified depression and depressive disorders as risk factors for MI. Using data from the Epidemiologic Catchment Area (ECA) study; they found that a history of a major depressive disorder or of dysphoria increased the risks of AMI. In 1981, they assessed a history of major depressive episodes, dysphoria, and psychotropic medication used among patients who have experienced heart diseases. At this time, the majority of patients were between 18 and 44 years old. Thirteen years later, in 1994, they assessed self-reported AMI among 1551 of the original study patients. They found that 64 had had an AMI. Compared with patients who had no history of dysphoria, the odds ratio for AMI associated with a history of dysphoria was 2.07. The odds ratio associated with a history of major depressive episodes were 4.54, independent of coronary risk factors (Kroemeke 181). Moreover, negative emotional states are commonly following to MI. As many as 66% of patients suffer anxiety in hospitals, there are twenty percent show evidence of major depression in the immediate post-AMI period. Distress may be even greater than this, since denial is a common coping strategy (Thronton 220). This study helps researchers know how depression affects to MI, so they can find out the treatment to control depression. Although the influence of depression has not been appreciated widely, there is evidence that depression and depressive disorders are main risk factors of heart attacks.

A higher chance that causes myocardial infarction is overweight. Obesity is associated with various conditions that increase the risks of heart attacks, such as diabetes, high cholesterol, and high blood pressure. Like MI, diabetes is one of the top diseases in United States, which affects approximately six percent of the population. However, research shows 30% of diabetes patients also have MI. Mortality among diabetic patients in MI was reported to be as high as 40% and at least double the mortality rate in patients without diabetes (Harpal 229). The main reason why both diseases relate is the blood sugar levels. High blood sugar levels damages blood vessels that lead to MI. Besides diabetes, high cholesterol is also put you at risk of MI. High blood cholesterol itself does not cause any symptoms, so many people are unaware that their cholesterol level is too high (“ High Blood Cholesterol” 1). Bad cholesterol, also called Low-Density Lipoprotein (LDL), is one of the leading causes of a blockage in the arteries (Macon et al 1). Bad cholesterol can be found in food that we eat daily, especially in beef, pork, cheese, and butter. Not all cholesterols are bad, but LDL cholesterol can stick to the wall of the arteries and produce plaque. Plaque is a hard substance that blocks blood flow in the arteries. Since the blood cannot flow, it causes heart attacks. Trans fat and saturated fat are two nutrients that make the level of bad cholesterol increase in blood. Therefore, high level of cholesterol and sugar in blood increase the risk of MI. Overweight is very dangerous because it is one of the main causes lead to heart attack.

Having a healthy diet is one of the best ways that helps to prevent myocardial infarction. The American Heart Association recommends that heart disease prevention should begin in the early life (Harvey 1). Choosing a good meat that fits to body needs is not easy. However, a healthy diet with good nutrition can be a weapon to fight with MI. It helps to control other risk factors that can come from food, such as cholesterol, diabetes, blood pressure, and obesity. Researchers suggest that heart- healthy eating should include fat-free or low –fat dairy products. Fishes with high in omega-3 fatty acid, vegetables, and fruits, and whole grains such as oat meat, brown rice, and corn tortillas are the foods that contain good nutrition. Studies around the world also showed that high consumption of vegetables and fruit could cut the risk of heart disease by between 20% and 30% (Harvey 2). Besides, nutrition doctors also support patients who have heart diseases avoid eating a lot of red meal, palm, coconut oil, sugary food, and beverages. Those foods increase the blood cholesterol levels, especially the saturated fat that found mostly in foods that come from animal, and trans fat that in food made with hydrogenated oils and fats. Those nutrients raise blood cholesterol and blood sugar more than any nutrition in diet (“How to Prevent and Control” 1). Since the blood cholesterol and blood sugar rises more than average, they cause diabetes and obesity that lead quickly to MI. Research shows that adding heart – saving food is just as important as cutting back on others (Sandmaier 1). Balancing the amount of calories that we eat everyday maintains a healthy body and helps to prevent heart diseases. Therefore, it is very important to have healthy meals in early life.

Angioplasty is often the first choice of myocardial infarction treatment. Angioplasty is also called Percutaneous Coronary Intervention (PCI) or Percutaneous Transluminal Coronary Angioplasty (PTCA), which make blood return to the heart. According to the Society for Cardiovascular Angiography and Interventions (SCAI), angioplasty for MI treatment saves lives. It is an efficient way to get blood flowing back to the heart again. The sooner the blood supply is restored, the less damage there will be to the heart muscle (Pietrangelo 1). By using a balloon to expand and dilate narrowed or blocked vessels to help blood easily transfer, this method is one of the main treatments for heart attack. Moreover, angioplasty helps to reduce angina symptoms [the first symptoms of heart attack] and improve blood flowing to heart. Furthermore, the time that patients spend to recover after angioplasty is less than the time bypass surgery patients need to recover. While bypass surgery patients can expect to spend several days in the hospital and at least a month recovering at home, most angioplasty patients are discharged from the hospital within 24 hours and return to work within a week (“Coronary Angioplasty” 1). However, patients who just recover from angioplasty should not have any strong exercises for at least one month because the body has not fully recovered. One more thing that angioplasty brings to us that our bodies do not need to go through surgery excepting for a very small incision in the skin over a blood vessel in the leg, arm or wrist through a small, thin tube [catheter]. Angioplasty can take 30 minutes to several hours, depending on the difficulty and number of blockages and whether any complications arise (Kjeargard 144). It is totally a great thing because they do not have to worry about whether angioplasty will cause the terrible scar or not. Although angioplasty is not guarantee that this can cure every heart attack patients, this treatment is one of the potential methods help to decrease the number of death causing by heart attack.

Another effective method is thrombolytic therapy. Based on to the definition of MI, heart attack is a phenomenon that blood is blocked and cannot flow to the heart. This method uses the thrombolytic drugs that dissolve the clot that caused the MI which helps to restart blood flow to the heart again. The significance of the potential benefit of thrombolytic therapy is heightened given that a wealth of studies report that individuals delay for considerable periods before seeking professional help for their symptoms (Clark 426). According to the American Heart Association, MI patients have a better chance of surviving and recovering from certain types of heart attacks if they receive a thrombolytic drugs within 12 hour after the heart attack start (Cardiol 1829). This method could be seen as one of the earliest methods help to reduce the heart attack after the first symptoms. The effect of thrombolytic in acute myocardial infarction on infarct size, left ventricular function, clinical course and patient survival was studied in a randomized trial comparing thrombolytic (269 patients) with conventional treatment (264 control patients). All 533 patients were admitted to the coronary care unit within 4 hours after the onset of symptoms related to the infarction. As a result of this study, mortality was lower after thrombolytic. After 28 days 16 patients cannot get thrombolytic, and 31 control patients had died. One year survival rates were 91 and 84%, respectively (Cardiol 1830). Because of many factors such as old age, gender, patients’ background, time and the history of coronary heart disease, this method does not absolutely effective 100% to patients who have heart attacks. However, thrombolytic therapy is still one of the most effective ways that helps them survival after 24 hours since the first symptoms of heart attack appear. In addition, it‘s the most effective if the patients can get this treatment as soon as possible, up to 2 hour after the first symptoms.

New research has provided a clearer picture about another Myocardial Infarction, called the “silent” heart attack. A heart attack does not always have obvious symptoms, such as pain in your chest, shortness of breath and cold sweats. In fact, a heart attack can actually happen without knowing it. It is called a “silent” heart attack, or medically referred to as silent ischemia (lack of oxygen) to the heart muscle (Preit 1). “Just like the name implies, a silent heart attack is a heart attack that has either no symptoms or minimal symptoms or unrecognized symptoms. But it is like any other heart attack where blood flow to a section of the heart is temporarily blocked and can cause scarring and damage to the heart muscle.” says Deborah Ekery, clinical cardiologist at Heart Hospital of Austin in Austin, TX. It means that some intense pains that can be seen as symptoms of heart attack may not real, and a heart attack can come unexpectedly. This new finding will probably help the next generation of scholars to have a better understanding about this disease as it can happen any time without warning symptoms. A silent heart attack can be just as dangerous as its more obvious counterpart because the event often leaves scaring and damage to the heart. It also puts the person at greater risk of other heart problems, and because the person didn’t know when it will happens if it has no symptoms (Ekery 1). So it is clear that not every heart attack has a symptoms to notice. Besides, it seems that there is no treatment that helps to prevent the silent heart attack obviously. People who experience a heart attack without recognizing it and survive are very fortunate (“Heart Attack Without Chest Pain” 1) All of things that MI patients can do is just follow to their health status and their diet to make sure the cholesterol, blood pressure are normal. Researchers believe that all of these new studies will lead them to see the new prevention silent heart attack in the near future.

Other new research is the underlying causes of myocardial infarction. Besides gender, old age can be seen as an underlying risk of MI. More than 80% of people who die of heart disease are 65 or older, and it’s not just men. In fact, older women who have a heart attack are more likely to die within a few weeks of the attack than older men who have heart attacks (Morissens 41). When we are older, our body start the aging – process, and our vessels are not an exception. Vessels become less flexible and smaller than it were, so the risk of blood blocked is much higher. In addition, almost medications for MI is not really effective in older people. Instead, older people are encouraged to use the long-terms drugs to control the disease as well as always get ready to call ambulance when the first symptoms of MI appear. Family history is also seen as a primary chance of heart attack. Both the risk of heart disease and risk factors for heart disease are strongly linked to family history (Morissens 43). Family history also plays a big role of heart attack causing. When our parents have the heart attack history, we will think that heart attack is not going to happen to us, but it’s pretty common. The men and women in the study were part of the ongoing Oxford Vascular Study. It began in 2002 to study strokes, heart attacks, and other vascular problems. It includes more than 91,000 people in the U.K., served by a single hospital. For this study, Banerjee’s group evaluated 906 men and women who had heart attacks or other heart problems. The average age of the heart patients was 70. Banerjee looked at the medical information to see if the parents of the patients had had heart attacks. They looked to see if the patients’ brothers or sisters had strokes or heart attacks. In this case, family history more strongly predicted heart attack than stroke in the siblings (Dohery 1). People who have family history of heart attack are almost double times than people who have no family history. Those factors [gender, old age, and family history] are underlying factors that we cannot change. Therefore, we are hoping that some preventions can be found in the future that helps to limits those factors or at least that some new treatments help to control this disease.

Other new research has focused on a new treatment to myocardial infarction. Although hospital provides some treatments to heart attacks, those treatments still leave some side effects. Each type of MI methods has different side effects. Thrombolytic drug [used in Thrombotic Therapy] are clot-busting drugs that are injected to prevent the ongoing damage of heart attacks, which saves many lives in emergencies. Nevertheless, they may cause low blood pressure and excess bleeding in some patients after administration. As with all drugs these have a variety of side effects although most are temporary (Bakalar 1). Thrombotic therapy is one of the best choices to treat MI; however, it is still not a perfect treatment. Besides, angioplasty also has some bad sides that affect to body. For example, an artery collapsing or closing again, especially when stenting is not an option. It also can cause bleeding or damage to the vessels where the catheter is inserted or in the inner lining of the artery. Scar tissue can grow within a stent [restenosis], requiring a repeat procedure (Salman 40). In addition, angioplasty become useless if patients do not use medicines. The medicines have to be taken and used regularly at least one month after Angioplasty methods. Nevertheless, some medicines help to prevent or control MI also cause some unsuitable symptoms. Aspirin is a common drug that decreases pain, inhibits blood clots. People who benefit from it are may suffer atherosclerosis, angina, bypass surgery and others with a high risk of myocardial infraction. The risks of taking aspirin are the possible development of stomach ulcers and abdominal bleeding (“Aspirin” 1). Furthermore, aspirin cannot be used in pregnancy women because it affects to the development of the baby. People who are waiting to the surgery are also warned to avoid using aspirin. Ultimately, there is no perfect treatment that not only treats MI but also leaves no side effects. Therefore, many heath professors and scientists have been researching a new treatment as well as improve old ones to control and cure Myocardial Infarction.


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