Heart Attack 02

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					       Lecture #3
Cardiovascular System II-
      Heart Attack
Cardiovascular System II - Heart Attack

I.   Definition of a heart attack

     -Coronary (crown) Artery Disease

     -Heart attack = loss of blood to heart due to
         artery damage

     -What causes artery damage?
Definition of a
Heart Attack

Sudden blockage of
blood flow to a portion
of the heart.

Medical term: MI
myocardial infarction
(heart muscle

Obstruction blood flow
-Blood clots can form in
    Brain blood vessel: “thrombus” (60%) – atherosclerosis!
    Body blood vessel, then travel to brain: “embolus” (20%)
  Key component of plaques:
What is cholesterol?
   Cholesterol is a fatty
   substance found in all parts
   of the body
   Used by the body to make:
     Cell membranes
     Steroid hormones
     Vitamin D
   Sources of cholesterol
     Liver and diet
Bad v. Good Cholesterol!
A lipoprotein is a biochemical assembly containing both proteins and lipids (fats).

   Function of
   LDL v. HDL?

   LDL = carries
   cholesterol to cells

   HDL = carries
   cholesterol away from
   cells               Here the driver and truck would be the lipoprotien.

        Lipoproteins in the blood, a water medium, carry fats around the body.
This is an example of a fairly good artery.
This one is not so good. Note the narrowing of the artery, which decreases the
amount of blood flow.
Good, or not so good?
This is an example of an artery with 100% blockage.
Heart Attack

Unlike angina, heart muscle
dies during a heart attack, and
loss of the muscle is

While heart attacks can occur
at any time, most heart attacks
occur between 4:00 A.M. and
10:00 A.M. because of the
higher blood levels of
adrenaline released from the
adrenal glands during the
morning hours. Increased
adrenaline may contribute to
rupture of cholesterol plaques.
Warning signals of a heart attack
• Uncomfortable pressure, fullness, squeezing or pain in
  the center of the chest lasting more than a few minutes.

• Pain spreading to the shoulders, neck or arms. The pain
  may be mild to intense. It may feel like pressure,
  tightness, burning, or heavy weight. It may be located in
  the chest, upper abdomen, neck, jaw, or inside the arms
  or shoulders.

• Chest discomfort with lightheadedness, fainting,
  sweating, nausea or shortness of breath.

•   Anxiety, nervousness and/or cold, sweaty skin.
•   Paleness or pallor.
•   Increased or irregular heart rate.
•   Feeling of impending doom.

                                         American Heart Association
• Not all of these signs occur in every attack.
• Sometimes they go away and return. If some
  occur, get help fast.


      Cardiovascular System II - Heart Attack
I.     Definition of a heart attack
II.    How is a heart attack diagnosed?
        - Coronary risk factors
           –   Smoking
           –   Lack of physical activity
           –   Stress
           –   Alcohol
           –   Family history
        - Blood test
           –   Standard markers : cholesterol, tri glycerides
           –   New: homocysteine, C-reactive protein, fibrinogen
How do doctors diagnose a heart attack?
1. Review the patient's complete medical
2. Give a physical examination.
3. Use an electrocardiogram (or EKG) to
   discover any abnormalities caused by
   damage to the heart.
4. Use a blood test to detect abnormal
   levels of certain proteins/enzymes in the
       Medical history/physical exam reveals
                     risk factors
•   High blood pressure – promotes vessel damage

•   High blood cholesterol levels – promotes atherosclerosis

•   Smoking - increases vessel inflammation promoting increased
    atherosclerosis, promotes excessive blood clotting

•   Lack physical activity – leads to high blood pressure and obesity

•   Stress – raises blood pressure

•   Alcohol – in moderation can increase HDL (“good” cholesterol),
    excessive levels lead to increased blood pressure and triglyceride

•   Family history of heart attack – genetic conditions may raise
    cholesterol levels, blood pressure; poor health habits
What lasting damage can a stroke cause?
                                 The effects of a stroke depend on the
                                 extent and the location of damage in the
                                 brain. Among the many types of
                                 damage that can result from a stroke

                                      Inability to move part of the body
                                      Weakness in part of the body
                                      Memory loss
                                      Inability to speak or understand
                                      Change in personality
                                      Confusion or poor judgment
                                      Difficulty swallowing
 Question: Why does a stroke affect
 different parts of the body?

 Answer: ???
How to help a stroke victim:

Call 911

Have him lie down

Lift chin to clear airway

Check for breathing and pulse

If he is unconscious, roll him on his side

Do not give food or drink

Reassure and comfort
       Heart Attack analysis - blood test

                                                        •    Cholesterol: LDL, HDL
                                                        •    Triglycerides
                                                        •    High levels of blood
                                                            1. Homocysteine
                                                            2. C-reactive protein
                                                            3. fibrinogen
  Cardiovascular System II - Heart Attack

I. Definition of a heart attack
II. How is a heart attack diagnosed?
III. Treatment
    - medication
    - intervention
    - bypass surgery
              Heart attack - treatment
•   Medications for this purpose may include:
     – aspirin
         • anti-inflammatory
         • prevents platelets from sticking together to form clots
     – heparin
         • blood-thinner
     – thrombolytic therapy
         • "clot busters" break apart fiberous tissue holding clot together
     – Statins?
         • typically used to lower cholesterol levels
         • appears to lower inflammation of heart muscle after attack

•   Interventional procedures
     – Angioplasty
     – Stents
         • open up the narrowed arteries
         • break up any clots that are blocking them

•   Coronary artery bypass surgery
     – If necessary, bypass surgery may be performed to restore the heart
       muscle's supply of blood.
    Heart attack – treatment: medication

•Clot buster drugs need to be administered within three hours heart attack
    -Every minute of delay shaves 11 days off a heart attack patient’s life
Heart attack – treatment:
“Balloon” Angioplasty

  •A catheter (fine, hollow tube)
  passed into an artery in groin or

  •X-ray used to guide catheter to
  blocked vessel

  •Balloon inflated

  •As balloon is inflated, stent (short
  tube of stainless steel mesh)

  •Balloon removed, leaving stent in

Heart attack – treatment: bypass surgery

•Bypass surgery creates new pathways of circulation around existing
•A healthy blood vessel from another part of the body becomes a "conduit"
to the coronary artery at a point beyond the narrowed artery.
•The blocked or narrowed portion of the artery is "bypassed" with this
vessel, allowing blood to flow to the heart muscle again.

Bill Clinton to Undergo Bypass Surgery
Sept. 3, 2004
                                         Former President Bill
                                         Clinton will undergo heart
                                         bypass surgery as early as
                                         Saturday, sources tell
                                         CNN. Clinton was in New
                                         York-Presbyterian Hospital
                                         on Friday undergoing tests
                                         for chest discomfort.
   Cardiovascular System II - Heart Attack
I. Definition of a heart attack
II. How is a heart attack diagnosed?
III. Treatment

IV. What can you do to prevent a heart attack?
     -Improve your diet!

 What fats should you eat?
Saturated fats     Unsaturated fats
Most animal fats     Most plant fats
are saturated        are unsaturated
                     (canola, olive oil)
                  Key points to remember
Dietary Habit                                 How it effects us

Healthy amounts of unsaturated        fat     Reduces LDL and increases HDL

Too much of saturated      fat                 Increases LDL

Any amount trans    fat                        Increases LDL and reduces HDL

Too much of any type of fat                    Increases weight ** and increases

Diet rich with Essential Fatty Acids with      Lowers triglycerides, lowers blood
proper ratio of omega-3 and omega-6           pressure, increases HDL
** could lead to increase in blood sugars, blood pressure as well as cholesterol.
                      Heart Attack - SUMMARY
1. Coronary artery disease (CAD): blockage of the arteries leading to
      the heart muscle resulting in
        - partial (heart attack) or
        - full loss (heart failure) of heart muscle activity

2. Causes of CAD:
       - poor diet (increases cholesterol levels)
       - anything that increases inflammation of the blood vessels

3. Diagnosis of heart attack complex:
        - cholesterol, homocysteine, C-RP, fibrinogen

4. Current treatment:
        - intervention or bypass surgery recommended
        - recent study shows medications are equally effective?

5. How avoid CAD?
        - eat well:   =replace animal fats with plant fats (oils)
                      =avoid “partially hydrogenated” / trans fat products
                      =eat correct levels of ocean fish

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