Heart Attack – myocardial infarction, ‘coronary’
A HEART ATTACK IS A TRUE EMERGENCY
Description: a heart attack feels like severe angina pain (as described in the angina section – heavy tight chest pains radiating into the arms, jaw and back) lasting more than 30-40 minutes and is often associated with sweating, nausea, faintness and a feeling of being unwell. It is caused by a total blockage developing in one of the coronary arteries. The greatest danger at this stage is the occurrence of a serious change in heart rhythm when the heart fibrillates (ventricular fibrillation) the cause of cardiac arrest or sudden cardiac death.
What doctors can do
Paramedic ambulances provide defibrillator and drugs at home. Get one to the patient as soon as possible.
Drugs. Aspirin to reduce the clot formation and thrombolytic drugs which can dissolve the clot causing the heart attack. Sometimes other drugs are used to control pain, blood pressure or rhythm disturbances.
Investigations. ECG, heart monitors are used to detect any abnormal rhythms and an echocardiogram can review the degree of heart damage. When indicated, an angiogram is arranged and this may be followed by angioplasty and stent or bypass surgery.
What you can do
Act immediately – this is not the time to have doubts or worry about it being a false alarm.
- Take one or two puffs of GTN spray (if you have one) every 5 minutes, sit quietly and try to relax,
- If the angina pain lasts more than 20-30 minutes, call an ambulance (111, 999, 911 depending on your location, and say you have prolonged chest pain). Often the pain is severe and associated with sweating and feeling faint, but not always. Any prolonged heavy pain needs to be a concern.
- Chew one aspirin tablet (300mg).
- Chew a magnesium tablet (800mg) if you have one.
The most important thing is to get to a place where your heart rhythm can be monitored and treated if necessary – this means in an ambulance or a coronary care unit.
Thrombolytic drugs dissolve the clot causing the heart attack and can actually reverse the damage, so the earlier this treatment is given, the less damage there is to the heart. Therefore get to hospital as fast as possible, preferably by ambulance, do not drive yourself!
Cardiac arrest – if the heart stops (cardiac arrest) the person will die unless they receive CPR to keep the heart beating, and then defibrillation to shock the heart back into action:
CPR is not difficult – it is no longer recommended for lay people to give mouth to mouth resuscitation. CPR just requires rapid chest compressions ( about 100 times per minute), pushing the chest in about 2 inches (5cm). click here
Defibrillators (AEDs) are now available in many locations and can be used by lay people. Place the leads on the chest as shown, turn on the machine and obey the simple instructions. These can shock the heart back into its normal rhythm and save a life! click here
After the heart attack
Usually a patient spends 4-5 days in hospital and then goes home. Convalescence is usually about 4-6 weeks to allow the heart to completely heal. Once the heart is healed the most important thing is to prevent another heart attack.
What doctors can do
- Drugs. Most patients are put on aspirin, a statin drug to lower the cholesterol; a beta blocker, to reduce the work of the heart and sometimes an ACE inhibitor. Other anticlotting drugs are sometimes also prescribed (clopidogrel). (Many people prefer not to take statin drugs – this is discussed below **)
- Investigations. An exercise ECG and an echocardiogram are usually organised after a few weeks and frequently an angiogram may be performed, to assess the degree of damage, but most importantly to determine if there is a risk of further attacks.
What you can do
- Exercise – gradually increase physical activity; walking is the best. Don’t overdo it and slow down if the exercise causes breathlessness or chest pain. Always warm up before doing more strenuous activity.
- Have a good night’s sleep and if necessary have an afternoon nap for the first few weeks. Learn how to relax or even meditate, and reduce the stresses in life.
- Diet is important. Don’t eat huge meals and don’t exercise after eating. Eat lots of fruit, vegetables, grains and fish. Limit the red meat, and use mainly monounsaturated oils and avoid trans fats. For heart patients, the Mediterranean diet is the best and easiest one to follow.
Although there are few trials on the use of supplements after a heart attack, the powerful data on the preventive benefits of supplements probably apply.
- A good multivitamin and multimineral provides the heart tissue with all the nutrition for efficient repair and also will lower the homocysteine which is a strong heart risk factor. In areas where the selenium levels of the soil are low added selenium, 150ug/day or make sure it is in the multi tablet.
- Calcium and magnesium, 800-1,000mg daily, help the heart function, enabling it to relax. Magnesium can also lower blood pressure and reduce rhythm abnormalities and may reduce the risk or further cardiac arrests.
- Vitamin D – there is increasing evidence that low vitamin D levels increase the risk of heart attacks. Sun exposure is good but most people probably require 5-8,000iu daily as a supplement as well.
- Omega 3 fish oils − at least 1 gram daily, preferably 2-3 grams daily − are very important in reducing recurrences and also reducing the risk of serious rhythm abnormalities including cardiac arrest.
- Coenzyme Q10 is very important at this stage. It is essential for energy production within the cells, and the heart muscle usually has a very rich supply of CoQ10. The statin drugs (Zocor Lipex, Lipitor), used in nearly all heart patients to lower cholesterol, also block the production of CoQ10. Many people suspect this could increase the risk of developing heart failure later in life. All people taking statin drugs should also be taking Coenzyme Q10 supplements (60–200mg daily).
The Nutritional supplements I use and recommend to my patients
For Heart patients – USANA – Cellsentials *, Biomega, Active Calcium plus, Coquinone and vitamin D –
Other therapiesThere are a number of other therapies which you might like to look at. They have not been specifically included with this disease because some are a form of treatment which is applicable to most diseases and many focus on the mind, body, spirit, and the universe. These include - acupuncture, Ayurvedic medicine, energy healing, homeopathy, naturopathy, prayer, visualisation and some people with this condition might like to look at these topics (I have described them more fully on another page on this website click here .) With my personal experience and reading, I do not think that I can comment of whether one or a number of these might help. They fit well with most conventional and complementary treatments and I suspect some or even all of them can be extremely powerful - if performed by an experienced practitioner. My only caveat is that if in the course of one of these therapies, you are given potions or herbs, do check with your health practitioner that they will not interfere with other treatments or drugs you are receiving.
Nutritional supplementsI believe in today's world that nutritional supplements are so necessary as to be an essential component of any form of both prevention and treatment. Not only is today's food lacking in nutrients because of the way it was grown and processed, but also most of us make the wrong choices in diet. It is virtually impossible to obtain optimal levels of most of the vitamins, minerals and other nutrients although many people try to do so, and even then fresh produce is not available all year round. *There are many quality supplements available on the market, including –Thorne, NFS, Douglas Labs, Xtend Life, True Star Health, USANA, and Metagenics. There are others, but do your due diligence before choosing one. USANA Health Sciences has added a new adjunct to its multivitamin and multi mineral called CellSentials. These are a patented blend of phyto-nutrients which they believe affects cell signaling and growth, and increases the production of preventative antioxidants within the cell. These should add to the value of the multi, so these are the multivitamin/mineral preparation I recommend.
** There is a strong anti-statin lobby making people resistant to taking these drugs. In part this is reasonable, and there is no doubt the pharmaceutical industry and some medical authorities are pushing the use of statin drugs in many situations, and there is even a suggestion that everyone over the age of 50 should be taking a statin as part of a ‘polypill‘. However the evidence for many of the claims is not strong, and just because the cholesterol is lowered, this does not necessarily reduce heart and other diseases. The drugs also have significant side effects – muscle pain, mental blunting, abnormal liver function tests, nerve pains. However in patients who have definite heart disease, statins in many good trials have been shown to reduce the risk of further heart attack, stroke or death bu 10 – 20%. For a person who has had a heart attack, a 20% reduction for further events is significant, and my advice is to take a statin drug. If it causes side effects try another one (most doctors give simvastatin or atorvastatin – switch to Pravastatin which is water soluble). If the side effects are still present, then discuss with your doctor about stopping them.
I have also written in greater depth on this website – look under Statins.