What is a Heart Attack? My very short description would be: A reduction, or complete loss of blood flow to some or all of the heart, which causes the heart tissue to begin to die. The longer the loss of flow lasts, the more tissue that dies.
Pretty general, don’t you think? Doesn’t tell you much, such as what caused it, or more importantly, what’s going to happen to you. The flippant answer to that one is: It Depends… As always, the devil is in the details. What does it depend on? Well, what caused the loss of flow? How complete is the is the loss of flow? How much of your heart is affected? How healthy is your heart? How healthy are you?
Now we know in general what a heart attack is (a loss of blood flow), and what causes it (some kind of blockage), it’s time to explore some of those devilish details, and then make a guess or two about what’s maybe going to happen.
What caused the loss of flow? is it due to some problem with the heart’s ability to pump effectively, or is it a blocked blood vessel (arteries in this case).
If it’s due to a reduced ability to pump? There are several conditions that affect the ability of the heart to effectively pump, but in the case of a heart attack, I’m going to focus on one in particular – Ventricular Fibrillation or V-Fib. What’s V-Fib? It’s not a lie… It means that instead of a coordinated squeeze every second (how the heart pumps – see my previous blog on How the Heart Works), it’s just quivering or trembling like that proverbial bowl full of gelatin. This is the time for someone to be performing CPR, and hopefully with access to a defibriallator. Uncorrected, the result is death. Delayed for more than a few minutes (about four minutes, more or less), varying degrees of brain damage. Like the heart, the brain can’t tolerate extended periods without oxygen and glucose.
If it’s a blockage, where’s the blockage? The larger the vessel (arteries in this case), the more of the heart that is going to be affected, usually. The more muscle that’s damaged or dies, the more severe the heart attack, and the worse the outcome (including sudden death). Thus, a blockage of the Main Coronary Artery (MCA) is certainly life-threatening, if not immeadiately fatal. On the other end of the circulatory spectrum, if it’s a small capillary (the smallest blood vessel, barely wider than a red blood cell), there may be no obvious symptoms at all – a Silent Heart Attack. What causes these blockages? Most commonly, a small blood clot. Where clots and other types types of obstructive material can come from, and how they can be prevented, or treated, is the subject for a future blog entry.
How much of your heart is affected? Based on the two previous “what if’s” you can see that if the heart is not pumping at all, the whole heart is affected. With a blocked artery or vessel, it ranges from the whole heart to a small area. Obviously, when it’s a large vessel, much if not all, of the heart can be affected. But, if it’s that small vessel, any issues there??? Well, there can be. Since there are nerves, as well as muscle tissue, if that small area affects nerve bundles that control the pumping impulses, we’re back to possibly having major symptoms.
How healthy is your heart? Why is this a factor? Well, if your heart is in good condition, with healthy vessels, in the event of a blockage, it may be able to increase blood flow to the vessels surrounding the blocked area, and by diffusion from those nearby vessels, help keep the tissue alive longer. On the other hand, if those surrounding vessels are loaded with fat or calcium deposits (calcium makes the vessel walls hard, just like it makes bones hard), there’s going to be less ability for the heart to increase the surrounding blood flow. And whether it’s a blockage, or fibrillation, if your heart already has scar tissue replacing muscle due to previous problems, your ability to recover is going to be reduced too.
How healthy are you? If you’re in good condition without any significant health problems, you’re going to be better able to tolerate the reduced function of your heart during and after the event. If you’re in poor health, especially with any respiratory or circulatory problems (say, long term smoker, COPD, or perhaps diabetic-related damage to your circulatory system), not only are you going to be further challenged afterwards, but your heart which is already working harder, if not at capacity, is going to be even more stressed. So, if the heart is damaged, you may not be able to return to your previous level of function.
Ok, we’re back to “What’s going to happen to you?” and as you can see from what you’ve just read, the answer remains: It depends…
Stay Well -NurseBob
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