Heart Attack!

[doc henderson]

So there is a lot of confusion on this topic.  Many people report having many heart attacks assuming any pain in the chest is there heart let alone a myocardial infarction.  a MI is really like a stroke but to your heart.  It is a miracle that our hearts last long enough to let some live into their 90s.  how many other pumps do you have that run 24/7 for that long.  

Our arteries get cholesterol in the lining of the wall.  this is seen in children.  this over time gets hard with calcium being incorporated.  imagine fixing a tire or innertube with concrete.  You feel a pulse over and artery because it expands and contract with the pressure change or wave with each time the heart has a contraction and half empties the ventricles.  

If a hardened plaque gets a crack in it, it exposes collagen, and your blood thinks you are bleeding so it try's to clot it off.  the heart muscle has its own blood supple from the outside of the heart via the coronary arteries.  when these have a calcium laden plaque that cracks, and you get a clot, you have an acute MI.  the clots blocks the blood flow. This will give you pain in the chest (with exceptions) and the location will be represented on your EKG.  There are dozens of measurements and segments we look at on the EKG.  The ST segment is elevated, and we should get you to the cath. lab ASAP.  We call this an ST elevated MI or STEMI.

You may get a heart cath. in general, scheduled at a later date if you are having problems with angina, or loss of strength in the muscle.  not all heart caths are an emergency.  

I will post an EKG, but i have to remove any identifying data first.

here is the first image of a coronary vessel at heart cath.  note the area of narrowing.  that is the plaque with clot on it.  you are seeing the contrast dye going through the vessel or in other words, the out line of the inside, and flow through the coronary arteries.




 





 

you can see in the cropped area, the wire and the narrow segment.  In the center of the cropped pic.
next is after a catheter with a balloon is put in and blown up to expand the area, and then a stent is placed over a balloon.  think of a small tube made like expandable meatal that expands as the balloon is inflated, and it hold or "stents" the area open.



 


the next is the actual clot that was retrieved.  




 

we are lucky to have a cardiologist that is able to do interventions beyond the normal and help folks in a smaller facility like ours.  I hope this helps to alleviate confusion about a heart cath., how and why it is done, and why it is not always done emergently.  

[LeeB]

Glad it was not as I thought when I saw your title.

[doc henderson]

Thanks.  I like a catchy title.  I was working and collaborated with the cardio doc.

[Magicman]

From the pictures I thought that we were gonna bait our hooks and go fishing.

[metalspinner]

Are any diagnostics ever done prior to an event? Then treatment to prevent? 

[beenthere]

Doc 
Great info you present. For certain answered questions about "suspect" flashing pain that causes one to panic a bit. 
Last Wed. morning I got dizzy and couldn't function very well. Called 911 for a visit to the ER and right away hooked me up with sensors all over the body. Said I was dehydrated so the started me on a drip bag. 
This morning, I looked up EKG to see if maybe they did an EKG test and suspect they did. No mention of any heart problem so "assume" that part of me is okay. (Have a nurse daughter, a pediatric PA son, and a 3rd year med-student grand-daughter to look at those reports)

The ER docs wanted me to make an appt. with my Dr. soon, but found out my Dr. is on a month vacation. So accepted a visit yesterday with a PA. Nice young gal who interpreted the ER report that she had from the ER visit. 
While there, I inquired about a test to check out my carotid arteries. Reason was my father had dizzy/throw-up spells for several years, until a country Doc in Arkansas asked him if he ever had his carotid arteries checked out. He said no, but subsequently learned one side was almost completely blocked and the other 60% blocked (iirc). Not sure what the next step was, but after some surgery work he suffered no more dizziness. 
So next week scheduled for an echo cardio imaging which apparently uses ultrasound to check out the carotid arteries. Am sure not the same, but cut my professional eye teeth developing ultrasonics tests to locate defects in wood. 

Doc: Much appreciate the knowledge you share with us here on the FF. We are quite fortunate.

[barbender]

That is something I think about a lot. My Dad had 2 heart attacks and a quadruple bypass surgery by the time he was 50. All due to blockages. The family has a disposition towards that, we have a lot of heart problems that come with Native ancestry. Going from a hunter/gatherer culture to a modern diet in less than a generation was kind of tough on us and we haven't adapted yet😊 

 Anyways, I did get a bunch of testing done, including a stress test, about 8 years ago. All was well at that time, but since then I have put on weight and had to start taking medication for blood pressure and cholesterol. Triglycerides are always off the chart, even when my other numbers are good. 

 All of that said, anytime Doc is giving some real world info on heart issues I pay special attention.

[Claybraker]

Are any diagnostics ever done prior to an event? Then treatment to prevent?

I have a stent because I didn't study for my stress test. I failed. The doc called me back for a follow up in a couple days, then scheduled the heart cath 2 weeks later. Pretty uneventful procedure except for the delay because someone else showed up at the emergency room in heart failure so they had to wheel me back out of the operating room to deal with that patient first. Then he couldn't clear the blockage in the left anterior descending artery and placed a stent. that was 2017, I passed my stress test in 2018, next week during a routine visit I figure the doc is gonna tell me it's time for me to be a gerbil on a treadmill again.

[doc henderson]

BT the echo will look mostly at your heart.  if they  tell you your ejection fraction is 60%, that is perfect.  many come and tell me they only have 50% heart function, but the is a 2 d view how much blood is ejected from the ventricle with each beat.  cannot eject 100% with each beat.  so it is easy to misunderstand the wording.  you may need a dedicated carotid doppler if they do not spend time on your neck.  

There is a cat scan that looks at the calcium in your coronaries, but many think it is too much radiation (risk vs benefit) so if at high risk, or having mild symptoms, you get a stress test.  if older they may let you lay on a bed and give a med to stress your heart.  they may do an echo at the same time to make the test more sensitive.  they may give you a radionucleotide to see what part of the heart are working.  The ultimate is a heart cath.  it has radiation and iodinated contrast that can be hard on the kidneys.  

In the ED we do a lab test called a troponin that goes up with heart damage, and EKG to look for elevation or the ST segment.  or other subtle things to raise our suspicions.  high risk with family history or cholesterol, diabetes or hypertension also gets our attention.  most people decline to call it chest pain, and say it was a pressure like a weight, and then we are more suspicious.  women and diabetic may have subtle symptoms, but really that is a campaign to increase our suspicion, since we used to think of MI as a older mans disease.

[GAB]

I guess they are more generous with stents in this area cuz I didn't study either and got 4 of 'em.
GAB

[doc henderson]

sounds like you passed.  some will wait on a 70% blockage and save the stent for later.  not if they think that lesion is causing the reported problem like fatigue.  some time the blockage is in a bad location or too many for stents and they do a bypass.  sometimes if a cath. or surgery is too risky then they medically manage.  nitro and or bp meds.  also platelets start the clot so we use aspirin and or Plavix.

coronary clots usually start in the coronary over a ruptured plaque.  stroke clots can form in the artery in the brain, or in the neck and break loose and go the next smaller size artery in the brain.  they branch and get smaller like a tree.  for pulmonary embolism they usually start in the legs or right atrium, and get caught up in the flow and go to the lungs.  that is what embolism means, flows from somewhere else until it gets to a smaller artery and gets lodged.  

[Texas Ranger]

My wife, serious health nut, had a takotsubo cardiomyopathy,  Stress or broken heart syndrome.  Felt a tightness in her chest, blood test showed elevated enzyme levels.  Trip to the ER, tested, shipped to Houston.  Two days later no blockage, no serious damage that cardiologist said would be/ and is  being treated to return to full heart health,  New meds, cardiac rehab` and it is working.

Don't play with your heart, get to the ER if you don't know what is going on.  

[Peter Drouin]

Don't take much to take you out.

[doc henderson]

 

 

skinny spot inside the coronary.  sent to cath. for stent.



 

open post cath.  vessel to the bottom of the heart.
the one that goes to the "place you love everyone from".  

[doctorb]

Good visual example.

[barbender]

Haha Doc if that means what I think you meant, definitely want that one opened up.

[doc henderson]

I just meant if you "Love someone from the bottom of your heart". that vessel goes there.  

I do not always get pics, but this one is easier for non cardiologists to see.  pt. did very well.

[Peter Drouin]

What symptoms did the person have to go looking for that?

[doc henderson]

chest pressure.  more a weight than a sharp pain.

but the ST segment is elevated. on the EKG. A STEMI.

funny you should ask, I was just handed this.



 

the flat area right after the spike, is the ST segment, and it should be in line with the rest of the baseline.  go to cath lab, do not pass go do not get 200 bucks.

[dougtrr2]

Went to the ER this weekend.  History of heart issues in family.  Father had bypass surgery.  Five years ago brother (two years older than me) had heart problem and required  stents.  He died two years ago after being given a clean bill of health a month prior.

Saturday I had chest pain like a band tightening around my chest.  I've had minor episodes of this but shake them off.  But this time I also had jaw pain.  So off to the ER I go.  The jaw pain is what spooked me.  I have never experienced that before.  Chest pain, could just be exertion.  I normally don't worry about an ache or pain if I have some idea of what caused it.  

They found nothing, EKG okay, heart enzyme stable, not further pain.  Blood pressure was high, to be expected I guess. I normally run low. Sent home and making a followup with primary care this week.

Doug in SW IA

[doc henderson]

I do not see your age, Doug, but they may want you to run a stress test.

[Iwawoodwork]

Doc, Thanks for the very understandable info and the visual pictures. 

[dougtrr2]

I do not see your age, Doug, but they may want you to run a stress test.

I'll be 69 this year.  At my last physical I related some of the minor/annoying issues I have.  Mainly, a random shortness of breath unrelated to activity.  He suggested if it was bothering me we could consider a stress test.  I have had them in the past, in fact I had one right after my brother's heart issue.  At that point I looked and him and said " Doc, last week I did a 108 mile ride on my bicycle with no issues,  do you think a stress test is going to find anything?"  He kind of chuckled and said" probably not".  We will see what comes out of today's appointment. With my family history, I do have a cardiologist.  I am not overly concerned, just being very mindful of the family history. 
Doug in SW IA

[doc henderson]

Everyone thinks heart.  get  follow up with the cardiologist.  there mare several systems that make the heart go.  may need an echo to check muscle strength, and poss. a monitor to r/o intermittent arrhythmia.  next may be a pulmonary doc and a pulmonary function test.  the bike rides are a good sign you are in overall good health.  some marathon guys drop over from having too conditioned a heart.  It could be reactive airways like asthma or even vocal cord dysfunction.  If you are a gaget guy, you can get a pulse-ox and check your own sats and heart rate during an episode.

[beenthere]

Last week had an echocardiogram, 48 hour Holter monitor, and carotid ultrasounds. The words that explain it get to be long and hard to understand, but so far the test reports are sounding good. Heart mostly normal, carotid arteries show minor plaque, and am waiting to hear the results from the Holter monitor, which I believe is an electrocardiogram.

Had a CT head scan and the Dr. said they found nothing..  : :  But smiled and said found nothing in the brain to be concerned about.
Was some additional words in the CT report "patchy areas of white matter in a pattern.... comparable with chronic microangiopathic white matter disease". Being in Wisconsin, sounds like cheese in the brain and probably because I am a cheese head. No other explanation.