Hello, my name is Dr, Jacquelyn Eubany. I am a cardiologist/electrophysiologist. I’m happy to be here. I’m here to talk to you and educate you about heart attacks.

Most insurances will cover treatment for heart attacks including cardiac catheterization and bypass surgery because these are life-saving therapies.

An exercise stress test is an an indirect way of determining how much blockage you have in your heart. Like I mentioned earlier, a heart attack happens when you have complete blockage of the heart, but not everyone presents with an acute occlusion of the vessel. In some patients it can take some time for the vessels to completely narrow to 100% blockage. As the heart continues to narrow patients experience chest pain with exertion, that gets worse over time. So if you are having these symptoms and you go to your doctor and you’re not having any evidence of an acute heart attack, a stress test can be done to determine whether or not you have a blockage. Now, a stress test will only pick up a blockage that’s greater than 70%. when the blockage is greater than 70% that is your heart and not able to compensate and get enough oxygen to supply the heart. When seeing your doctor for chest pain, he will most likely order a stress test to determine whether or not you have a significant blockage in your heart. Now the results of these tests can take up to a day to come back. So it’s not something that you wait for prolonged periods of time to get the results. There are different kinds of stress tests can be done to determine whether or not you have a blockage. These include one, an exercise treadmill test where you just run on the treadmill and you have your heart monitored throughout the duration of the run to determine whether or not there’s a significant blockage. A second kind of stress test includes imaging along with exercise. We call this a stress echo or a nuclear stress test. In this situation, a patient runs on the treadmill and gets their heart rate to the maximum level possible. And then the hearts image to see if there are any wall motion abnormalities that will determine whether or not a patient has a blockage. And the third kind of test is a pharmacological nuclear stress tests. That is a way of imaging the heart to look to see if there are any blockages greater than 70%.

You can decrease your risk of having a heart attack by up to 80% by implementing some simple lifestyle changes. We say eating a heart healthy diet. These are usually foods that are rich in micronutrients. In grains and olive oil. We recommend the Mediterranean diet that has actually been studied recently and it showed to improve your heart health. We recommend increasing your physical activity. The American Heart Association recommends 150 minutes a week of moderate physical activity and 75 minutes a week of a vigorous physical activity. We say quit smoking if you smoke. Smoking overall is bad for your health. And we say alcohol in moderation. For a woman that’s one glass of wine a day, a five ounce glass of wine a day or one beer a day. You want to maintain a healthy weight. And if you have other risk factors like high blood pressure, diabetes, or high cholesterol, you should make sure you see your doctor on a regular basis and get these ailments controlled.

So medications that you most likely remain on indefinitely after you’ve had a heart attack, include aspirin, a medication for cholesterol, which most likely is a statin medication, medications for blood pressure, like a Beta blocker. And if you have diabetes, you will most likely remain on your diabetic medications indefinitely.

So once you’ve undergone a cardiac cath and you’ve had a stent placed, you usually put on blood thinners to prevent acute occlusion of the stents. You’re usually put on aspirin and another antiplatelet agent. It’s very important for you to take both agents chronically and not to forget to take any of those pills cause it can cause an acute blockage of one of the stents in your heart. In terms of long-term therapy for prevention of heart attack, cause once you’ve had a heart attack, you’re always at risk for having another heart attack, treatment is aimed at reducing your risk factors for heart disease and that includes controlling your cholesterol. If you do have high high cholesterol and if you’ve had a heart attack, we usually want your cholesterol to be much lower than normal. So it’s not unusual to be started on what we call statin medications for uh, for your high cholesterol. Also controlling your blood pressure cause that’s another big risk factor for heart attack. So you may be put on multiple medications to ensure that your blood pressure is adequately controlled. If you have diabetes, your blood sugar will also be tightly regulated with medications and with Diet, and of course, we encourage increasing your physical activity, eating a heart healthy diet, and making regular follow-up appointments with your doctor.

So one side effect of a statin or cholesterol medication is that of a muscle pain and muscle ache. This side effect is pretty rare, but can be deadly. If you’re taking a statin and you experience muscle pain, you should report this to your doctor ASAP for further testing and potentially stopping the medication.

For more information about heart attacks or any ailments involving the heart, you can visit the American Heart Association website.

Prevention of a heart attack is key. Knowing your risk factors and being able to decrease your risk factors, we can really decrease your risk for having a heart attack by up to 80%. Some of these risk factors or some of the things that you can do to decrease your risk for heart disease include increasing your physical activity, eating a heart healthy diet, weight loss, or maintaining a heart, healthy weight, cutting out alcohol, quitting smoking if you do smoke, and if you have other risk factors like hypertension, diabetes, or high cholesterol, you should make sure you see your doctor on a regular basis and get treated adequately for these ailments.

There are risk factors that predispose you to a heart attack. Some of these risk factors include hypertension, diabetes, being overweight, decreasing physical activity, smoking, drinking excessive amounts of alcohol, and in general, as you get older, your risk for heart attack actually increases.

The most common symptom associated with the heart attack is a chest pain or pressure. Patients describe a left sided pressure that radiates down the left arm, and sometimes it radiates up to your jaw. It can also be associated with nausea, vomiting, sweating, shortness of breath, swelling in your legs, and just overall a feeling of doom.

So the classic symptom of a heart attack includes the left sided chest pressure that radiates down the arm associated with shortness of breath. But there’s some symptoms that are not quite typical for heart attack, and that can be mistaken for other things. Some of these symptoms include nausea, vomiting, abdominal discomfort, insomnia, and sometimes shortness of breath.

Some complications associated with the coronary artery procedure includes bleeding, infection, you can actually have a heart attack while having this procedure. There’s also a risk of stroke and there’s the risk associated with the anesthesia medications that you get during the procedure.

So recovery for after a bypass surgery varies with different patients. You’re usually in the hospital for one week post surgery and then you require longer term rehab after that. The recovery time after a stent is usually 48 hours or less. Patients are able to go back to their normal activity as soon as they’re discharged from the hospital.

In conclusion, if you feel like you’re having a heart attack, you should call 911 ASAP because time is tissue. The quicker you call 911 and the quicker you get to the hospital for treatment, the more likely you are to recover 100%. it’s also important to take a baby aspirin if you feel like you’re having a heart attack.

If you have a history of a heart attack or if you have what we call chronic angina, you most likely have been given a prescription for Nitroglycerin by your doctor. If you’re at home and you experience chest pain, which you consider to be your typical angina, you should take your nitroglycerin. We say take two nitroglycerin or five minutes apart, but if you don’t have any relief of your chest pain, you should call 911 ASAP. So what Nitroglycerin does is it causes vasodilation, allowing more blood flow to the areas of your heart that lacks oxygen as a result of the blockage.

Heart attacks happen when you have an acute blockage of your arteries supplying the heart with the oxygen and nutrients it has. Aspirin is very important therapy for a heart attack because we say aspirin is a clot buster, so aspirin is able to break open that clot as it forms acutely in a heart attack and allow for reperfusion. So it’s a life-saving therapy for heart attacks.

When you’re having a heart attack, you are taken emergently to the cardiac cath to determine which artery is blocked and what percentage of blockages you have. What the cardiac cath entails is shooting a contrast through the blood vessels in your heart so that we can see all the arteries of the heart and determine where the blockages are and whether it’s fixable. So your options at that point, will include putting a stent to open up the blocked artery or refer you to surgery if these blockages are not able to be fixed with stenting. Reasons for this include smaller blood vessels being clogged, multiple arteries clogged, or your heart function just being lower than normal. In that case, you would be referred to see a cardiothoracic surgeon for bypass, which is open heart surgery and a revascularization of these vessels.

When you present to the emergency room with the heart attack, you’re initially given aspirin for therapy and some other form of anti-platelet agent, whether it be Clopidogrel or Ticagrelor. Once the diagnosis has been made, you’re taking rapidly to the cath lab to open up the blockages of your heart by putting in a stent or balloon angioplasty. Once you’ve gotten your arteries reperfused, you then go on to be treated with other medications, to include cholesterol medications, blood pressure, medications, and medications for diabetes if you do have diabetes.

So the typical symptoms for heart attack includes chest discomfort radiating down the arm associated with sweatiness, nausea, shortness of breath, very, very uncomfortable feeling. If you have any of these symptoms, you should call 911 ASAP. If you have the atypical kinds of symptoms, like the nausea, shortness of breath, and you’re not sure what you have, it’s important to seek medical attention right away because we say time is tissue. The quicker you get diagnosed with the heart attack, the quicker your artery is opened up and reperfusion is achieved, the more likely you are to recover 100% from this incident.

So coronary angioplasty is when a stent is placed in blocked arteries. So the way the procedure works is you’re brought into the cardiac cath lab, you’re sedated by the sedation nurse and catheters are put in through the groin and taken all the way up to the heart. Contrast is then injected into the arteries of the heart where you can see clearly which arteries are blocked. Then when the block artery is identified, a stent can then be put across that blockage and be ballooned open so that you have blood flow through that blocked artery.

So what is a heart attack? So heart attack happens when you have blockages in the arteries that supply the heart muscle with the oxygen and the nutrients it needs to survive. When you have complete blockage of this artery the heart tissue does not get any oxygen and nutrients and it therefore dies. These leads to symptoms of chest pain and discomfort and this is the definition of a heart attack.

Once you have been diagnosed with a heart attack and you are discharged home, you will be discharged on several new medications. It’s not uncommon to feel fatigued and tired as a result of the medications, but unfortunately you have to stay on the medications because once you’ve had a heart attack, you’re always at risk for having a second heart attack. And these medications aim to decrease your risk for having a heart attack.

So transthoracic echocardiogram is used to determine your heart function. After you’ve had a heart attack, depending on how big the heart attack is, or depending on which blood vessels is blocked, you can have abnormal function of your heart where your heart is not squeezing normally. So the echocardiogram allows us to see the normal function of the heart, to evaluate the valves of the heart, and to determine how much damage your heart has sustained as a result of having a heart attack.

So when you’re having symptoms of a chest pain and you present to the emergency room, one of the first tests that’s done in the ER to determine whether or not you’re having a heart attack is an electrocardiogram. The electrocardiogram shows a normal heart rhythm, but when you have a blockage in your heart and you have what we call ischemia, that is the heart and muscle is deprived of oxygen. There’s some changes that you see in the EKG’s that either point to the artery that’s blocked and what segment of the heart is not getting enough oxygen. And this is one of the first tests that we use to diagnose heart attacks in the emergency room.

If you feel like you’re having a heart attack at home, it’s very important for you to call 911 ASAP. Because we say time is tissue. The quicker you get help and the quicker that artery is opened up, the more likely you are to recover 100% from this incidence. So as you call 911, it’s important to take an aspirin, a baby aspirin, if there’s one available. You take a chewable aspirin by the time the EMS gets there. If you present to the emergency room with chest pain and there’s several tests that are done ASAP to determine whether or not you’re having a heart attack. The first of these tests is in electrocardiogram or EKG. An EKG is the first line that helps the emergency room doctor determine whether or not you’re having something acute that requires intervention right away or whether we can wait and continue with medical management. The next test that is done are blood test called troponins. A troponin is this enzyme that’s leaked by the heart when the heart is in distress. And when you have a heart attack, your levels of troponins rise. They may not rise initially, it takes several hours to rise. But once you come to the emergency room, it’s one of the tests that’s done ASAP. If the, if they do determine that you are having an acute heart attack, you are quickly taken to the cath lab for Cardiac Cath where that blockage is opened up acutely to allow reperfusion to the tissue. The quicker the tissue receives the oxygen and nutrients it needs, the less likely it is to, to completely die.

Once you’ve been discharged home after having a heart attack, you will most likely be enrolled in a cardiac rehab program. You do physical activity while you are being monitored. Your heart rate, your blood pressure and ECG, sometimes would be monitored while you exercise. This allows for you to heal quicker and if there are any abnormalities seen while you’re doing any physical activity, there are people around, they can stop, help you and get a doctor’s attention quickly.

So heart attack happens when you have a blockage in the arteries that supply the heart with the oxygen and nutrients that it needs to function normally. So there are different ways that this can happen. You can either have an acute occlusion of blood clot that forms rapidly, that causes a massive heart attack where you can potentially drop dead suddenly. Or this narrowing can happen over time with multiple risk factors. And as this narrowing is happening, you may experience chest discomfort with physical activity that gets worse over time as your arteries are narrowing to a close.

So once you’ve had a cardiac cath and the blockages in your heart has been defined and it’s been determined that it cannot be fixed with stents, you are then referred to a cardiac surgeon for bypass surgery. So this is open heart surgery where they attempt to bypass these blocked vessels. They get veins either from your legs or an artery from your chest that’s sewn over the blocked arteries that you have to allow blood to bypass that area of blockage. So bypass surgeries is usually recommended in patients who are not good candidates for angioplasty and stent placements. So these tend to be patients who are sicker, have multiple comorbidities, many more arteries blocked, simultaneously, or your heart function is depressed.