Wednesday, February 01, 2006

Signs of a heart attack

This is part eleven of the series the heart of the matter. Part ten can be found here and the disclaimer can be found here.

A heart attack usually causes severe chest pains which is usually over the center of the chest, but feels deep seated. The pain sometimes radiates to the throat, jaw or inner aspect of the left arm. It is usually unprovoked or can also occur following exertion.

The pain, sometimes described as heaviness, crushing, tightness, or shortness of breathe, is usually so severe that it is accompanied by profuse cold sweat, nausea and vomiting. Often, in old people, the pains can be very atypical. Heart attacks in the elderly, can present as faints, loss of consciousness, nausea, vomiting, or just feeling generally unwell. Often, heart attacks can occur silently, especially in diabetics, and only to be discovered on incidental ECG recording for other reasons.

It is fair to say that in patients of the coronary risk group (two or more coronary risk factors), any chest pains should be checked out, the more unwell, the sooner. Better to be overcautious and safe, then to be late and sorry. The ECG is a simple non-invasive means to diagnose a heart attack.

Your doctor may see an ECG such as the one above where the ST elevation is indicative of a heart attack.

Besides an ECG, certain blood test can also be used to diagnose a heart attack. The blood test are to estimate the level of cardiac enzymes in the blood. When heart muscles die, they release enzymes (certain cellular proteins that help in cellular functions). The higher the level, the greater the degree of heart muscle damage.

Some of the heart uscle enzymes that we routinely measure, are SGOT, SGPT, LDH, CPK, CKMB, Troponin T, Troponin I, and others. Some of these blood test can be done by the bedside, eg Troponin T, so that the results can be known immediate, and a definite diagnosis made. REMEMBER TIME IS HEART MUSCLE. For a definite diagnosis of heart attack WHO (World Health Organization) recommends at least two of the three criteria being present. The criteria are definite history suggestive of heart attack, ECG changes of heart attack, or blood test suggestive of a heart attack.

Next we discuss what to do in case of a heart attack.

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