Living with
Myocardial Infarction (Heart Attack)

A heart attack, referred to as myocardial infarction (MI) in medical terms, is permanent damage of the heart muscle, or death of parts of the heart muscle due to lack of blood supply and insufficient oxygen provided to heart muscle (the myocardium). 

How do you know it is a heart attack?

If you are having a heart attack you may experience the following common symptoms: 

• Chest pains 

• Shortness of breath (dyspnoea) 

• Sweating, palpitations and anxiety 

• Fatigue and weakness 

• Nausea and/or vomiting. 

However, there is evidence that at least 45 % of all myocardial infarction incidents have no visible symptoms and are considered to be “silent” infarctions. 

What are the causes of heart attack?

The prevalence of heart attack is on the rise in South Africa, and the Heart and Stroke Foundation estimate that five people experience a heart attack every minute. 

The root cause of most heart attacks is a blood clot that blocks one of the coronary arteries. The coronary arteries are blood vessels responsible for bringing blood and therefore oxygen to the heart. If blood flow is blocked, the human heart is starved of oxygen and the heart cells

die. Blockages are commonly caused by a hard substance called plaque (made up of cholesterol and dead cells) that builds up in the walls of your coronary arteries. 

A heart attack usually occurs in two cases: 

1) When the plaque’s hard, outer shell cracks (i.e. plaque rupture), platelets (particles in the blood that aid clotting) come to the area, forming blood clots at the site of the rupture. The clot may block the supply of blood to the heart, triggering a heart attack. 

2) Although less common, a heart attack can also be caused by a spasm of a coronary artery. Blood supply to heart is reduced when the coronary artery spasms or restricts. 

Coronary heart disease (CHD) is type of heart disease that occurs when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. CHD is commonly caused when a waxy substance called plaque builds up within the coronary arteries. This is known as atherosclerosis. Atherosclerosis is a gradual process. Sometimes, plaques may rupture inside of an artery, or, in other cases, the plaque becomes large enough to completely block blood flow through a coronary artery. 

Coronary artery spasm is a less common cause of heart attack as compared to coronary heart disease. A severe spasm (tightening) of a coronary artery may cut off blood flow through a coronary artery that is NOT affected by atherosclerosis. A coronary artery spasm may occur due to cigarette smoking, usage of drugs such as cocaine, extreme emotional stress or pain or exposure to cold weather. Coronary artery spasms often occur at night between midnight and early morning, unlike angina, which usually occurs with exercise. 

The risk factors for heart attacks are:

• A family history of vascular disease like stroke, arrhythmia and CAD (atherosclerotic heart disease) or angina. 

• Age. These diseases mostly affect men over the age of 45 and women over 55. 

• Cigarette smoke 

• Frequent or excessive alcohol usage 

• A sedentary and inactive lifestyle

• High-fat diet 

• High stress levels 

• Obesity 

• High blood pressure 

• High cholesterol 

• Diabetes 

• A history of preeclampsia 

• Illegal drug use 

• An autoimmune condition, such as rheumatoid arthritis or lupus 

Living and Managing 

Knowing your risk factors and reducing them can significantly reduce your risk of suffering a heart attack or the risk of experiencing a further one and heart damage if you have had one before. 

By working closely with your doctor, you can reduce your risk of heart attack by focusing on the following healthy lifestyle measures: 

• Manage your blood pressure 

As hypertension is the biggest cause of heart and blood vessel disease, keeping your blood pressure levels within healthy limits is very important in preventing heart attack. 

Click here to read more about how to better manage your blood pressure, including reducing your dietary salt intake. 

You can also access your own Cooking from the Heart Low Salt booklet, containing listed salt contents of South Africa’s most popular foods and nutrition brands. You’ll never be tricked again and might save yourself a headache trying to understand complicated, and often misleading, food labels. Download it now for healthier cooking, shopping and snacking! 

• Eat a healthy diet low in fat and cholesterol

If your cholesterol levels are high, even with a healthy diet, speak to doctor about medication to manage your cholesterol levels. 

Click here to read about how to eat a heart-healthy, low-fat diet. 

• Exercise and try to maintain a healthy weight 

Try to keep as active as possible. You don’t have to join a gym to do this; instead, just take regular walks, ride a bike or dance along to the music on your radio. Your goal should be 30 minutes of moderate activity (makes you sweat and your heart beat a little faster) most days of the week. Regular physical activity helps you manage your blood pressure and glucose levels, lose weight, and alleviates stress, thereby reducing the risk of heart disease. 

• Manage your diabetes 

Eating a healthy low-fat and low-sugar diet, exercising regularly and maintaining a healthy weight will all help you successfully manage your blood sugar levels. 

If your blood sugar levels are still above normal, even with healthy diet and exercise, then speak to your doctor as you may need to take medication to manage your blood sugar levels. 

• Manage stress 

When you are stressed, your heart rate and blood pressure go up – this is not good for your heart or blood vessels. You may also not manage your blood pressure or other chronic conditions and forget to exercise, eat correctly or take your medicines when you are anxious. 

Find ways to relieve stress, like meditation, mindfulness or yoga. 

• Stop smoking 

Talk to your doctor about ways to quit smoking, as tobacco smoke significantly increases your risk of heart disease. 

• Limit your alcohol consumption 

As excess alcohol consumption damages the heart and blood vessels, you will need to speak to your doctor or healthcare provider about what amount of alcohol is appropriate for you to consume. Generally, to stay healthy, it is recommended that women not exceed one glass of alcohol per day, while men should have no more than two glasses per day.

What is the treatment for a heart attack? 

If you have the symptoms of a heart attack, seek medical attention as soon as possible to prevent sustained heart damage. Your blood pressure, pulse and temperature will be checked and diagnostic tests, including an electrocardiogram (ECG) and blood tests, will be run. 

If you are having, or have had a heart attack, you will be treated immediately and you may have to undergo further tests. This can include a chest x-ray, echocardiogram, angiogram, cardiac CT or MRI. 

Doctors will determine a treatment plan depending on the severity of your condition, as well as other health conditions you may have. This can involve thrombolytic therapy, percutaneous coronary intervention or, for severe cases, bypass surgery will be performed to unblock the affected coronary artery

Long-term medical treatment for heart attacks usually includes a combination of the following: 

• Antiplatelet therapy (like aspirin) 

• Beta-blockers 

• ACE-inhibitors 

• Statin if you have high cholesterol. 

There is some evidence that supplementation with magnesium may benefit those with heart disease as well. 

WHAT ARE THE COMPLICATIONS OF A HEART ATTACK? 

Complications from heart attack are very likely to occur immediately. This is why heart attacks can be fatal and need immediate attention. 

These complications can include, amongst others: 

• Cardiac arrest 

• Cardiogenic shock 

• Heart failure 

• Arrhythmias 

• Myocardial rupture 

• Pericarditis (inflammation of the pericardium, or membrane around the heart) 

What are the complications of a heart attack?

Complications from heart attack are very likely to occur immediately. This is why heart attacks can be fatal and need immediate attention. 

These complications can include, amongst others: 

• Cardiac arrest 

• Cardiogenic shock 

• Heart failure 

• Arrhythmias 

• Myocardial rupture 

• Pericarditis (inflammation of the pericardium, or membrane around the heart)