Everything you need to know about myocardial infarction

Dr. Cabrera is a recognized specialist in Cardiology in Madrid, an expert in the field of percutaneous treatment of cardiac rhythm disorders, especially atrial fibrillation. He is head of the specialty in different Quirónsalud centers, and Professor at the European University of Madrid. He has published more than 80 articles and book chapters, and has presented more than 400 communications and papers at national and international congresses. He is also a member of different associations and institutions.

What is the incidence of myocardial infarction?

Before the end of the year some 70,000 people in our country will have had an acute myocardial infarction. The problem is that 30% of these people do not reach the hospital. This implies the need to establish prevention of cardiovascular disease from the onset of symptoms. Cardiovascular disease accounts for a mortality of about 120000 people per year, which indicates that it is the most frequent cause of death in the western world. This puts us physicians on alert to establish prevention in diagnosis, prevention in treatment and avoid the mortality of the disease.

How does it occur?

Acute myocardial infarction occurs in the context of arteriosclerotic disease. Arteriosclerotic disease is a progressive disease that occurs by three facts: one is inflammation, the second is oxidation and the third is thrombosis. What does thrombosis mean? Thrombosis means that a thrombus, a clot, occurs in one of the arteries of the heart. It is easy to understand. We have a cardiac muscle which is the ventricular myocardium, that is why we speak of myocardial infarction. The ventricular myocardium is vascularized, it needs blood, it needs its arteries to irrigate it. When an acute myocardial infarction occurs, one of the main coronary vessels, one of the main arteries of the heart becomes thrombosed, that is, occluded. A thrombus forms inside it. And when the thrombus forms inside, the rest of the cardiac muscle is not vascularized and then dies. That is the concept of acute myocardial infarction. What determines that a person can have an acute myocardial infarction? There are genetic factors, but in general it is environmental factors, our lifestyle habits. Whether or not we lead a heart-healthy life. Controlling our coronary risk factors. What are the coronary risk factors? We are talking about important factors, factors on which we can act, we can modify them. We as patients who want to avoid having a heart attack, or I as a cardiologist, who want to avoid having a heart attack, am looking to prevent cardiovascular risk factors. The main ones are hypertension. We have to control blood pressure, both high and low. Systolic and diastolic blood pressure. Second is cholesterol control. Keeping the cholesterol level in check is very important. The third important factor is to avoid smoking. We cannot smoke. Young children are smoking and that indicates that there may be progression of cardiovascular disease from a young age. Hypertension, hypercholesterolemia, smoking. But undoubtedly a major risk factor, which is very important, that we should not forget is overweight, obesity, and physical inactivity. Both factors determine, in a very important way, the progression of the disease, the formation of the thrombus and the risk of occluding a vessel and, in short, the risk of having an acute myocardial infarction. There are other important factors. Obviously a person who is stressed, emotions are a determining factor in some types of people, stressed people, people who have a family environment with difficulties, people who have a work environment with problems. This work stress, family stress, and even some genetic determinants can also influence as a coronary risk factor. So a heart attack is a thrombotic occlusion of an artery, there are environmental determinants and genetic determinants that cause you to have a heart attack, stress, hypertension, diabetes, but of course, what is absolutely important is that throughout your life you are aware that you do not have the same risk factors. The loss of estrogen in women when they reach menopause favors an increase in bad cholesterol, what we call LDL. And the good cholesterol, HDL, decreases. This increases cardiovascular risk in women. That is why women are more likely to suffer a heart attack when they reach 50 years of age. Men in an earlier decade than women have a greater tendency and a higher prevalence to have a heart attack. Women in the menopausal age have to control themselves especially, avoiding obesity, exercising, controlling cholesterol, and above all, being happy. Because emotions are a determining risk factor in women at that age.

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How do I know if I am suffering a heart attack?

What are the symptoms that should alert us that we may be suffering from a disease in the arteries of the heart, an acute myocardial infarction? They can be variable, depending on age, other determinants and associated factors. But, in general, what happens is that we feel a tightness in the center of the chest, in the retro sternal area, and it is like a weight. A weight on the sternum, which oppresses us. It is not a pain, it is not a twinge, it is a tightness in the center of the chest that is generally accompanied by a significant discomfort, a feeling of I feel very bad, sweating, paleness and in some patients they may feel this pressure that is also directed to the neck, they may have this tightness in the shoulders, directed to the hands. In short, what we are talking about, neurovegetative cortex with chest pain. Central thoracic oppression, thoracic oppression, plus sweating and pallor. In the face of these symptoms we have to be alert that we may have an acute myocardial infarction. It is certainly not the only symptom that can be associated with coronary artery disease. Sometimes in the morning we wake up and feel a tightness in the chest, which subsides when we stop exercising. Or, in the afternoon, a moment or situation of stress, a moment when we are nervous, we feel a tightness in the chest, when we calm down or stop, it subsides. Faced with these symptoms, which may be angina pectoris, which may be alerting us to the possibility of having a heart attack, we have to go to our cardiologist or our doctor, who will take care of us and inform us.

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What to do when you are suffering a myocardial infarction?

If we are having chest pain or we think we are having something like a heart attack, because a lot of times, not being a doctor, you don’t know exactly if what you are having is angina, you are having anxiety, or your chest is hurting in relation to an acute myocardial infarction. The most important thing is the time factor. Time is what essentially determines whether the outcome of having a heart attack and its treatment is good. The first thing we have to do when we have the sensation that we are having a heart attack is to warn. It is to notify and notify the emergency services, or to notify a mobile ICU, or, in short, to go to a hospital or a health center that will treat us. Time is the most important factor. If we go to a hospital in less than an hour, in the hospital the artery can be opened, the thrombus occluding the artery can be removed, and in short, there is much less damage to the heart muscle. This is important because later, if we finally have damage to the heart muscle, the heart can contract better, the walls of the heart are not affected and the consequences of the infarction are much less. In short, the time factor. Go to a health center as soon as possible.