Myocardial Infarction or Heart Attack

The symptoms of a heart attack can vary, but the main symptom is an oppressive pain in the chest with a vice-like feeling, and/or the feeling that your chest is being crushed. Often, the pain radiates into the jaw, neck, left arm, shoulders, or the entire rib cage and upper part of the abdomen. The pain is sometimes accompanied by cold sweats, breathing difficulties, nausea or vomiting, dizziness, an irregular pulse, severe anxiety, and a pale face.

Symptoms of a Heart Attack in Women
Women sometimes experience different symptoms, with the only signs of a heart attack being breathing difficulties, nausea, and pain in the upper part of the abdomen.

In most cases, there are warning signs before the heart attack occurs. These include some of the symptoms above, often in a less intense form, which occur mainly upon exertion in the days or weeks before the heart attack. They should not be taken lightly, and if you experience them you should see your doctor.

A heart attack is an indicator of heart disease, which is an obstruction of the arteries*An artery is a blood vessel that takes blood from the heart to other tissues in the body. that supply blood to the heart (known as the coronary arteries*These arteries cover the heart muscle (or myocardium). They supply blood to the heart and therefore nourish it.) that leads to not enough blood being provided to the heart muscle (or myocardium*Myocardium is the technical name for the muscle tissue of the heart. This comes from the Greek myo- for muscle and carde for heart. The rhythmic contraction of the heart is controlled by the autonomic nervous system. Therefore, the contractions do not depend on a conscious effort on the part of the human being.).
It can be caused by too much cholesterol*Cholesterol is a type of fat. that builds up on the interior walls of the arteries forming a buildup of plaque over time (a phenomenon called atherosclerosis). This plaque reduces the inner diameter of the arteries. If some of this plaque breaks off, small blood cells called platelets stick together and a blood clot*A clot is a small mass caused by coagulation of the blood. A clot is also often called a thrombus. is formed. In only a few minutes it can completely block the vessel affected. The part of the heart muscle that is affected stops receiving any blood or oxygen, which causes the heart attack. The chest pain is therefore the heart muscle dying.

Not everyone is at the same risk of a heart attack. Some predisposing factors (or cardiovascular risk factors) have been identified, including:

• diabetes*Diabetes is a disease that affects the way the body regulates blood sugar levels.,
• smoking,
• a cholesterol level above 3 mmol/l,
• blood pressure above 140 mm/Hg,
• a family history of heart attacks,;
• being overweight (BMI>25),
• doing no or little exercise.

There is a tool for assessing your risk of a heart attack, which can be found on the Lipid and Atherosclerosis Working Group page of the Swiss Society of Cardiology's website (currently available in French and German).

During a heart attack, the priority is to remove the obstruction from the vessel concerned in order to avoid, or at least limit, damage to the heart. The purpose of this is to re-establish blood supply to the heart as quickly as possible. To do so, doctors will administer antiplatelet agents to the patient that will dissolve the blood clot and perform a coronary angioplasty, a procedure that dilates the narrowed artery using a probe with an inflatable balloon on the end. A vascular endoprosthesi (stent*A stent is a medical device used to keep arteries open.) is then inserted as a support to keep the artery open.
In rare cases, a surgical bypass*A bypass is a technique used in heart surgery to bypass an obstructed blood vessel by implanting another blood vessel. is required when long stretches of an artery have narrowed or several arteries are affected. The surgeon compensates for the narrowed artery by replacing it with an intact segment of another artery taken from the leg or mammary artery.
After being discharged from hospital, the patient will need to be monitored and take antiplatelet medication to prevent blood clots forming, normally for the rest of their life. Their personal contribution to living a healthy lifestyle directly affects the progression of the disease.

A heart attack can cause the heart to stop at any time, for example in the case of a cardiac rhythm disorder (arrhythmia). This is why a heart attack is treated as a medical emergency.
After leaving hospital, patients must adopt a healthier lifestyle to prevent another heart attack. This includes doing regular exercise and taking the medication they are prescribed.
In some cases, a heart attack can lead to anxiety and/or depression, which also require treatment.
In some patients, a heart attack can also be connected to high blood pressure, hyperlipidemia*Hyperlipidemia is when there are abnormally high levels of fat (lipids) in the blood. and/or diabetes*Diabetes is a disease that affects the way the body regulates blood sugar levels., which must be treated using appropriate medication.

The importance of prevention is widely recognized today. The patient's full cooperation is crucial. This approach provides good results, even in elderly patients, if the disease is at an advanced stage, and/or they have already had a heart attack (relapse).
The following preventative measures are tried and tested:

• stopping smoking,
• eating a healthy diet (following a Mediterranean-style diet),
• staying a healthy weight and avoiding stress (knowing your limits), 
• exercising regularly (30 minutes a day is enough to protect the vascular system) – walking is medicine, 
• checking your blood pressure regularly (high blood pressure increases the risk of a heart attack and may require medication),
• getting your blood lipid levels (cholesterol and triglycerides) and blood sugar levels (glycemia) checked regularly. Medication may be required to treat high levels of these too.

There are some signs that indicate an impending heart attack, in particular when they appear in a healthy person:

• a feeling of tightness in the chest and/or difficulty breathing during exercise,
• pain in the chest radiating towards the left arm, back, shoulder blades, or lower jaw;
• sharp pain in the upper part of the abdomen.

These signs must be taken seriously and you should talk to your doctor if you experience them. In many cases, there are warning signs several days or weeks before a heart attack happens.

An electrocardiogram (ECG) and blood tests are used to confirm an acute heart attack. The ECG records the heart’s electrical activity using electrodes placed on the chest, wrists, and ankles. Blood tests can detect a heart attack marker in the heart muscle. Some proteins that regulate the contraction of the heart such as troponin are released into the bloodstream during a heart attack. A highly sensitive rapid assay test has been available for several years.

A definitive diagnosis is made based on clinical signs and the assay test for cardiac enzymes. Coronary angiography, a medical imaging technique used to visualize the coronary arteries, is performed to confirm the diagnosis and apply a treatment.

After receiving treatment, the patient will have the option to follow the Cardio Tour plan. This cardiovascular rehabilitation plan focuses on physical activity under the medical guidance of specialist physiotherapists. It lasts six weeks and aims to improve cardiac function, improve your quality of life in the long term, teach you how to manage cardiovascular risk factors, help you to understand your medication, and help you to manage everyday physical activities. Accredited by the Swiss Society of Cardiology, this plan is part of the non-invasive cardiology department at Hôpital de La Tour and managed by Dr. med. Stéphane Zaza and Dr. med. Dominique Fournet.