Emergency Live – Pre-Hospital Care, Ambulance Services, Fire Safety and Civil Protection Magazine
‘Infarction’ is in fact a generic term for the death (necrosis) of certain cells in a given tissue because they do not receive an adequate supply of blood and oxygen from the circulatory system.
For example, cerebral stroke, also called ‘stroke’, is the infarction of a part of the brain.
It happens when an obstruction in the coronary arteries, the arteries that carry blood to the heart, prevents the regular flow of blood’.
There are several reasons why a coronary artery becomes obstructed.
The main reason is undoubtedly related to atherosclerosis, a disease of the vessel itself that leads to the accumulation of cholesterol, then to the formation of a plaque.
This plaque can progressively narrow the artery, thus giving rise to what we call ischaemia, a different phenomenon from infarction.
We speak of an infarct, in fact, in the case of a total interruption of blood flow, while ischaemia occurs when there is a ‘slowing down’ of the flow, caused by a stenosis, i.e. a narrowing of the lumen of the vessel precisely because of the atherosclerotic plaque.
It can also happen that the plaque can ‘rupture’ within the vessel.
In this case, the body reacts by defending itself as it does, to simplify, in the case of a wound, triggering a dynamic that can go as far as an infarction.
The reparative process set in motion in response to the rupture of a plaque consists of forming a clot, the thrombus, which threatens to generate a thrombosis of the vessel, i.e. an occlusion of the artery that completely blocks the flow of blood.
Obstructions are not always caused by plaques but also by functional problems, such as vasoconstriction of these arteries.
Plaques are not the only causes of coronary obstructions sometimes it is functional problems, such as vasospasm, that produce the interruption of blood flow.
Take, for example, the abuse of drugs such as cocaine: well, this can give rise to what is known as coronary spasm, which, if it persists for a prolonged period of time, is another cause of a heart attack.
The cardiologist reminds us that we are all prone to atherosclerosis, but we must try to advance it as little as possible and thus work on cardiovascular risk factors.
Among the risk factors are certainly diabetes, hypertension, high blood pressure, high cholesterol values, even triglycerides, not forgetting obesity, being overweight, smoking and family history.
In fact, even a sort of genetic predisposition can accelerate and aggravate the natural process of atherosclerosis.
Other risk factors are certainly age and male gender.
But what are the symptoms that make us suspect a myocardial infarction?
In infarction, time is of paramount importance.
Time is the decisive factor, without a doubt.
The sooner we recognise a heart attack, the sooner we arrive at a diagnosis, and the sooner we can treat it, and thus save more tissue: the quicker we are, in short, the more we can contain the damage of the heart attack.
The symptoms are those of the common imagination, i.e. pain in the chest and left arm, but given the importance of a rapid self-diagnosis, let us be more precise in describing the most common and least common symptoms that should alarm us.
Myocardial infarction is often manifested by a pain in the chest, in the centre of the thorax, with quite specific characteristics: many patients describe a sort of vice, the sensation of a strong oppression in the chest.
More than a muscle pain, it is an asphyxiating, oppressive pain at the level of the chest, under the sternum, the bone in the centre of the chest.
The chest pain, which is oppressive and continuous, is often accompanied by a pain that typically radiates to the shoulder and left arm, particularly the outer part, where the little finger is located.
These are typical features of a chest pain that can be a warning sign of an ongoing heart attack.
The chest pain is also often accompanied by a peculiar breathlessness, a real hunger for air.
Medicine, even on this delicate subject, is not an exact science.
Pain can also radiate in a characteristic manner posteriorly, between the shoulder blades, or up to the neck, reaching under the jaw.
Not only that: sometimes the right arm may also be affected by the radiations of a cardiac pain.
So, to sum up: an intense pain in the chest of an oppressive type, radiating to the left arm, to the jaw, perhaps even posteriorly, and associated with laboured breathing, these are all alarm bells that should make us worry and seek help.
As if that were not enough, this is obviously associated with great malaise.
There are people who report feeling a sense of death, then anxiety, cold sweats, and sometimes this can even result in fainting.
However, it is important to remember that there are cases in which the ongoing heart attack does not produce any symptoms, any pain.
There are patients who report no pain at all, or only feel a soreness in the arm, jaw or stomach.
It is quite common to confuse an infarction with epigrastralgia, i.e. pain in the stomach.
This is a lower chest pain, at the point where we locate the stomach.
That, too, can actually be a site of a cardiac pain.
So it seems that people underestimate what they think is a gastric pain, a pain from gastritis, with what turns out to be a heart problem instead.
How to distinguish a common stomach ache from a heart attack?
One must pay attention to the type of pain.
If epigastralgia manifests itself with the radiations we described earlier, if it is associated with sweating or breathlessness, then it may not be stomach pain but chest pain of cardiac relevance.
Then a special warning to women.
It may happen that women suffering a heart attack, instead of a real chest pain, experience nausea, vomiting, or even just sweating, or feel pain confined to the back of the body.
Because of these less recognisable, more nuanced and ambiguous symptoms, it often happens that women, who suffer from heart disease as much as men, especially after a certain age, are less quickly rescued, with very serious consequences.
What to do if one of these symptoms appears?
First of all, one has to make sure that it is a cardiac event because, as we have said, the symptoms are not very easy to decipher.
Only doctors can do this, and it is therefore necessary to go to the emergency room as quickly as possible.
The pains we have described sometimes occur intermittently: twinges alternate with moments of relief.
Should these symptoms persist for 15-20 minutes, the advice is not to delay and to contact the emergency medical service immediately by calling 112 or 118.
Only in the emergency room, in fact, once the cardiac nature of the symptoms has been ascertained – in this case, even just an electrocardiogram or other types of examinations are sufficient – can the doctors act quickly on the myocardial infarction.
In this regard, we have a network of haemodynamics laboratories where the best emergency treatment of cardiac infarction is carried out: using local anaesthesia and the insertion of small catheters inside the arteries, the coronary arteries are visualised and the occlusion is treated by means of the so-called ‘primary angioplasty’, which consists of reopening the vessel and implanting a small stent inside the diseased coronary artery.
Increasingly, it is also possible to perform electrocardiograms in the ambulance when emergency services are called.
This allows a very early diagnosis and a referral of the patient to the most equipped facility for this type of rescue.
So, the message that I would like to repeat is: not underestimating the symptoms allows you to intervene early and greatly limit the damage of a heart attack’.
It can also happen, however, that a heart attack goes completely unnoticed.
There are people who do not realise that they have had a heart attack, and it happens that there are patients who are unaware of it.
In this case we are dealing with the so-called ‘silent heart attack’, which is mainly found in diabetic patients. Or the symptoms were there but could not be traced back to the heart attack.
For example, the patient, prompted by the doctors, remembers having had severe stomach pain in the past.
There, at that moment, we can reconstruct that that pain in the stomach was not a sign of gastritis, but of infarction, then fortunately evolved well, stabilised over the years, because only a small area of the heart had been damaged, without causing a general impairment of the organ.
A distinction that is often not so straightforward is that between myocardial infarction and cardiac arrest.
They are two different, though related, things.
We speak of cardiac arrest when the heart no longer functions, no longer performs its pump function and, therefore, stops supplying blood to the other organs of the body.
If the blood does not reach the organs, the cells die. The first organ to be affected is the brain, because it continuously needs oxygen (and thus an uninterrupted flow of blood) to function.
This is cardiac arrest.
Often the arrest is produced by an electrical problem.
Let me try to be clearer: the heart is a muscle that works thanks to intrinsic electrical stimuli.
It can happen that, for a wide range of reasons that I will not list here, a kind of ‘short circuit’ occurs, a disorganisation of the electrical activity that leads to an irregular or excessively fast contraction of the heart, which eventually compromises its pump function.
Cardiac infarction, on the other hand, is, as we have said, the obstruction of the coronary arteries: a mechanical obstacle that prevents the regular flow of blood to the heart.
Cardiac arrest and myocardial infarction are therefore not synonymous.
However, infarction is one of the causes of cardiac arrest.
Those who have a heart attack may indeed have a cardiac arrest, although not necessarily: many heart attacks do not involve cardiac arrest.
Conversely, not all cardiac arrests are due to the heart attack.
As already explained, cardiac arrest originates from an electrical problem, arrhythmia, which causes disorganisation of the overall electrical activity and thus, in severe cases, leads to cardiac arrest.
In these episodes of severe arrhythmia, there are unfortunately various pathologies and chronic conditions that predispose to such arrhythmias, the brain is the first organ to suffer and, because of this, the patient loses consciousness and faints.
If we do not act immediately with chest compressions and early defibrillation, brain death or death of the entire organism can occur.
Even in these cases, therefore, prompt intervention is extremely important: ‘cardiac massage’, or rather chest compressions, allow us to gain precious time and preserve the brain in some way, but it is the defibrillator, recognisable by its green acronym ‘AED’ or ‘EAD’, that is almost always decisive.
The defibrillator is in fact capable, autonomously, of recognising severe arrhythmia and ‘interrupting’ it with an electric shock.
As can easily be guessed, effectiveness is all the greater the earlier the defibrillator is used: once again, the time factor is vital.
The doctor then launches a message to citizens to protect their hearts.
Prevention is certainly important, breaking down all risk factors as much as possible.
Hence, education on a healthy lifestyle, i.e. a balanced diet, smoking cessation, physical activity and stress reduction, as well as regular check-ups to check blood pressure and cholesterol values and possible treatment of diabetes.
A person may feel perfectly fit, but if they do not measure their blood pressure, they will never find out that they have high blood pressure, because this can be asymptomatic.
The same thing applies to blood tests, because high cholesterol is not perceptible to the patient, it can only be ascertained by a blood test.
As I have tried to explain, it is crucial to avoid delays as much as possible. In case of symptoms of myocardial infarction, we do not wait, we do not delay: we call the emergency medical service immediately.
Any hesitation can be lethal.
During the pandemic, many people, understandably frightened by the risk of infection with the Sars-CoV-2 virus, underestimated their symptoms and delayed calling for help, sometimes arriving too late.
Cardiopulmonary resuscitation manoeuvres should be part of everyone’s civic education: being able to recognise a cardiac arrest, performing even just chest compressions, at a given depth and rhythm, calling for help and obtaining a defibrillator are extremely valuable early interventions in the event of a cardiac arrest and literally allow us to save people’s lives.
This is why it is so important to insist on the need to distribute defibrillators throughout the territory.
Suffice it to say that defibrillators in public buildings and offices are just as important as fire extinguishers: having more defibrillators, and more courses on the correct use of these simple machines, means having a better chance of saving the lives of people affected by cardiac arrests.
As is often the case, widespread knowledge and the intertwining of individuals and communities are the best allies of life and health, including that of the heart.
Combining personal precautions, i.e. prevention and screening, recognition of alarming symptoms and prompt intervention in the event of cardiac arrest are the three key elements to avert irreparable damage.
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25/10/2022