In October 2008, I was admitted to the hospital for a heart attack. I had 3 EKGs, echocardiogram, and catheter done. All of them showed that my heart was fine and there was no damage. But my enzyme levels were elevated. My understanding of the enzymes is that when elevated there is some damage done. Why would all 3 tests that was performed show that my heart is okay? And would a panic attack cause enzyme levels to elevate?
Enzyme levels do not reflect damage, they are released when the heart is under stress.
You can have high levels of enzymes with no damage, or low levels of enzymes with damage. The level simply indicates how high the stress level is. I had 5 heart attacks over 3 days and my enzyme levels were high, but I suffered no tissue damage.
The blood tests for an infarct is time sensitive. You were immediately tested and the results were negative and apparently you did not have any heart muscle damage or an infarct.
I assume it was creatine kinase (CK) and that is the blood test most commonly used to confirm the existence of heart muscle damage.
For some insight, a small fraction of the CK enzyme, CK-MB, is often measured as well. CK-MB shows an increase above normal in a person's blood test about six hours after the start of a heart attack. It reaches its peak level in about 18 hours and returns to normal in 24 to 36 hours. The peak level and the return to normal can be delayed in a person who's had a large heart attack, especially if they don't get early and aggressive treatment.
Cubbie, one cannot have a heart attack without heart muscle damage. The heart cells can be only stunned and prompt treatment with oxygen can save some of the cells.
The hospital initially did an echo scan to see if there was any damage. It showed
all dimensions in limits etc but no conclusion could be reached regarding tissue death.
A nuclear perfusion scan was performed. You basically get the heart worked up into
a fairly high rate on a treadmill, then a radioactive isotope is injected into the bloodstream. The isotopes attach themselves to the red cells and a scanner is aimed at
the heart to detect these isotopes. As the heart tissue uses the red cells to get oxygen,
the isotopes react and show up on the scanner. So basically, every heart cell using
Oxygen (meaning it is alive) will glow on the scanning image. Dark areas mean tissue
death. My cardiologist told me that you have 20-40 minutes to resume blood supply to
heart tissue before the cells die completely.
Look at it this way. Let's say your heart needs X amount of Oxygen to live when you are
resting. It needs Y amount of Oxygen when the heart is working hard. You have a restriction in an artery which will not allow enough Oxygen for the state of Y but will supply enough for the state of X. This could be a 90% blockage for example. This means
at rest you will feel better, but when exerting, such as running, you will feel pains. If the
level of Oxygen for Y is way too low, you will suffer a heart attack because not all the cells can get the right level of oxygen. This is what a heart attack is. A heart attack is
also when a complete blockage occurs, this is called ACUTE heart attack.
If you have the 90% blockage in my example, when you sit down and relax, the heart
will relax and only require level X of Oxygen which the arteries are able to supply. This
will save the cells in the heart muscle from death.
tissue damage only occurs if the tissue is without oxygen totally for more than about 40 minutes. Lots of people I met at cardiac rehab had suffered heart attacks and didnt have
tissue damage. There are different scenarios. Picture your heart as millions of tiny muscle cells all linked together and each one requires Oxygen to live. The more you work those cells, the more Oxygen they will require.
You have a partial blockage in one of your coronary arteries. While you are relaxed in a
chair, your Heart is fine, each cell is getting enough Oxygen because the heart isn't being worked very hard. Now you eat a small meal and the digestive system requires more blood to be directed to it for digesting the food. The heart now has to work harder.
Each cell is not receiving enough oxygen any more and a heart attack starts because the cells are being stressed. This will have started to happen after just 2 minutes of
starting to eat. Around 15 to 20 minutes later the stomach relaxes because you only ate a couple of mouth fulls of food and the heart can relax. Now the attack will stop and the cells will recover. This was a heart attack but no permanent damage. You could have
started jogging and not eaten food.
You form a blood clot in a blood vessel and the artery is completely blocked. Thousands of cells are now without oxygen. You start to have a heart attack. You call for an ambulance which takes 15 minutes to reach you. It takes the paramedics several more
minutes to diagnose your problem. It has now been over 20 minutes. They rush you to the hospital which takes another 15 minutes. In the hospital they wheel you on a trolley to the emergency area. It has now been 40 minutes and its too late. Those cells will be dead and can never recover. Permanent heart tissue damage has occured.
Now paramedics are trained to administer clot busting drugs and issue the correct treatment to reduce the risk of tissue damage much more.
When there is a heart attack by definition it is an infarct (myocardium) and there IS heart cell damage. The damage is necrosis (death) of heart cells, sometimes within a very short time frame and depending on the degree of damage the heart cells may be "stunned" (nevertheless damage) and some cells may be revitalized with immediate action. One of the most important things you can do to survive a heart attack is to recognize what's happening and to take immediate action. Of the people who die of heart attacks, most die within the FIRST HOUR hour after the onset of signs and symptoms, and up to 99% within 3 hours.
Another condition sometimes referred to as having had a heart attack occurs when ischemia (lack of oxygen) happens over a period of time with occluded vessels. Heart cells can go into hibernation and cause hypokinesis as opposed to akinesis (death of heart cells). Proper treatment can sometimes return the cells to normal functionality.
Five years ago I was in ICU for several days due congested heart failure. I never had any prior symptoms until heart failure and that caused pulmonary edema (heart pump less blood into circulation than it received from the lungs and blood backup into the lungs causing fluids to leak into lung tissues). There was hypokinesis of the left ventricle wall and my EF was 13 to 29%. Treatment has returned my heart to normal size, heart wall contractions are normal and recently the EF was 55% (I do MVR though). Damaged cellls were in hibernation! The condition developed slowly, and gradually the occluded vessels were depriving heart cells of sufficient oxygen causing a reduction of EF.
To not have heart cell damage from a heart attack is absurd. Some people believe having angina (severe chest pain) due to ischemia is a heart attack...not true. I have been reading (1000's) and answering heart related posts for more than 5 years on this board and another board, and it becomes obvious some people are simply misinformed.
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