Heart attack

[ed34]

I am truly confused about the term 'heart attack'. The definition used in cardiology seems to be that it refers to heart muscle being zero supplied by oxygen and necrosis is a result. Yet, we hear so many times of people having a heart attack, going into the angio suite, having no procedure and being sent home with no damage. This cannot be a heart attack then? In march, my troponin was elevated and I was told by the cardiologist that I had a heart attack. I had no tissue damage and that was because the paramedics gave me nitrates which relieved things. However, in rehab last week, the senior cardiac nurse said "oh, if nitrates eased the pain, then it wasn't a heart attack, nitrates won't help because it's a total blockage". I can see his point on this, but can't nitrates open the artery enough just to get a trickle of blood through? enough for the heart at rest? even 5% would make a huge difference.
So when does the term get used?  If for example a patient had a thrombus form at a plaque rupture site, and it caused the start of a heart attack, would it still be classed as such if the thrombus broke down sufficiently after a few minutes? What if a stent is inserted before necrosis, does this remove the term heart attack from the equation?
Isn't it amazing how words can cause so much confusion lol.
I even asked a Cardiologist when I was in hospital in March, "when does angina actually become a heart attack? surely pain means damage, so how do we know if it's a heart attack or not? is severe angina a heart attack in reality?" I felt an idiot when he said "I know what you are trying to say, but angina is the symptom, not the actual physical event". It still left me wondering though. If I had a 90% blockage and exercised, then I would get pain. This pain is telling me that damage is occurring. So, if I carry on with pain, exercising even harder for hours, then would I cause irreversible damage to some cells? if so, did I cause a heart attack?
Surely it's much simpler than this?

[ed34]

I would have to assume yours are not the severe type because you are thankfully here to type on the forum :) I wouldn't worry about it because anxiety may be a trigger for them.

[ChatterAlly]

Wow, Ed.  I wasn't aware of all of that. Now I am worried. Before I thought of it as nothing more than a symptom, but now I think I need to ask more questions about this.  The nitro does work every time though.  I do have them quite often.  The ones that wake me from a dead sleep are really bad.  I have had osme that were so bad that I hurt in my back and all the way up to my cheek bones. Man!

[jrbon]

Heart Attack = Myocardial Infarction

From Wikipedia:
"In medicine, an infarction is the formation of an infarct, that is, an area of tissue death (necrosis) due to a local lack of oxygen caused by obstruction of the tissue's blood supply."

Therefore if there is not necrosis there is not heart attack.

Jesus

[ed34]

Vasospasms are in effect going to give the same symptoms as a heart attack if severe enough. I read somewhere that a vasospasm can constrict an artery anywhere between 5-99% which is a huge range. It also depends on how fast the spasms are and in relation to the heart beating. If you have very fast vigorous spasms of 99%, then I can imagine the pain would be very bad indeed. If at the other end of the scale, 5%, I have no idea what you would feel but I doubt if any pain would exist. So a vasospasm can do the same thing as a heart attack, severely affect the flow of blood. I did also read that vasospasm can kill in very severe cases.

[ChatterAlly]

Amen to this post, Ed.  I had no damage with any of my heart attacks.  The first stent (cardiac) I had put in was a result of a trip to the ER with "symptoms".  (July 04) I went to the ER because it felt as though an elephant was sitting on my chest, it was hard to breath and I had some minor chest discomfort.  It was never described to me as being a heart, but the symptoms did encourage the doctor to do an angio. This cath showed the >90% block in my RCA. But I was never told I had a heart attack.  I developed chest pains as soon as the stent was put in.  I suffered with a "heart attack" the following June (05)
and the following July ('06).  Both times I was told the same thing. That I had some smaller blockages, and the doctors told me they would treat this with meds. I still believe the stents are the cause of my heart attacks and the coronary artery spasms.  After last year's trip to the hospital (April '10) I was told I had a new blockage that was 50% - 60%, and again I was told they would treat this with meds.  If this one becomes troublesome I will need bypass.  But here's the thing........it was determined I did not have a heart attack.  The chest pains were actually vasospasms. Hmmmmm What do you think?Thanks, Ally

[curmudgen]

It boils down to the precise definition and use of the of the term "heart attack"  - from the  the texas heart institute -
"A heart attack is also called a myocardial infarction (MI) or an acute myocardial infarction (AMI). Many heart attacks are caused by a complete blockage of a vessel in your heart, called a coronary artery. A blocked coronary artery prevents oxygen-rich blood and nutrients from reaching a section of the heart. If blood cannot reach the heart muscle, it will die. By getting medical treatment quickly, you can reduce this damage, but once a section of heart muscle dies, the damage lasts forever."    

Even this definition leaves open the question of what it really is

I guess your question is -   Is a heart attack a heart attack if there is no muscle damage?  Does it really matter what the medical record states as long as there is no damage?