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Coronary Thrombosis (Heart Attack)

If there is a sudden blockage of a coronary vessel supplying blood to the heart muscle, or myocardium, the portion of the heart affected will die (myocardial infarction). The seriousness depends on where the blockage or infarct occurs: only one small part of the heart may be affected, in which case the person may survive the heart attack even though a part of the heart does not work. If, however, the blockage halts the blood supply to a large area of the myocardium it may be fatal.

The main cause of coronary thrombosis is atheroma, a thickening of the blood-vessel walls by fatty and calcium deposits, or plaques. This thickening causes the blood to slow down so that it clots and blocks the artery which may already be narrowed by arteriosclerosis (described below). Alternatively, a piece of the fatty material may break off and have the same effect. The causes of atheroma and its related conditions are described later in this section.

Coronary thrombosis is the largest single cause of death in the western world, and a major cause of illness. For every fatal heart attack there are tWo or more where the victims survive. Men are more likely than women to have a heart attack, and it is most common in the forty to forty-five age group. It can happen at any age, however.

Symptoms

A heart attack usually comes without warning, and the main symptom is likely to be pain. This is relatively constant and is felt in the centre of the chest beneath the breast bone, probably spreading out to one or both arms and sometimes the neck and jaw. Weakness, giddiness and breathlessness may accompany the pain, depending on how severe the damage is. The degree of pain may vary from a dull ache to a feeling of tightness to a crushing, vice-like gripping sensation.

Immediately after a heart attack, the victim is usually pale and still, but he or she may be restless, sweating or anxious. In a so-called 'silent' coronary thrombosis, which occurs mainly in the elderly, there is no pain, but there may be weakness, shortness of breath and giddiness. This may have been preceded by a period of unusual tiredness, lassitude and general malaise. Occasionally, though, even these symptoms are absent and the fact that a heart attack has occurred is only discovered during a routine medical examination, when abnormally low blood pressure or abnormal electrocardiogram traces indicate the possibility. The exact diagnosis relies on electrocardiograph examination and blood tests which may show chemical disturbances or changes in the white blood count.

Treatment and recovery

A heart attack is an emergency and needs prompt medical attention, even if symptoms are mild. One of the dangers of coronary thrombosis is cardiac arrest, where the heart stops beating. This may be caused by a sudden failure of the heart's conducting system (heart block). If the affected person is unconscious, external chest compression and artificial resuscitation should be started. In every case, stay with the heart attack victim until medical help arrives.

Most people are hospitalized after a heart attack, and treated according to its severity. Many who appear to have had a very severe attack make a smooth recovery and have no further signs of coronary disease. However, there may be complications and treatment is designed to anticipate these and to deal promptly with any that do arise.

Intensive care units, where the vital functions are monitored continuously, have revolutionized the treatment of coronary thrombosis. In these, specially trained medical staff are backed up by cardiac monitoring devices, respirators and apparatus for reversing any abnormal heart rhythm which may develop, and for stimulating the heart if it ceases to beat. However, although intensive care units are often essential, in some cases treatment at home may be preferred, particularly for elderly people.

The pain of a coronary attack, which seldom persists for long, can be treated with pain-killing drugs. In severe case; oxygen is given for the first few days, either in a tent or by face mask. Common complications during the early stage; of recovery are disturbances in cardiac rhythm, shock and heart failure. The most dangerous arrhythmia is ventricular fibrillation, where the ventricles begin to contract very rapidly, and which may be fatal. Heart block, sudden cardiac arrest caused by a failure of the electrical conducting mechanism, is another hazard. Both of these conditions can be treated with electrical apparatus, heart massage and drugs. If they recur, drug treatment or the fitting of a heart pacemaker, which stimulates the heart regularly, can be useful.

The period of convalescence after a heart attack depends on the person's age and previous health, as well as the severity of the attack. Most people, once out of intensive care, are actively encouraged to take gentle exercise to speed their recovery. This can be positively beneficial to the damaged heart. Many people are, not surprisingly, shocked and frightened after having suffered a heart attack. But most can be encouraged to lead a normal life and do not have to feel they are invalids. It is, however, important to reduce the chance of a further heart attack by improving one's lifestyle. For most people, this means stopping smoking and losing weight, and in particular cutting down on the amount of fat in the diet.

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