Myocardial infarction is a serious threat because when it occurs, blood does not reach the heart muscle due to blockage of the arteries that supply the myocardium, thus causing necrosis of the walls that can lead to arrest. The blockage is usually due to the accumulation of fat, cholesterol and other substances in the wall of the blood vessels that create the so-called atheromatous plaques.

“Myocardial infarction is one of the most frequent causes of death and disability worldwide. The morbidity from this disease shows a frequency of 195.3 cases per 100,000 people for men and 115 cases per 100,000 for women. In the last ten years, there has been a decrease in mortality and the number of complications associated with myocardial infarction, due to the development of cardiology science and medical technology,” says Mr. Emmanuel Kallieris Assistant Professor of Cardiology, Fellow of the US College of Cardiology .A., Director of the Intensive Heart Attack Unit at Metropolitan Hospital.

Mr. Kallieris then answers everything we would like to know about such a serious and life-threatening event:

What are the risk factors for myocardial infarction?

The most common causes for its appearance are:
• Age, as age increases, so does the risk of myocardial infarction
• Gender, men get sick more often than women
• Smoking
• Alcohol consumption
• Sedentary life and lack of exercise
• Dyslipidemia
• Hypertension
• Abdominal obesity
• Diabetes mellitus
• The stress

What is the mechanism of infarction?

A heart attack can be due to 1) the rupture of an atherosclerotic plaque and the formation of a clot within the vessel or 2) the reduced supply of oxygen to the heart due to a large blockage, greater than 75% of one or more vessels.

When is it caused?

“Myocardial infarction is caused when an artery of the heart, also known as a coronary artery, is blocked by a blockage. Consequently, the heart muscle, which depends on a supply of oxygen to function, is left without this vital element of perfusion.

The main reason for this blockage is atherosclerotic plaque, which is created through a complex process caused by several factors. However, the main factor remains the high level of apolipoprotein B (apo-B) and high (LDL), known as “bad cholesterol”, adds the expert.

What happens to the body when it has a myocardial infarction?

“The process begins with a small accidental damage to a point in the arterial network. At this point, lipoproteins accumulate in the inner lining of the coronary artery (arteries are made up of three layers: the inner, middle and outer lining), which cause an inflammatory reaction, in which special cells known as macrophages are found, the which, when they contain cholesterol, are called foam cells.

As the process continues, thickening of the intima is observed and runs the risk of necrosis with threatening implications for the patient’s health when it becomes completely occluded. At the same time, collagen deposition in the area encloses the damage in a “fibrous capsule”, which is gradually revealed. As the atherosclerotic plaque process continues, the vessel changes in size, usually increasing in diameter, maintaining at least in the initial stages a constant diameter of the vessel.

As the atheromatous plaque increases and the diameter of the vessel gradually decreases, then symptoms of angina appear, either in a stable form (chest pain occurs during some activity), or in an unstable form (chest pain occurs even at rest ).

But when the fibrous capsule ruptures, a clot suddenly forms inside the coronary artery, causing blood flow to slow significantly or stop completely if the clot covers the entire lumen of the coronary artery. This condition is called a myocardial infarction,” explains Mr. Kallieris.

Can a heart attack be caused by another cause?

Heart attacks can also occur in cases of patients with an insufficient amount of oxygen in the body due to pathological conditions, such as anemia or heart failure, spasm due to stress or from the use of drugs.

What are the symptoms of myocardial infarction?

“The classic symptom of myocardial infarction is chest pain, which is usually described as tightening or excruciating and gives the patient a feeling of heaviness. However, the pain can also present itself as a simple burning or numbing sensation. It usually manifests itself in the retrosternal area, that is, in the middle of the chest, perhaps slightly to the left and can also reflect on the left arm (inner surface), left neck, left lower jaw or back, and also stomach pain (epigastric pain).

It is important to note that chest pain is not necessarily an indication of a myocardial infarction. It can also be due to other problems such as: stable or unstable angina (indicating limited blood flow to the heart, but not a complete blockage) lung disease, gastrointestinal problems or musculoskeletal issues. Usually, it is accompanied by sweating, shortness of breath, and a feeling of fatigue, and the patient may faint,” emphasizes Mr. Kallieris.

How is the diagnosis made?

The diagnosis of infarction is based on the clinical picture, laboratory and imaging tests. A diagnosis can be made only on the basis of the patient’s history, electrocardiogram (ECG) and troponin biochemical testing. An important role is played by the patient’s symptoms, their duration, the factors that affected the pain and where it is located, as well as possible accompanying symptoms such as fever, shortness of breath, vomiting.

What are the laboratory tests that help diagnose myocardial infarction?

“As we mentioned above, the EKG is an extremely useful tool for diagnosis, as it depicts the main lesion that causes a heart attack, namely ST-line elevation. In addition, laboratory analyzes of troponins are a reliable way to identify infarction. Subsequently, patients with myocardial infarction, based on the findings of the ECG and laboratory tests, should be immediately transferred to the intensive care unit of infarctions and coronary angiography to restore the blockage of the artery. In addition, tests that may help in the differential diagnosis of angina pectoris are the echocardiogram, computed tomography of vessels (bloodless coronary angiography) and magnetic resonance imaging of the heart,” he adds.

What should someone who has had a heart attack do before going to the hospital?

As time passes from the moment of the interruption of the blood supply to a part of the myocardium, the effects of the infarction become increasingly unfavorable for the patient. Therefore, it is important to start treating the heart attack before the patient arrives at the hospital, wherever and whenever possible. It is equally important that the general population is able to recognize the symptoms of a heart attack and seek help, or even that there are people in the community who can provide cardiopulmonary resuscitation (CPR).

What should someone do after a heart attack?

“The most important measure after a heart attack is to prevent and prevent a second event, as the causes that caused the first episode continue to exist.

A helpful step the patient can take is to identify their personal risk factors and then make lifestyle changes step by step.

Some common heart attack prevention measures include:
• Stop smoking
• Lower cholesterol levels
• Reduction of high pressure levels
• Treatment of diabetes (keeping sugar levels within normal limits)
• Regular cardiovascular exercise
• Change to a healthy diet
• Reduction of excess weight
• Consumption of alcohol in limited quantities
• Reduction and prevention of anxiety (stress)

It is imperative that he consistently take the medication to protect the heart, have regular cardiac check-ups and blood tests. It is also important not to fall into inactivity, but not to overdo it for fear of a new episode. The best thing is to consult your cardiologist and act according to his instructions”, concludes Mr. Kallieris.

*The Metropolitan Hospital has a modern, fully equipped and well-organized Cardiology Unit that competes with the leading cardiology centers abroad. The Cardiology Clinic has received certification according to the ISO standard and has won the trust of the Greek community, since for more than 24 years it has demonstrated its high scientific competence in the care and treatment of patients with difficult and complex cardiac problems. The excellent scientific and nursing staff and the use of advanced equipment technology, as well as the Cardiology Clinic are always available to deal with any cardiac incident, be it unexpected or long-term, round the clock.