What
Is a Heart Attack?
The
heart is the human body's hardest working organ. Throughout life it continuously
pumps blood enriched with oxygen and vital nutrients through a network of
arteries to all parts of the body's tissues. It has its own network of arteries,
known as coronary arteries, that carry oxygen-rich blood to the heart's muscular
walls (the myocardium). If blood flow to the myocardium is interrupted, an
injury known as an infarct occurs, in other words, a myocardial infarction,
more commonly known as a heart attack. In most cases of myocardial infarction,
this restriction of blood flow to the heart results from atherosclerosis, a
process in which atheromas, layers of yellowish plaque made up of cholesterol,
fats, and other particles, are deposited on the walls of arteries. The
cholesterol plaques slowly thicken, narrowing the arteries (a condition known as
stenosis) until blood flow is reduced. When the body's demand for oxygen exceeds
its supply, ischemia, the deficiency of oxygen in vital tissues, occurs.
Prolonged periods of ischemia can lead to tissue injury, which may be severe
enough to cause a heart attack. Although atherosclerosis is ultimately
responsible for almost all heart attacks, the attack itself is triggered by a
particular event. Most often a blood clot, or thrombus, forms on the fatty
plaque, completely blocking the already narrowed coronary artery. In other
cases, the plaque can rupture or the artery can go into spasm; both of these
events may also block the coronary artery, depriving a portion of the heart
muscle of its vital oxygen. The severity of a heart attack depends upon the
amount of the heart muscle involved, how long the ischemia lasts, and the extent
of the infarction.
Cardiovascular
disease is the number one cause of death in the United States. This introductory
article briefly discusses several diseases that have a role in the development
of cardiovascular disease. Refer to the following articles for further
information: angina,
atherosclerosis,
cardiac
arrhythmia, cardiomyopathy,
chronic
venous insufficiency, diabetes,
heart
attack, high
cholesterol, high
homocysteine, high
triglycerides, hypertension,
insulin
resistance syndrome, mitral
valve prolapse, and stroke.
Many risk factors
are associated with cardiovascular disease; most can be managed, but some
cannot. The aging process and hereditary predisposition are risk factors that
cannot be altered. Until age 50, men are at greater risk than women of
developing heart disease, though once a woman enters menopause,
her risk triples.1
Many people with
cardiovascular disease have elevated or high
cholesterol levels.2
Low HDL cholesterol (known as the “good” cholesterol) and high LDL
cholesterol (known as the “bad” cholesterol) are more specifically linked to
cardiovascular disease than is total cholesterol.3 A blood test, administered by most healthcare
professionals, is used to determine cholesterol levels.
Atherosclerosis
(hardening of the arteries) of the vessels that supply the heart with blood is
the most common cause of heart
attacks. Atherosclerosis and high cholesterol usually occur together, though
cholesterol levels can change quickly and atherosclerosis generally takes
decades to develop.
The link between high
triglyceride levels and heart disease is not as well established as the link
between high cholesterol and heart disease. According to some studies, a high
triglyceride level is an independent risk factor for heart disease in some
people.4
High
homocysteine levels have been identified as an independent risk factor for
heart disease.5
Homocysteine can be measured by a blood test that must be ordered by a
healthcare professional.
Hypertension
(high blood pressure) is a major risk factor for cardiovascular disease, and the
risk increases as blood pressure rises.6 Glucose intolerance and diabetes
constitute separate risk factors for heart disease. Smoking increases the risk
of heart disease caused by hypertension.
Abdominal fat, or a
“beer belly,” versus fat that accumulates on the hips, is associated with
increased risk of cardiovascular disease and heart attack.7
Overweight
individuals are more likely to have additional risk factors related to heart
disease, specifically hypertension, high blood sugar levels, high cholesterol,
high triglycerides, and diabetes.
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