YOUR HEALTH - MEDICINE 101

The Pain of a Heart Attack

If you are having a heart attack, one of the new drugs called "Clot Busters" can help " may even save your life " but you had better hurry. Most frequently, the first symptoms that there is something wrong is a discomfort or pain in the chest. It"s usually not a sharp stabbing pain, more often it is a constriction or a tight feeling, and it is usually felt in the centre of the chest. It is often described as being "like a weight sitting on my chest". The discomfort can also be felt in the back, in the upper abdominal area, in the neck or law or in either arm.

The pain comes from nerve fibres that are found right in the muscle of your heart and that are stimulated when that muscle is not getting enough blood.

The heart is composed mainly of muscle, and this muscle receives blood from the two coronary arteries on either side. These arteries are often blocked with hardening of the arteries or atherosclerosis. That"s when deposits of fatty material accumulate on the inside of the arteries, they narrowing and decrease the amount of blood that can flow to the heart muscle. These fatty deposits or plaques as they are called act just the way rust does on the inside of a pipe. The plaques however, are much more interesting than rust. Placques begin to form in most of us in our late teens and they get worse with all the risk factors for heart disease, such as smoking, high blood pressure, diabetes and obesity. Each of these plaques has a hard outer shell and a soft inner core but, for reasons that are not well understood, sometimes the outer core breaks open allowing some of the softer material inside to be exposed to the blood flowing past.

Here is where it gets interesting! When the plaques opens up (doctors call it rupture of a placque) platelets that are floating by in the blood spring into action. They clump together and form a clot or thrombosis on top of the opened area on the plaque. Remember platelets function to close off blood vessels that are bleeding, and platelets identify the rupture in the plaque as being something they should stick to to try to close.

Unfortunately, if enough platelets stick to this ruptured area the clot closes off the blood vessel. Now the heart muscle isn"t getting enough blood and it starts complaining " and that"s when you feel that squeezing pain.

Here"s where the clot buster comes in: intravenous drugs break up the accumulation of platelets and allow the blood to flow again. But the blood flow must be restored quickly or the heart muscle will die. That"s why it"s important that any symptoms, even suggestive, of a heart attack should be treated seriously and properly evaluated in the Emergency Department.