Tag Archives: Myocardial infarction

Your heart – What is a heart attack?

The heart beats on average 70 times a minute to push blood around the body. Like any busy muscle, the heart tissues need a good supply of blood from their blood vessels, which are called the coronary arteries. When this process is interrupted or doesn’t work properly, serious illness and even death can result.

A heart attack occurs when blood flow to part of the heart is blocked, often by a blood clot, causing damage to the affected muscle. The clot, often caused by rupturing or tearing of plaque in an artery, is sometimes called a coronary thrombosis or a coronary occlusion.

If blood supply is cut off for a long time, the muscle cells are irreversibly damaged and die, leading to disability or death depending on the extent of the damage.

Diseases that narrow the coronary arteries can reduce the supply of blood and cause a shortage of oxygen and essential nutrients in the heart muscle. This triggers chest pain known as angina, especially when the heart is made to work extra hard, for example during exercise. If someone has angina, the more severe the narrowing of the arteries, the less they can do before they experience pain.

A heart attack can occur if the shortage of oxygen to an area of heart muscle is severe and prolonged. Heart attacks (also known as a myocardial infarction or MI) can also occur when a coronary artery temporarily contracts or goes into spasm, decreasing or cutting the flow of blood to the heart.

Most of the deaths from heart attack are sudden, occurring within one hour of onset of symptoms and before reaching hospital, and are often due to dangerous heart rhythms. Most people who survive the first month will still be alive five years later, but many are left with long-term heart problems.

Heart attack symptoms

Unfortunately, for many people the first indication that something’s wrong is a heart attack. This happens when the blood supply to a part of the heart muscle is completely interrupted or stops, usually when a blood clot forms in a diseased coronary artery that’s already become narrowed by atherosclerosis.

The symptoms of a heart attack include:

*Chest pain, usually a central crushing pain that may travel into the left arm or up into the neck or jaw, and persists for more than a few minutes. Unlike angina, the pain doesn’t subside when you rest. Sometimes it can be mild and be mistaken for indigestion. Some people have a heart attack without experiencing pain

*Stomach or abdominal pain

*Shortness of breath or difficulty breathing

*Nausea or vomiting

*Sweating

*Unexplained anxiety

*Weakness or fatigue

*Cold sweat or paleness

*Feeling light-headed or dizzy

*Palpitations or an abnormal heart rate

Heart disease

Heart disease

Heart attacks must be recognised and treated as quickly as possible because once a coronary artery is blocked, the heart muscle will die within four to six hours.

If you suspect you or someone else is having a heart attack, seek medical help immediately by calling 999. Modern treatments can restore the blood supply to the heart muscle. The sooner treatment is given, the less permanent damage there will be.


Causes of a heart attack

The UK has one of the worst heart attack rates in the world. It’s estimated that someone has a heart attack every two minutes in the UK. More than 1.4 million people have angina and each year about 275,000 people have a heart attack. Of these, more than 120,000 are fatal.

Common causes include:

*Atherosclerosis, where fatty plaques build up on the inner lining of the coronary arteries (often compared to the furring up you see inside a kettle)

*Smoking

*High cholesterol

*High blood pressure

*Diabetes

*Family history of heart disease

Men are also more likely to have a heart attack than women.

There are many steps you can take to change your lifestyle and reduce your risk, including quitting smoking, eating healthily and keeping your weight under control, and getting regular exercise.

Heart function and stem cell therapy

Stem cell therapy improves heart function in patients who had previous heart attacks, according to researchers from the University of Louisville and Brigham and Women’s Hospital.

In a Late-Breaking Clinical Trial session at the American Heart Association Scientific Sessions 2012 meeting, Roberto Bolli, M.D., of the University of Louisville and Piero Anversa, M.D., of Brigham and Women’s Hospital, Boston, presented data from their groundbreaking research in the use of autologous adult stem cells with patients who had previous heart attacks.

They report that after two years, all patients receiving the stem cell therapy show improvement in heart function, with an overall 12.9 absolute unit increase in left ventricular ejection fraction (LVEF), a standard measure of heart function that shows the amount of blood ejected from the left ventricle during a heartbeat.

No adverse effects resulting from the therapy were seen. Moreover, MRIs performed on nine patients in the trial showed evidence of myocardial regeneration – new heart tissue replacing former dead tissue killed by heart attack.

“The trial shows the feasibility of isolating and expanding autologous stem cells from virtually every patient,” said Bolli, who is the Jewish Hospital Heart and Lung Institute Distinguished Chair in Cardiology and director of the Institute for Molecular Cardiology in the Department of Medicine at UofL.

“The results suggest that this therapy has a potent, beneficial effect on cardiac function that warrants further study,” he stated.

The trial – called SCIPIO for Stem Cell Infusion in Patients with Ischemic CardiOmyopathy – was a randomized open-label trial of cardiac stem cells (CSCs) in patients who were diagnosed with heart failure following a myocardial infarction and had a LVEF of 40 percent or lower; the normal LVEF is 50 percent or higher.

Heart disease

Heart disease

The investigators harvested the CSCs, referred to as “c-kit positive” cells because they express the c-kit protein on their surface, from 33 patients during coronary artery bypass surgery. The stem cells were purified and processed in Anversa’s lab in Boston so that they could multiply. Once an adequate number of stem cells was produced – about one million for each patient – Bolli’s team in Louisville reintroduced them into the region of the patient’s heart that had been scarred by the heart attack.

The researchers reported that in the 20 patients receiving CSCs, LVEF increased from 29 percent to 36 percent at four months following infusion. None of the 13 control patients in the trial received CSCs and this group showed, on average, no improvement.


The beneficial effect of the CSCs persisted and became progressively greater at the one- and two-year mark following infusion. At the one-year mark following infusion, LVEF increased by 8.1 percent, and at the two-year mark, by 12.9 percent.

Nine patients in the trial were able to undergo magnetic resonance imaging of their hearts that showed a profound reduction in the size of the infarct, that area of the heart that is dead tissue as a result of the heart attack, and an increase in viable tissue.

The MRIs showed that the infarct size was at 33.9 grams prior to treatment and 18.2 grams at two years. The MRIs also showed that viable left ventricle tissue increased, from 146.3 to 164.2 grams. The remaining patients in the trial were not able to undergo MRIs because they had previously implanted devices that interfered with the procedure.

One patient, Jim Dearing of Louisville, showed no trace of the two heart attacks he suffered prior to participating in the trial. Echocardiograms performed in 2011 and 2012 showed his ejection fraction went from 38 percent to 58 percent and his heart is working normally.

The researchers plan to follow the study cohort for two more years and with funding, expand their research.

“The findings warrant larger, phase 2 studies. If the larger studies continue to confirm our findings, we potentially have a cure for heart failure because we will have something that conceivably, for the first time, actually regenerates dead heart tissue,” Bolli said.