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The human heart requires a constant supply of blood in order to function well. The blood supply is maintained by the left and right coronary arteries.

Sometimes, one of the coronary arteries becomes blocked by a blood clot. When this happens, the blood supply to a part of the cardiac muscle is cut off. This area of the cardiac muscle becomes permanently damaged if the obstruction lasts for more than a few hours.

Such a blockage of a coronary artery and the subsequent destruction of cardiac muscle is called a heart attack. Dr. Abhijit Chatterjee who is one of the most renowned heart specialist in Kolkata has his expertise in many areas.

Some of the known risk factors are high blood pressure, diabetes mellitus, high blood cholesterol, tobacco abuse, and a bad family history.

Patients who suffer from a heart attack complain of chest pain. This is similar to the chest discomfort that occurs in the patients of chronic ischemic heart disease, but has important differences.

As in ischemic heart disease, the pain occurs in the center of the chest. It may spread to the left or right sides of the chest, to the inner aspect of the left arm, to the area in between the two shoulder blades, and to the throat and lower jaw. Sometimes it spreads to the upper abdomen and is mistaken for gas.

It differs from the discomfort of ischemic heart inasmuch as it is more prolonged and more severe. The patients of chronic ischemic heart disease prefer to stand, sit, or lie down quietly in order to get relief from the discomfort. On the contrary, the patients who have an acute myocardial infarction are restless because of severe pain. They may have nausea, vomiting, or severe sweating.

All the patients of heart attack do not complain of the characteristic chest pain. About 20% of the patients have unusual features during an episode of acute myocardial infarction

Some patients have breathlessness, sudden fainting, fall of blood pressure, or an irregularity of the pulse,

A very high index of suspicion is necessary if one is to make the correct diagnosis.

Elderly (> 75 years) people, women, diabetic subjects, and post-operative patients are the ones who commonly present with unusual features during a heart attack.

Rib fractures, pain in the muscles of the chest, herpes zoster, pneumonia, diseases of the food pipe (esophagus), peptic ulcer, and gall bladder disease often present with chest pain that can be confused with a heart attack.

On the other hand, the pain of acute myocardial infarction may spread to the upper abdomen and be wrongly ascribed to gas, thus delaying the diagnosis and treatment.

They should get the patient to chew and swallow 300 mg of aspirin, and swallow 80 mg of atorvastatin. They should start administration of moist oxygen, and rush the subject to a health care facility where there are facilities to restore the blood flow to the heart.

The crushed aspirin tablet gets quickly absorbed into the blood stream right from the mouth. On the other hand, an enteric coated aspirin tablet takes a longer time to give its beneficial effects if it is swallowed.

Please remember that chewing of the other tablets administered during acute myocardial infarction (e.g., clopidogrel, atorvastatin) is not recommended.

If the patient reaches the hospital in time, doctors try to clean the block in the coronary artery. There are two basic approaches.

The first is the pharmaco-invasive approach. The clot is dissolved with the help of intravenous medicines, followed by angioplasty 2-24 hours later.

The second is the invasive approach. Here, the doctor opts for immediate angioplasty without trying to dissolve the clot with medicines.

Our medical science continues to use these medicines because innumerable lives are saved by their use. The number of fatal and non-fatal bleeds arising out of their use is miniscule.

There are a set of contraindications for the use of these agents. But even when these guidelines are meticulously followed, there will be people who present with massive bleeding. Unfortunately, there are no means to determine which patients will have bleeding.

Angioplasty that is done in the first few hours of a heart attack preserves the pumping function of the heart. The patients live longer, and have useful and productive lives. Disclaimer

The information given in this article is for the general knowledge of the members of the public. This is not intended to be a guideline for treatment by the patients or their doctors. No responsibility will be taken for acts of commission or omission caused by treatment using the information provided here.