Heart attacks heart represent 60% and stroke by 25% of deaths in people with diabetes. A 1998 study reported that patients with type 2 diabetes and no history of heart disease have the same risk of a heart attack at age seven than non-diabetics with heart disease.

Insulin resistance in the long run, even without type 2 diabetes, appears to have significant harmful effects on the heart. This condition occurs when insulin levels are normal to high, but the body is unable to use insulin to regulate blood sugar metabolism and keep it for energy. In such cases, the body compensates for this by increasing insulin levels (hyperinsulinemia), which in turn increases triglycerides and lowers HDL cholesterol. Normally, insulin stimulates the release of two substances, endothelin and nitric oxide, which are important to keep open the arteries elastic. Insulin resistance can cause an imbalance in these substances. [For more information, see chapter egalenia encyclopedia on Diabetes: Type I and Diabetes: Type II].

Homocysteine

Abnormal levels of the amino acid homocysteine ​​in the blood are closely linked to increased risk of coronary heart disease and stroke. Homocysteine ​​can damage the inside of the arteries and promote blood clotting. You can find high levels of this amino acid in the presence of deficiency of vitamins B6, B12 and folic acid. Some experts believe that high levels of homocysteine ​​are only indicators, not causes, of heart disease. However, some studies have suggested that there is a strong association between this factor and heart disease.

Obesity

Obesity is associated with hypertension, diabetes, high cholesterol levels and lack of exercise, all factors contributing to myocardial infarction. Abdominal obesity (“curve of happiness”) is a higher risk. In fact, a 2000 study stated that men with a waist size over 90 cm. and high triglyceride levels (plus 2 mmol/L) are at increased risk of developing heart disease in the next five years.
Obesity in children is a risk factor for future heart problems larger than a family history of heart disease. People who are overweight in midlife may not completely reduce the risk of coronary heart disease later, even though losing excess weight. People who are overweight or obese have high levels of C-reactive protein, an indicator substance of inflammation and a marker of heart disease.

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For example, brisk walking has the following advantages:

- Low heart rate and blood pressure
- Improved cholesterol
- Lowers blood sugar levels
- Open the blood vessels and, in combination with a healthy diet can improve blood clotting factors.
- Reduces stress and improves mood.

Some studies indicate that for most cardiac protection, what counts is not the duration of exercise, but the total daily energy expenditure. Therefore, the best way to exercise may consist of short periods of intense exercise. Even elderly people with unstable angina or who have previously suffered a heart attack may benefit from a structured exercise program. Exercises that train and strengthen the muscles of the chest can also be very important for patients with angina.

It should be emphasized that strenuous exercise (such as removing snow or mowing the lawn) may be a risk of angina and myocardial infarction for these people. Also, activities that involve raising your arms above your head can involve risk, and people with angina should never exercise after eating.

People who have risk factors for heart disease should seek medical advice and consent and the requirement of a detailed program of exercises. Everyone, including healthy persons, must observe his body, ignoring the discomfort they may feel while exercising. [See the chapter on Exercise egalenia encyclopedia].

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- Optimum (below 120/80 mm Hg).
- Normal (between 120/80 and 130/85 mm Hg).
- Normal-high (between 130/85 and 139/89). (Some studies indicate that high-normal places the patient at an increased risk of cardiac events and stroke, although others suggest that the risk exists mainly in diabetics).
- Hypertension, or high blood pressure (140/90).

Several studies have shown that elevated systolic blood pressure is significantly more accurate indicator of hypertension, particularly in the elderly. (Systolic pressure is the highest and the first issue of blood pressure measurement. It measures the force of blood against artery walls and cardiac contractions to pump blood. [For more information, see the chapter on egalenia encyclopedia on hypertension].

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Smokers between thirty and forty years have a heart attack rate five times greater than nonsmokers of the same age group. Cigarette smoking may be directly responsible for at least 20% of all deaths annually, or about 120,000 deaths annually. Cigar smoking can increase the risk of early death from heart disease, although the evidence is more conclusive for cigarettes.

Cholesterol and other lipids

A number of studies have now shown that reducing LDL (bad cholesterol) and total cholesterol levels and increase HDL levels (the so-called good cholesterol) improves survival and prevents heart attacks. Depending on risk factors, people should try to reach the following levels of cholesterol:

General values ​​for cholesterol:

- Total cholesterol: 200 mg/dl or less.
- Levels of LDL cholesterol: 160 mg/dl or less. (The less the better).
- Levels of HDL cholesterol: 45 mg/dL for men and 50 mg/dL for women, with approximately 60 objective (higher is better).
- Levels of triglycerides: 200 mg/dL or lower. (Although there is evidence to suggest that people should reach levels below 100 mg / dL to reduce the risk of heart disease)

Values ​​for people with two or more risk factors for heart disease:

- LDL levels 130 mg/dl or less.

Values ​​for people with existing heart disease:

- LDL levels under 100 mg/dl. Now is also believed that high levels of other lipids, including lipoprotein (a) and apolipoprotein A-1 and B are important indicators of cardiac risk. Apolipoprotein B, for example, can be a very accurate indicator of heart disease risk in women. [For more information, see the chapters of the encyclopedia egalenia, Cholesterol and heart-healthy diet].

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Sex

Coronary heart disease is more common in middle-aged men. Women spend on average ten to fifteen years longer than men, suffer from heart disease, but as they age women reach men. In fact, women are more likely to have angina than men. As regards age, survival rates for heart attacks are similar in men and women, but young women are at increased risk of death from stroke than men the same age. The reasons for this are not clear.

In Spain, coronary artery disease is responsible for 32 percent of deaths in women and 25 percent of men.
Estrogen, which seem to protect the heart, may have something to do, and may be that many young women who suffer heart attacks have lower estrogen levels. For example, in a 2000 study, women who came early in the natural process of menopause (35-40 years for) had a higher risk of death from a heart attack than women who entered menopause later in .

Many studies have reported that women receive less aggressive treatment than men in all stages of heart disease. Recent studies have suggested, however, is similar for both men and women during the late stages of heart disease. Younger women with heart disease often do not have the same symptoms as their male counterparts and less likely to be diagnosed properly or aggressively. In fact, it is less likely to develop symptoms as typical angina and evidence are often more women than men to detect gastrointestinal problems. (An interesting 1999 study found that while, in fact, women with unstable angina were treated less aggressively than men, when compared risk factors, men had worse long-term).

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On the positive side, however, improved treatments significantly decreased the mortality and hospital readmission.
High-risk individuals. A heart attack is always more severe in some people:

- Elderly (particularly those who are thin)
- People with risk factors or history of myocardial
- People with heart failure
- People with diabetes
- People on dialysis for some time

Factors that increase the severity. The presence of other diseases during a heart attack can contribute to a worse prognosis:

- Arrhythmias (abnormal heart rhythm). A very serious arrhythmia called ventricular fibrillation is the leading cause of death in the short term following a heart attack. Such arrhythmias are more likely to occur in the first four hours and is associated with a high mortality rate. (Patients who are successfully treated, however, have the same long-term prognosis than those who have not had this type of arrhythmia).
- Signs of serious physical injury to the heart.
- Shock. It is a very dangerous situation which is characterized by low blood pressure, decreased urinary flow and cellular alterations. The shock occurs in 7% of heart attacks. Its incidence has not declined in recent years, although the survival rate has improved.
- Heart block, also called atrioventricular block (AV) is a disorder in which the conduction of electrical impulses through the specialized cardiac conduction system slows down or is interrupted. Although the locks are dangerous, can be effectively treated with a pacemaker, and rarely produce long-term complications in patients who survive.

Long-term results

The long-term prognosis in both the duration and quality of life after a stroke depends on the severity and the preventive measures taken later. Although currently there are no tests that can reliably predict whether another heart attack will occur, experts estimate that over 30% of fatal attacks and some subsequent surgeries could be avoided with the adoption of healthy changes in lifestyle and compliance of medical treatment. Two thirds of patients who have suffered a heart attack, however, follow the steps to prevent the next.

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Common symptoms of myocardial infarction. Some signs to which we must pay attention are the following:

- Sometimes a month before the episode of heart attack, the patient may experience mild chest pain, unexplained fatigue and malaise, and depression.
- Just before a heart attack, many patients experience chest pain, usually precipitated by exercise or stress that continues even after taking medication or rest.
- Many patients experience pain from a heart attack like a crushing weight against his chest, accompanied by profuse sweating. The pain may radiate to the shoulder and arm, neck or jaw, and even, though less frequent on the right arm. The arm can even be numb.
- It should be pointed, however, that the degree of pain experienced varies greatly depending on the individual. Some people experience severe pain, while others only have a tingling sensation. Others may feel only a sensation of pressure or tightness in the chest.
- It is a common feeling of indigestion or heartburn, and nausea and vomiting.
- Some people report great fear of imminent death, a phenomenon known as angina animi.

Atypical symptoms in specific population groups. It is important to note that one third of all patients who have suffered a heart attack have no chest pain, which puts them at increased risk of misdiagnosis.

- Women are more likely than men to have nausea and feel pain in upper abdomen or chest. Your first symptom may be extreme fatigue after exercise before chest pain. Symptoms of angina in women are often atypical and more likely the discomfort of chest pain are caused by other problems. Due to these reasons, it is less likely to become aggressive testing to women than men to detect heart problems when they go to the ER. You should always take seriously any chest pain.
- The symptoms in the elderly may be just short of breath. A 2000 study suggested that may not be diagnosed heart attacks in people over 65 who have no history of angina or heart failure.

Immediate steps to follow:

Patients with angina should take 1 dose of nitroglycerin at the onset of symptoms and every five minutes remaining three doses.
Calling an emergency medical services should be the first step to take if the chest pain continues in patients with angina who have taken the full three doses of nitroglycerin or any individual with severe chest pain. People who suffer chest pain should go immediately to the emergency room, preferably with an ambulance. They should conduct themselves.

The patient should take an aspirin and ensure that health professionals are informed of emergency so that it does not give them an extra dose.

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Angina is the primary symptom of coronary artery disease and, in severe cases of myocardial infarction. Usually you experience chest pain. It is often referred to as stable angina (predictable) or unstable (less predictable and a sign of a more serious situation). Angina itself is not a disease. There is much evidence that, indeed, the onset of angina within 48 hours before myocardial infarction may be protective, possibly by conditioning the heart to resist damage resulting from the attack.

Angina may be experienced in different ways and can be mild, moderate or severe:

- It is defined as an oppressive feeling but mild, it may seem to an object that presses on the chest.
- The pain often radiates to the neck, jaw or to the shoulder and arm.
- More rare is that patients explain burning sensation in the chest, stinging, or pain extending into the right arm or back.
Sometimes the patient experiences shortness of breath, fatigue, or palpitations instead of pain.
- The intensity of pain is not always related to the severity of the medical problem. Some people may feel severe pain due to weak ischemia, while others may experience only mild discomfort from severe ischemia.
- Some people have also reported increased sensitivity to heat the skin with the onset of angina.
- Angina can also be precipitated by large meals that require an immediate demand for more oxygen to the heart.

Stable angina. In stable angina chest pain is predictable. Although less serious than unstable angina, can be extremely painful. Usually relieved by rest and responds well to medical treatment (typically nitroglycerin).
Any event that increases oxygen demand can cause an attack of angina. Some typical triggers include:

- Exercise
- Cold Weather
- Emotional stress
- Meals copious

Episodes of angina may occur at any time during the day, but a large proportion appears to occur between the hours of 6:00 AM and noon.

Unstable angina. Unstable angina is a much more serious and is often an intermediate stage between stable angina and heart attack. Unstable angina is usually diagnosed when a patient has the following symptoms:

- The pain wakes the patient or occurs at rest.
- The patient had never before experienced angina pain feels a strong or moderate while doing mild exercise (climbing a flight of stairs or walk two blocks).
- Stable angina has progressed in severity and frequency over a period of two months and the pain-killing drugs are less effective.

Prinzmetal angina. A third type of angina, called variant or Prinzmetal’s angina, is caused by a spasm of the coronary arteries. It almost always occurs when the patient is resting, and frequently presents with irregular heartbeats. Irregular heartbeats are common, but pain is usually relieved with treatment.

Silent ischemia. Some people with severe coronary artery disease do not experience anginal pain, a condition known as silent ischemia, which some experts attribute to abnormal processing by the brain of heartache. This is a dangerous condition because patients have no warning signs of heart disease. In one study, people who had silent ischemia had higher rates of complications and mortality than those who suffer pain. (Anginal pain may actually protect the heart conditioned before a heart attack).

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The heart is the organ of the body that works harder. Throughout life, is responsible for continually pump oxygen-rich blood and vital nutrients through a network of blood to all organs and tissues of the body. It has its own arterial system, known as coronary arteries, which carry oxygen-rich blood to the heart muscle (myocardium). If the blood flow to the myocardium is interrupted, an injury occurs known as heart attack, or in other words, a myocardial infarction, popularly known as heart attack or heart attack.

Coronary heart disease

The most common cause of myocardial infarction due to coronary artery disease. To carry out the arduous task of pumping blood, the heart muscle needs a plentiful supply of oxygen-rich blood, which comes from the network of coronary arteries. Coronary heart disease is the end result of a complex process called atherosclerosis (commonly called “hardening of the arteries”). There are different stages in this process, and some of them are not known at all:

- A series of environmental or physical factors are involved in triggering excessive amounts of unstable particles known as oxygen free radicals, which bind and alter other molecules in a process known as oxidation. (The particles are released as a normal part of the internal processes of the body, but certain environmental toxins, such as snuff, may produce excessive amounts)
- When free radicals are released from the artery wall, react with low density lipoprotein (LDL), oxides. (Lipoproteins are spherical shaped bodies that carry cholesterol and LDL are also known as “bad cholesterol”).
- LDL cholesterol deposited thick layers of rust on the walls of the artery. Cholesterol accumulates.
- Cholesterol accumulates.
- The lesions in the arteries during the process alert the immune system to release white blood cells at that point (especially those called neutrophils and macrophages. This starts a process called harmful and significant inflammatory response.
- Macrophages “eat” foreign bodies literally, in this case the oxidized cholesterol and become foam cells, which are attached to the muscle cells of artery walls, making them grow.
- Over time cholesterol hardens into plaque, which accumulates in the walls of the arteries.
- The immune system, detecting other harm, releases other factors called cytokines, which attract more white blood cells and perpetuate the whole cycle, causing persistent lesions in the arteries ..
- The internal walls of injured vessels do not produce enough nitric oxide, a substance vital to maintain the elasticity of arteries.
- In the long run, these arteries calcified (hardened) and inelastic are narrower (a condition known as stenosis). As this process continues, blood flow slows and prevents oxygen-rich blood to the heart.
- This oxygen deprivation in vital cells is called ischemia. When it affects the coronary arteries, causes lesions in heart tissue.
- The episode of myocardial infarction may occur as a result of one or two effects of atherosclerosis:
- If the artery is completely blocked and ischemia is so extensive that cardiac tissues are deprived of oxygen, the cells of the same die.
- If the same plaque develops fissures or tears. Platelets adhere to that point to seal the plate and form a blood clot (thrombus). So a heart attack can occur if the formed blood clot completely obstructs the passage of oxygen-rich blood to the heart.

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The development of advanced cardiac care in hospital and good post-hospital care means that heart attack patients have a good chance to make a full recovery. This is important information to remember when you are reassuring to someone who has a heart attack.

Signs and symptoms of heart attack

These signs and symptoms are usually identical to those of angina – in fact, the patient may initially the attack of angina sufferer who becomes a heart attack.

The key difference is that heart attacks do not always follow physicalexertion. While sufferers will of angina is recovering from his attack on resting, the heart attack patients do not tend to improve without medical treatment.

Treatment for heart attack

• Move the death in a semi-sitting, head and shoulder supported and knees bent, as this is usually the best position to breathe in..
• Reassure the death and not let your move, as this will put an additional strain on the heart.
• Call for an ambulance as soon as possible because death required hospital care.
• If death has angina medication, let your take this. If you have a regular aspirin, to give you one to chew (without water).
• Save a continuous check on the breath and pulse and be prepared to resuscitate if necessary.

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