Severe Heart Attacks: Causes and Treatment

At Cooper and Inspira Cardiac Care, we’re here to help you prevent heart disease and its effect — with heart attacks being the most dangerous and life-threatening of all. The deadliest type of heart attack is ST-elevated myocardial infarction (STEMI). Myocardial infarction, or MI, is the medical term for a heart attack. An electrocardiogram (EKG) tracing shows a particular area that is called the ST segment. When this segment is elevated, the person is said to have a STEMI.

If you believe that you or someone else is having a heart attack, even if you’re not sure, call 911 right away.

A STEMI is caused by total or near-total blockage of a coronary artery that supplies oxygen-rich blood to part of the heart muscle. This type of heart attack requires prompt treatment. Unlike skin or hair, once heart muscle is damaged, it will never grow back. All heart attacks are serious, but a STEMI is the most dangerous of all.

All patients with STEMI are treated at one of our heart catheterization facilities, which offer specialized equipment and staff. In southern New Jersey, we successfully treat patients with STEMI every day. We are available 365 days a year, 24 hours a day. We are experts in providing the specialized care required to deliver the best possible outcome.

What Causes a STEMI Event?

When the flow of blood to a section of the heart suddenly becomes blocked, the heart — which is basically a powerful muscle with valves — cannot get the oxygen it needs to function properly. The section of heart muscle that is deprived of oxygen will begin to die.

A STEMI occurs because of coronary heart disease, also called coronary artery disease. This is a condition in which a waxy substance called plaque builds up inside the arteries that supply oxygen-rich blood to your heart. This buildup of plaque occurs over many years.

When an area of plaque breaks loose from an artery wall, it can cause a blood clot to form. When a STEMI occurs, the clot is large enough to block the normal flow of blood to the heart muscle. Unless treatment is provided quickly, the portion of heart muscle fed by the artery will begin to die. Healthy heart tissue is replaced with scar tissue. This heart damage may cause severe or long-lasting problems.

All heart attacks are serious, but a STEMI is the most dangerous of all.

Signs and Symptoms

Often, people aren’t sure what’s wrong when they are having symptoms that can indicate a heart attack. Here are some of the most common warning symptoms of a heart attack for both men and women:

Chest pain or discomfort. Most heart attacks involve discomfort in the center or on the left side of the chest. This discomfort usually lasts more than a few minutes. It may go away and then return. People may experience pressure, squeezing, fullness, or pain. It may also feel like heartburn or indigestion.
Upper body discomfort. You may feel pain or discomfort in one or both arms, your back, shoulders, neck, jaw, or the upper part of the stomach above your belly button.
Shortness of breath. In some cases, this may be your only symptom. It may also occur before or along with chest pain or discomfort. It may occur when you are resting or during mild physical activity.

Other possible symptoms of a heart attack include:

Breaking out in a cold sweat
Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
Feeling nauseated (sick to the stomach) or vomiting
Feeling light-headedness or sudden dizziness

Symptoms of a heart attack can vary from person to person. However, the more signs and symptoms you have, the more likely it is that you’re experiencing a heart attack.

Treatment of Heart Attack

Our treatment methods for STEMI have evolved over the years. Today treatment means taking the patient directly to a heart catheterization laboratory. The specialized Cooper and Inspira Cardiac Care cardiologist who treats patients with STEMI is an interventional cardiologist whose expertise is specifically in the catheter-based diagnosis and treatment of heart diseases. The cardiologist will determine the best course of treatment based on the patient’s symptoms and the results of an EKG.

A cardiac surgeon will perform any necessary procedure. At Cooper and Inspira Cardiac Care, we offer the most advanced cardiac surgery services in southern New Jersey. Our nationally recognized cardiothoracic surgeons offer a full range of state-of-the-art surgical treatment options for patients with STEMI.

Most patients with STEMI undergo a procedure that involves mechanically opening the blocked artery that is causing the heart attack. We first place a catheter (a very thin tube) into the blocked coronary artery through either the wrist or the groin. We then temporarily insert and blow up a tiny balloon at the site where the artery is clogged. The inflated balloon pushes against the walls of the blood vessel to allow more room for blood to flow.

A stent — a small, flexible, expandable metal coil — is then placed in the artery to help keep it open. Depending on the patient’s needs, different types of stents are used. Some stents are coated with medication to help keep the artery open (drug-eluting stents), and others are not (bare-metal stents).

The catheter and the tiny balloon are removed, but the stent stays in place to keep the coronary artery open.

Advances in STEMI Treatment

As recently as the 1990s, the standard of care for a STEMI was to give thrombolytic therapy — drugs that break up or dissolve blood clots. Today, heart catheterization and stent placement procedures are performed at most community hospitals, such as Inspira Medical Centers Vineland and Mullica Hill, as well as at major university/medical centers, such as Cooper University Hospital.

Today, emergency medical services monitor and send patient information — such as EKG results — directly from the ambulance to the hospital as the patient is being transported. This information allows our hospital team to prepare for the patient’s arrival and helps to establish the diagnosis. On arrival, the patient is taken directly to the catheterization laboratory for diagnostic catheterization and intervention, as required.

We have been offering 24/7/365 ability to treat people with acute Myocardial Infarction by taking them directly to the heart catheterization lab and mechanically opening up the blocked artery causing the heart attack, typically placing a stent in place. That’s the standard of care.

Kurt Kaulback, MD

Interventional Cardiologist

Time Is Important

With a STEMI event, the sooner the patient is seen and treated, the greater the likelihood of a good outcome. That’s the whole reason why today heart attacks are treated at local and community hospitals. No longer do local emergency departments have to send patients to a university hospital or major medical center for treatment. Saving a half-hour or a couple of hours can make a huge difference for the patient.

Standards established by the Medical Board of the State of New Jersey recommend a 6-hour treatment window from the onset of symptoms. However, we have learned that there is value in treating a heart attack up to 12 hours after the onset of symptoms if the patient is still having active symptoms.

We want to treat all patients as quickly as possible, and patients should seek care, even if they believe that they’ve experienced symptoms for more than 6 or 12 hours. The quicker we start treatment, the more heart muscle is salvaged, and the more heart muscle that is kept alive, the better the heart muscle will perform.

With a STEMI event, the sooner the patient is seen and treated, the greater the likelihood of a good outcome.

Outlook for Patients After STEMI

Once a patient reaches the catheterization laboratory, our ability to open the blocked vessel is nearly 100%. Unfortunately, the national mortality statistics for a STEMI event remain high because of two factors: significant complications after the procedure and inability of patients to receive treatment early. It is estimated that 50% of STEMI-related fatalities occur because the patient was unable to receive treatment promptly.

If an artery has been blocked for more than an hour, the cells in the heart muscle that are no longer receiving oxygen start to rupture and die. Once normal blood flow resumes, irritation of the heart muscle can result in transient problems with heart rhythm, some of which may require shocking to reestablish a normal rhythm. We are well equipped to manage these issues to help the heart return to its normal function, but arrhythmia after STEMI is uncommon.

Patients who have had a STEMI are at increased risk for repeated heart attacks, heart arrhythmias, heart failure, and stroke. In addition, many patients experience anxiety and depression after STEMI.

Release From the Hospital

Typically, within two hours of completing the procedure, the patient can sit in a chair. We try to have patients back home within 72 hours and sometimes as early as 48 hours after a STEMI event.

Depending on a variety of factors, after an uncomplicated STEMI event, with only a single coronary artery affected, patients are typically home within two to three days. Before the patient is discharged, we ensure that the performance of the heart muscle has returned to normal, a follow-up ultrasound shows no other issues, and the patient is tolerating medications without any problems with heart rhythm or symptoms of heart failure.

Returning to Normal

We see all patients who have STEMI soon after they are discharged. We try to see anyone who is discharged from the hospital within a week, and within 72 hours if possible.

With rare exceptions, everyone who has a heart attack or has a stent placed needs to follow a daily medicine regimen that includes aspirin and a class of drugs called statins, which act as cholesterol-lowering agents. The patient will also be prescribed an ACE (angiotensin-converting enzyme) inhibitor. These medications help to relax the veins and arteries to lower blood pressure.

For a period after stent placement, depending on the type of stent that is used — whether it’s bare metal or coated with a drug — patients need to take an additional blood thinner for a period that can range from four weeks to a year.

We generally perform a stress test after catheterization. If the stress test shows no issues, the patient is cleared to return to work and normal activities. Changes in diet and care in recognizing the symptoms of heart disease are important in the long-term outcome after STEMI.

Most patients who have experienced a STEMI event and receive treatment quickly will have a good outcome.

After STEMI, we encourage patients to enroll in cardiac rehabilitation, which is offered as an outpatient program in Elmer, Vineland, and Mullica Hill. In our rehabilitation centers, under the guidance of cardiovascular experts, personalized programs may include:

Exercise: The plan gradually increases in intensity over time to improve heart health and overall wellness.
Nutrition counseling: A registered dietitian provides guidance for maintaining a heart-healthy diet.
Education/support: A dedicated team provides continuous education and support to help patients through the recovery period and beyond to reduce the risk of future cardiac-related events and improve overall health and well-being.
Occupational therapy: Occupational therapists can help patients to regain strength and confidence so that they can resume normal daily activities confidently.

Currently, we are developing a remote cardiac rehabilitation program to allow patients to exercise while their heart rhythm and heart rate are monitored. This program will help patients to participate in rehabilitation, even if they don’t live within easy driving distance of one of our rehabilitation centers.

Many, if not most, patients who have experienced a STEMI event and receive treatment quickly will have a good outcome. In the past 25 years, we have made tremendous strides in the treatment of STEMI. Fewer patients have significant issues with heart muscle performance, and the mortality rates continue to drop, as do the rates of post procedure complications. A STEMI event is life-threatening, but at Cooper and Inspira Cardiac Care, we are equipped and experienced in helping our patients to survive the event and return to good health.