Myocardial Infarction - The heart of the matter

Then one day a sudden pain in your chest stops you dead in your tracks. The fact of the matter is that your fast-paced lifestyle has taken its toll on your most vital organ…your heart.

A heart attack, or myocardial infarction (MI) is the death of the heart muscle due to a lack of oxygen. This is usually caused by a decrease or lack of blood supply to the heart.

Myocardial Infarctions generally occur when a diseased blood vessel becomes partially or fully blocked by a blood clot.

In South Africa, between 1997 and 2004, it is estimated that 33 people died per day from heart attacks with the prevalence of heart attacks being significantly higher in men than in women - for every woman that dies of a heart attack, two men die.

The heart is the hardest working organ in the body, ensuring that all the other organs receive blood enriched with nutrients and oxygen via a network of vessels. In order for the heart to do this very important task, it needs its own blood supply. The network of blood vessels that supply the heart is called the coronary arteries and it is these coronary arteries that become blocked during a heart attack.

A person experiencing a heart attack may have severe chest pain (which feels like a heavy pressure on the chest) or pain in the arms or neck, lasting approximately 15 minutes. However, some people may only experience mild discomfort like indigestion or heart burn. Additional symptons could include nausea, sweating, shortness of breath and feeling faint.

If a large portion of the heart is damaged at the time of the heart attack the person may die, but this is uncommon.

Historically, the probability of death after suffering a heart attack was extremely high. However people are now more aware of the symptoms and the necessity for early treatment; and there has been an improvement in treatment for heart attacks within the medical fraternity, these factors have led to a decrease of the death rate following a heart attack to about 30 percent. More than half of these deaths occur before arrival at the hospital.

The long-term prognosis for both quality and length of life depends on the amount of damage that has been done during the heart attack. Depending on the extent of this damage and which coronary vessels are affected, the person may develop complications or chronic problems. These could include:

*  Arrhythmias (abnormal heart rhythms) – this is when electrical "short circuits” develop, resulting in abnormal heart rhythms, some of which can be fatal.

* Heart failure – when the damage to the heart muscle is severe enough to stop the heart from adequately pumping the blood through the heart chambers and into the rest of the body’s circulation. This can be either a temporary or chronic problem.

* Heart rupture – this is when a weakened area of the heart ruptures, leaving a hole in the heart. This tends to be fatal.

* Valve problems – resulting in the heart valves no longer functioning properly.

* Higher risk individuals

A heart attack is always more serious for those with certain characteristics. These include:

* The elderly

* People with a history of heart disease or risk factors for heart disease (raised cholesterol, high blood pressure, raised BMI, sedentary lifestyle, smoking)

* People with heart failure

* Diabetics

* Those on long-term dialysis for kidney failure

* Smokers

Most heart attack victims present at the casualty department. The emergency doctor or sister needs to determine the cause of a patient’s symptoms, in order that the correct treatment can be given to resolve the problem and alleviate those symptoms.

This is not always as straightforward as it seems, as there are many other causes of chest pain. Like Gallbladder diseases, panic disorders and anxiety and respiratory problems, such as asthma.

In order to make a diagnosis of a heart attack, a doctor needs to understand the patients medical history and examine the patient for signs which make the diagnosis of a heart attack more likely.

The doctor will perform an Electrocardiogram (ECG) and do blood tests for cardiac enzymes, which are released by the heart muscle when it is damaged and will therefore be raised at the time of the heart attack. These enzymes may also be raised after a person has had an angiogram (an invasive test during which a catheter is inserted into the coronary vessels to check for patency).

The risk of a second heart attack is highest in the first year after the initial event. Insurance companies will need to know the extent of the damage to the heart, treatment given at time of heart attack, which vessels were involved, any associated complications, any co morbid conditions like diabetes, any risk factors for a cardiovascular event such as raised cholesterol or hypertension and the control of these factors, family history etc. The applicant will also be requested to do medical examinations which can include a stress ECG, blood tests such as cholesterol and medical examinations such as a blood pressure check.

Not all companies will pay out on all heart attacks under critical illness cover. Whether a claim is paid or not depends on the definition in the person’s critical illness policy.

Most large insurance companies in South Africa use the SCIDEP definition, which means that the company uses the standardised definition for heart attacks as described by ASISA. This definition has four levels with certain requirements that the client needs to fulfil before a claim will be paid.

Each level of the definition requires a clinical history of chest pain, specific ECG changes that are seen at the time of a heart attack and certain enzyme levels which need to have reached specific levels at the time of the heart attack to qualify for a payout.

A cardiologist may diagnose a heart attack according to the clinical definition which may not qualify for a payout under the insurance benefit definition.

In conclusion, a heart attack is a serious cardiovascular event which can lead to death or chronic health problems. Most of us know that a healthy lifestyle and regular blood pressure and cholesterol checks can help reduce that risk. However, if an MI happens, the person needs to have the correct cover in place to avert financial problems. This cover can include critical illness products, occupational disability and income protection.

Unpublished data of Professor Debbie Bradshaw, Burden of Disease Research Unit,

Medical Research Council, South Africa.

http://www.mrc.ac.za/chronic/heartandstroke