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HEART INJURY AND ITS CONSEQUENCESThe doctor said that you had a heart attack. This simple statement will be repeated over and over again in your mind in the months to follow. The important thing, however, is that you understand what this statement means. The terms that you hear will be confusing; heart attack, coronary occlusion, coronary thrombosis, and myocardial infarction are virtually synonymous. Angina pectoris is not synonymous with coronary occlusion. When a person has a heart attack, a portion of the heart muscle dies. In angina, there is a temporary insufficiency of blood flow to a part of the heart, and heart muscle death does not occur.The heart is basically a pump that is composed primarily of muscle that expands and contracts to push blood through the body. This muscle, like all muscles in the body, must be fed with food and oxygen to function properly. If the muscle or part of the muscle is deprived of food and oxygen, serious consequences develop. Food and oxygen are carried to the heart muscle by blood flowing through the right and left coronary arteries. These are two blood vessels that arise from the aorta as soon as oxygen-rich blood has left the heart. In other words, the very first organ that the heart pumps blood to for nourishment is itself. Both coronary arteries supply a different part of the heart by way of their branches. If a main artery or one of its branches becomes obstructed for any reason, a portion of the heart muscle dies. This is a heart attack. The moment of blood vessel occlusion (blockage) and heart muscle death is usually accompanied by profound symptoms such as severe chest pain, possibly weakness, sweating, a sense of fear, and, in some instances, shortness of breath, palpitations, or fainting. If the rest of the heart can compensate during this initial phase of profound injury, the heart muscle will heal itself and the pump may again function in a near-normal fashion.The common medical term used to describe this condition is myocardial infarction. “Myo” refers to muscle, cardial to heart, and infarction means an area of dead tissue that is caused by interruption in blood supply. This point must be emphasized – the fact that a portion of the heart muscle has died – to help you understand the immediate and long-term restrictions that this condition may impose upon you.A great many people have the erroneous impression that a coronary thrombosis or coronary occlusion means only that an important blood vessel has been obstructed. That is correct, but it omits the consequences of heart muscle death. They have then heard that in time drugs will dissolve the blood clot that obstructs the vessel, and they then infer that they are back to “normal” again. Other people have the impression that, when a blood vessel is obstructed, “collateral blood vessels” will supply the deprived tissue with an adequate blood flow. This again is a half-truth. Collateral circulation refers to the presence of small blood vessels which communicate with the larger blood vessels. If a block occurs in a large vessel, these branches have the capacity to enlarge and shunt blood flow around the blockage to an area in need of blood. It is true that in time a blood clot may disappear, and it is also true that in time collateral blood vessels may supply with extra blood an area of the heart that lacks it. However, the diagnosis of myocardial infarction distinctly indicates that a portion of heart muscle has died before either of these two potential solutions have had time to become a reality.In time, the area of dead muscle will be replaced by scar tissue. The time element is considered to be approximately six weeks. The reason that the patient’s activity should be greatly curtailed during the six-week period is that the heart should be given a chance to form an adequate scar. The function of the heart is to pump blood throughout the body. Working muscles of the body require a greater blood flow and, therefore, impose a greater load on the heart. A person at rest requires minimal blood flow to his body muscles and, therefore, minimal heart work. A distinct possibility in the person who does not rest after a myocardial infarction is that the area of dead muscle will soften and rupture before a scar has formed. The effect is the same as punching a hole in a gas tank. When the gasoline runs out, the engine will no longer run. In the case of the human being, he dies.Restricted activity during this critical healing phase permits the formation of a tight, effective scar. Scar tissue is incapable of performing any work. Scar tissue cannot contract to make the heart a more effective pump. A good scar, however, will draw the living muscles as close together as possible so that they can function properly without the useless part. If the heart is overworked during this period, it will tend to enlarge and a loose, thin, bulging scar will form which will hamper the work of the adjacent muscle. This loose scar is called a ventricular aneurysm.*5/309/5*

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