Myocardial Infarction (MI) [Heart Attack]  - Myocardium is heart muscle and infarction means death thereof from CAD-n-HA (Coronary Artery Disease and Heart attack) .

The very widely used term heart attack, bad in English as it is, is widely held equivalent to acute damage that the heart suffers because of blockage of arteries supplying blood to the heart. The damage to the heart is called myocardial infarction (MI). The arteries of the heart on account of their position are called coronary arteries. Since it is held that the blockage of coronaries leads to less or no blood going to the heart, the disease is called ischemic heart disease (IHD) or coronary artery disease (CAD). The pain over the chest (angina pectoris) and /or elsewhere that accompanies such an event has led to the coining of the term heart attack – as if the heart is attacked. No wonder, a similar process affecting the brain and usually called stroke in now also referred to as brain attack.

The term heart attack however has a major snag. So often there would be pain but no damage to the heart. Quite often, the heart would be damaged (infarcted) but the owner would not perceive any pain or any other symptom. Put plainly, it would be a case of heart/brain disease without any dis-ease or lack of ease. Medically, such painless diseasing is called a silent heart attack. Commonly accepted explanation for pain of MI or CAD is that the heart suffers from want of adequate supply of blood and expresses itself by causing some sort of ischemic pain. Since the site of pain (chest, arm, neck, jaw, tummy or back) is not the site of pathology, such pain is called referred pain.

The most advanced medical science has no explanation for the fairly common (25 to 40%) silent heart/brain attack. These can be multiple and the person may be totally at peace with body and life. Occasionally, the attack may arrive very silently to end in death. The only advantage that the person with pain has is that the illness gets noticed, emergency gets created and relief measures provided. Doctors rush in to relieve pain, sustain various parameters (pulse, BP, rhythm of the heart) and undo the assumed coronary block by simple or severe measures. Whether such activism improves survival or prevents death is as yet in the realm of statistics.  Times of India (13/8/2011) reports that pain and heart attack are not synonymous - "Researchers at the Hospital of the University of Pennsylvania, who looked at more than 3,000 patients, also found that the most severe chest pain was not a good predictor of who was actually having a myocardial infarction, nor of which patients were more prone to having one over the next month".  "The opposite was also true,....If chest pain isn’t severe, that doesn'’t mean it’s not a heart attack".

Can Healthy Heart Have an Attack?

The answer is  a firm YES. The theory of less blood supply is a theory and concept of apoptosis (genetically regulated process leading to the death of cells and triggered by the presence or absence of certain stimuli) it is cell determined programmed death of cardiac attack.

James Harrick proposed in an article of  JAMA (1913 AD) that coronary occlusion or blockage follows the death of part of heart, silently or painfully. This chicken and egg story of what precedes what, namely, does arterial blockage lead to infraction or infraction produces coronary blockage is yet unsettled . But cardiologist is a proactive profession chosen to believe that coronary blockage is a primary event. This particular assumption is the spring board from which all studies and procedures are launched.

The Current Medical Diagnosis and Treatment [CMDT] , which is a massive update on all problems from Lang Publication for last several editions underlines the fact that the strictest control trials have failed to show any advantage of interfering with coronary angioplasty and by pass over non-invasive ordinary treatment. It must be remembered that so-called coronary revascularization through invasive procedure dates back to 1899. Therefore invasive coronary procedure is 112 years old and yet statistically totally invalid.

We must understand the principle of TRAS i.e. Tissue Requisitions Arterial Supply. Artery never denies blood to tissue which demands it. When brain or heart stops functioning it does not demand blood. So the debate raised by Dr. James Herrick continues till date since 1910 is it the heart / brain which dies first or the coronary is closed. Medical fraternity has hypothetically assumed that it is coronary which closes but fails to explain why 40% of heart attack comes silently.

Some recent  instances of healthy heart, including in-form sportsmen having an attack is worth mentioning (its just a sampler):

Classical signs of heart attack

It is well known that all chest pains are not heart attack. However chest pain accompanied by the following symptoms are classic ones:

• Heaviness in chest

• State of nervousness

• Pain radiating to pit of stomach, jaw, back and left upper limb

• Perspiration

Assistance needed for  person having heart attack

Instead of focusing on shifting a person, who has a heart attack, instantaneously to hospital, it is suggested to carry out the following:

• Make the person sit and relax

• Allow ample of air to pass so that the patient can breath

• Put a Sorbitrate (medicine available easily with all chemists) under the tongue of the patient

• Make the patient lie down

Only after the above steps have been taken medical assistance should be sought. It should be borne in mind that Heart Attack is a transient phenomenon and it should be allowed to pass off, rushing a person instantaneously amidst traffic jams without making the person relax and recuperate may aggravate the condition.