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"What is a coronary thrombosis? The heart is surrounded by three major coronary arteries that supply it with blood and oxygen. If a blood clot develops in one of these arteries, the blood supply to that area of the heart muscle will stop. This is known as a heart attack, or in medical terms a coronary thrombosis or myocardial infarction.  A heart attack will cause severe chest pains behind the breast bone, often radiating towards the left arm.  If the blockage (thrombosis) is not dissolved quickly with medication or treated with an emergency catheter procedure (balloon angioplasty), the area of heart muscle that isn&amp;#039;t getting enough oxygen will stop working properly. What causes coronary thrombosis? Atherosclerosis is the name given to the build up of cholesterol and fat (fatty deposits or plaques) in the artery walls.  The arteries become narrow and hardened, their elasticity disappears and it becomes difficult for blood to flow through.  The fatty plaques can also rupture, causing blood to clot around the rupture. If blood can&amp;#039;t then flow past the clot to the necessary part of the body, the tissue dies. Plaque rupture is the most common cause of heart attacks. Most people in the developed world have atherosclerosis in some parts of their body, without ever noticing it.  Atherosclerosis develops gradually over time and can start as early as in childhood. What are the risk factors? The main risk factors for a heart attack include:  smoking lack of exercise. being severely overweight stress a family history of atherosclerosis high cholesterol levels high blood pressure diabetes Type 1 or Type 2  What are the symptoms of a coronary thrombosis? Some people get chest pains (angina), which are a sign that atherosclerosis has narrowed the coronary arteries. Other people have no symptoms until the plaque ruptures and causes the following:  sharp pain behind the breast bone or on the left-hand side of the chest, which may spread down the left arm pain can also radiate towards the hands, jaw, ear, stomach or the right arm a constricting sensation in or around the throat  breathing difficulties  sudden fainting or severe dizziness, often accompanied by pain.  What are the danger signals? If you suddenly get severe chest pains or any of the other symptoms mentioned above, it could be a sign of a blocked coronary artery. People with angina should watch out for the following.  If glyceryl trinitrate medicine used to manage the chest pains no longer seems adequate. If it takes less exertion to bring on the pains.  These are signs that coronary artery disease is worsening.  This is because angina usually happens only after some sort of effort, and the physical effort required to bring it on is generally the same from day-to-day.  It is of great concern when angina comes on with no effort at all. If chest pains suddenly happen at rest and last longer than 20 minutes, you should call 999 for an ambulance.  At the hospital they can decide whether this is heart attack, severe angina or possibly something completely different. What should I do if I experience sudden severe chest pain?   Get to a hospital as quickly as possible. Dial 999 and wait for the ambulance. Don&amp;#039;t drive to hospital yourself, because your condition might worsen on the way.  Rest while waiting for the ambulance. Chew an aspirin (eg Disprin) of 300mg strength (this thins blood). If relatives or friends are close by, call them and ask them to come and wait for the ambulance with you. Remain quiet and try not to get anxious, though this may be difficult.  How does a doctor make the diagnosis? The doctor will request a electrocardiogram (ECG), which will indicate if a coronary artery is blocked.   ECGs are not 100 per cent accurate. In some cases, a small clot that affects a small area of heart muscle might be overlooked. If pain is persistent, a second ECG may be taken 30 minutes later. Once you are admitted to hospital, a series of blood samples will be taken over the first 24 hours. These will check if there&amp;#039;s been any injury to the heart muscle and the extent of that injury.  How is a coronary thrombosis treated? If you haven&amp;#039;t already taken aspirin, one 300mg tablet of aspirin is given on arrival at the hospital.  This prevents platelets (small blood cells) from sticking together around the clot that&amp;#039;s blocking the artery.  The treatment of choice is an emergency operation where the blocked coronary artery is dilated using a balloon catheter.  This procedure is known as coronary angioplasty, usually called percutaneous coronary intervention (PCI). It is only done in specialist centres. A PCI should be performed as soon as possible after symptoms begin. The earlier it is done, the better the result.  In parts of the country where the distance to a PCI centre is too long medicine to dissolve the blockage (thrombolytic medicine) is injected into a forearm vein before the patient is transported to a PCI centre.  What medication is used after a heart attack?  Aspirin Aspirin (eg Angettes 75) is always prescribed unless it can&amp;#039;t be tolerated.  It has a mildly blood-thinning effect and goes some way to prevent further cardiac events. Aspirin must be taken for the rest of your life. Clopidogrel (Plavix) is often combined with aspirin in the first year after the heart attack.  Nitrates Nitrates act by expanding the arteries. Quick-acting glyceryl trinitrate tablets or spray (eg Nitrolingual) may be prescribed for episodes of chest pain. Long-acting oral nitrate, such as isosorbide mononitrate (eg Imdur), helps prevent attacks of angina and is useful for shortening the duration of any such attacks. Beta-blockers  Among other effects, beta-blockers such as atenolol (eg Tenormin) block the action of adrenaline hormones on the heart.  This lowers blood pressure while the heart beats more slowly, reducing the workload on the heart and increasing blood flow in the coronary arteries.  Beta blockers can reduce mortality rates and the rate of repeated heart attacks.  Calcium-channel blockers Calcium-channel blockers reduce the muscle tension in the arteries, expanding them and so allowing a larger blood flow.  They also slightly relax the heart muscle, reducing the need for oxygen.  There are different types of calcium-channel blockers available that have different effects on the heart rate, the coronary arteries, the heart muscle and the circulation. These medicines are not routinely used early after a coronary thrombosis, but may be used for angina management in the long term.  Nicorandil (potassium channel activator) Nicorandil (Ikorel) reduces muscle tension in the coronary arteries and dilates the vessels accordingly.  This improves blood flow to the heart.  It also dilates blood vessels elsewhere in the body, which reduces the amount of work the heart has to do to pump blood around the body.  ACE inhibitors ACE inhibitors such as lisinopril (eg Zestril) prevent the formation of a hormone called angiotensin-II.  Angiotensin-II makes the blood vessels contract and may increase the thickening of heart muscle away from the heart attack area. So these medicines relax the blood vessels and reducing the workload for the heart.  They may be very helpful in improving the function of the heart and in preventing late complications after a heart attack. A doctor is very likely to prescribe a medicine from this class, unless a person has a persistently low blood pressure.   Diuretics Diuretics are medicines that help the body secrete excess fluids and salt, which reduces blood pressure (this may be helpful if heart failure occurs). Diuretics can have different effects in the kidneys and can be divided into thiazides, loop diuretics, potassium sparing diuretics and a combination of these.  Often, oral potassium is added because the kidneys discharge lots of potassium when treated with diuretic medication.   Cholesterol-reducing medicine If blood cholesterol levels are too high, medicines can lower natural cholesterol production in the liver.  Statins (eg Zocor (simvastatin) and Lipitor (atorvastatin)) are the most effective medicines for lowering cholesterol.  These reduce the production of &amp;#039;bad&amp;#039; LDL cholesterol by the liver, which decreases LDL cholesterol blood levels by up to 50 per cent. LDL cholesterol contributes to fatty deposits in the arteries. What examinations may be performed after a heart attack?  Usually patients after a successful PCI procedure do not require any further examinations but will be in need of lifestyle modification and medication.  However, if there are still signs of angina or even of heart failure one of the following examinations may be indicated:  Fitness test: either on an exercise bike or a treadmill where a continuous ECG can be taken. The test can reveal if there are areas of the heart suffering from lack of oxygen supply. This is usually done at around four to six weeks following discharge, unless you experience chest pains while still in hospital.  Echocardiography: ultrasound scan of the heart, which shows the doctor how well the heart pumps, and to how great an extent the heart has been injured by the thrombosis. Coronary artery examination (coronary arteriography): a dye that shows up on X-rays is injected into the coronary arteries. It reveals stenoses (narrowing) or occlusion (blockage) in the coronary arteries that may require treatment.  Recovering from a heart attack Physical consequences After a heart attack, a scar will develop in the heart muscle and this part of muscle will function less well.  Much of the muscle is transformed into fibrous (connective) tissue and the pumping action is lost. Any loss of physical ability will depend on the extent of this damage to the heart.  Small injuries will often not be noticed afterwards. Larger damaged areas can reduce the heart&amp;#039;s functional level in the long term, reducing the amount of physical work you can do and increase the likelihood of heart failure.  An echocardiogram of the heart before discharge can show the doctor how extensive the damage is. Some people feel tired and need much more sleep in the immediate aftermath of a heart attack.  For patients after a heart attack it is recommended to participate in a cardiac rehabilitation programme.  These programmes help patients on the road towards a heart-healthy lifestyle and to both physical and mental fitness. Mental consequences Depression can sometimes follow a coronary thrombosis, along with a general feeling of being physically tired. Many people are afraid of having a relapse, and this can affect their mood.  In this instance, depression is more likely where the hospital doesn&amp;#039;t arrange an exercise rehabilitation programme. If you experience persistent episodes of low mood, you should talk about them with your family, good friends and GP.  Depression is treatable, but you will need help getting through this difficult period. What can I do to prevent further heart attacks?  1. Quit smoking Giving up smoking is the most significant thing you can do to reduce your likelihood of another heart attack.  It is also important that your partner does not smoke. 2. Take regular exercise Thirty minutes of exercise three to five times a week, for instance on a bicycle or walking, has many positive effects on health, such as it will help to significantly reduce a raised cholesterol level and lessen cardiovascular risk. 3. Eat a healthy diet Reduce saturated fat by limiting the amount of red meat, cakes and pastry in your diet.  Eat oily fish, reduced fat dairy products and lean cuts of meat, eg skinless chicken breasts. All food should be preferably be grilled instead of being fried. You should aim to eat five servings of vegetables and fruit per day. Other people also read: Hardening of the arteries: what are the symptoms of atherosclerosis? Angina: people with angina experience pain in the centre of the chest. Heart attack: what are the risk factors?  Based on a text by Dr Sabine Gill, Dr Steen Dalby Kristensen  Last updated 02.03.2015 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/conditions/heart-and-blood/a1140/coronary-thrombosis-heart-attack/>