- Massive Heart Attack Definition
- Causes of Massive Heart Attack
- Coronary Microvascular Disease
- Coronary Artery Spasms
- Diagnosis of Massive Heart Attack
- Electrocardiogram (ECG)
- Blood tests
- Chest X-ray
- Magnetic resonance imaging (MRI) and Computerized tomography (CT) scan
- Massive Heart Attack Treatment
- Survival Rates
Massive Heart Attack Definition
A massive heart attack is a severe form of heart attack that causes damage to a large portion of the heart. This may result in unconsciousness and permanent heart damage. Worst cases cause the heart to stop beating (cardiac arrest), leading to death. 
Causes of Massive Heart Attack
The main cause of a massive heart attack is atherosclerosis, a coronary artery disease. In atherosclerosis, the arteries get blocked because of accumulation of plaque, making the walls of these blood vessels hard and narrow. When this happens, blood cannot circulate properly throughout the circulatory system. It also impairs the normal expansion and contraction of the heart. 
Picture 1: Narrowing of arteries in atherosclerosis
Image source: nhlbi.nih.gov
The main cause of atherosclerosis is the accumulation of fats from eating too much food high in fat and cholesterol. White blood cells may also accumulate in the arteries. When the white blood cells attach to the arteries, a substance called netrin-1 is released, prohibiting the out migration of the white blood cells from the arteries. Other factors that can lead to the obstruction of arteries are high blood sugar level, high blood pressure, and smoking. 
Coronary Microvascular Disease
Coronary microvascular disease is a condition when the small arteries in the body are damaged. Just like atherosclerosis, coronary microvascular disease is caused by high fat and cholesterol levels, high sugar levels, high blood pressure and smoking. It can also be caused by having a sedentary lifestyle, because it can lead to obesity. However, although they have the same causes, no palques are formed in coronary microvascular disease. 
Coronary Artery Spasms
Coronary artery spasm is a sudden and transient narrowing of the arteries of the heart which cause an obstruction in the blood flow, therefore depriving the heart of oxygen-rich blood. These spasms often occur in the arteries that already hardened, or in arteries where plaques build up. The muscles of the artery walls are squeezed, causing the spasms. It is felt as a chest pain and tightness under the sternum or on the left side of the chest. 
This condition is triggered by high blood pressure or high blood cholesterol. It can also happen during emotional stress, alcohol withdrawal, and exposure to cold environments. Vasoconstrictors and stimulant drugs can also cause coronary artery spasms. When this happens, it may lead to mild or massive heart attacks. 
The main symptom of a massive heart attack is chest pain and tightness, and the pain usually radiates to the jaw, neck, back, shoulders and arms. A burning sensation may also be felt on the chest. There is also difficulty in breathing. During a massive heart attack, the patient takes shallow and irregular breaths.
Other less common symptoms of a massive heart attack include:
- Nausea and vomiting
- Excessive sweating
- Cold hands and feet
- Low blood pressure
- Loss of consciousness
Other symptoms happen more commonly in women. These symptoms are:
- Abdominal pain
- Clammy skin
These symptoms may happen anytime, during work or play, and even during relaxation. Some people may experience warning symptoms, such as recurrent angina, days before the heart attack. However, a massive heart attack may also occur suddenly, which may cause cardiac arrest. 
Diagnosis of Massive Heart Attack
This is the main diagnostic test done during any type of heart attack. An electrocardiogram records the electrical responses of the heart, and shows these as waves in an electrocardiograph. An impaired heart muscle has difficulties in conducting electrical waves, and this abnormality can be seen in the results. The progress of the heart attack can also be monitored using this test.
Picture 2: Electrocardiogram
Image source: daviddarling.info
While this test is done, the patient and responders are also asked about the symptoms of the patient. 
A damaged heart produces certain enzymes, which can be detected during blood tests .
Chest x-rays are helpful in allowing the doctors to see the size of the heart and the blood vessels, especially the arteries. It can also show if there is already fluid build-up in the lungs .
Angiogram, or coronary catheterization, shows the condition of the arteries. It can be seen when these arteries are blocked or narrowed. This is done by administering an imaging dye to the coronary arteries through an artery in the groin or leg. This dye can be seen during an x-ray and narrowing and blockage can be easily seen.
While doing the test, treatment can also be done at the same time. This treatment is called angioplasty or coronary artery balloon dilation.
In this procedure, small balloons are placed inside the arteries to allow it to widen. Tubes or stents are also placed to prevent it from narrowing again in the future. 
Picture 3: Angioplasty
Image source: bostonscientific.com
This diagnostic procedure involves the imaging of the heart through the use of sound waves. These sound waves bounce off through the heart and back to the chest. The waves are then processed to provide a digital image of the heart. This test shows if the heart is damaged, or if it is not beating normally. 
Magnetic resonance imaging (MRI) and Computerized tomography (CT) scan
This imaging tests show how severe the heart damage is. This determines whether the heart attack experienced by the patient is mild or massive. 
Massive Heart Attack Treatment
- A massive heart attack necessitates an emergency medical attention. The emergency hotline must be contacted immediately. 
- While waiting for medical attention, aspirin can be given to the patient. This prevents the clotting of blood in the coronary arteries. Nitroglycerin can also be given if the patient has taken it before. Nitroglycerin helps in relieving the chest pain felt by the patient. 
- Cardiopulmonary resuscitation or CPR should be done when the patient already fainted, so that the brain will continuously be supplied with enough oxygen. This is done by applying pressure on the patient’s chest at a rate of about 100 pumps per minute. 
- Upon the arrival of emergency professionals, an automatic external defibrillator must be immediately used to restore the normal heart beat. 
At the hospital, the patient is treated with medications, such as the following:
- Thrombolytics. These drugs dissolve the blood clot that blocks the blood flow around the heart. This prevents further damage of the heart muscles. The earlier thrombolytics are given, the greater the chance of recovery.
- Superaspirins. These prevent the formation of more blood clots. An example is clopidogrel.
Beta-blockers. These help the condition by relaxing the heart. It slows down the heart beat, and it also decreases blood pressure.
- ACE inhibitors. These drugs reduce blood pressure, thereby relieving the heart from further stress and damage. 
Surgery is also immediately performed. One type of surgery is angioplasty . Another type is coronary bypass surgery, wherein veins and arteries are sewn in the parts of the heart where the blood vessels are obstructed. This procedure restores the normal blood circulation in the heart. This is done 3 to 7 days after recovery from heart attack .
Picture 4: Coronary bypass surgery
Image source: bhf.org.uk
Massive heart attack had been one of the leading causes of death, but as people learned of the symptoms and treatment, more people have survived from a massive heart attack . With proper treatment, professional monitoring, and lifestyle change, many people can already survive and live several more years after a massive heart attack .