This happens when there is a sudden, complete blockage of the coronary artery, causing permanent damage to part of the heart muscle. This is usually due to a sudden rupture of the lining of fatty plaque inside the artery, causing clot formation and subsequent complete blockage of artery. It can also occur at rest.

1. Analgesics

2. Prescribe a powerful blood thinning medication to dissolve clot and unblock artery. Success rate of unblocking arteryis only slightly more than 50% and serious bleeding complications from other areas can result.
 
3. Unblock artery by inserting a balloon or stent through a small puncture in the groin or wrist to open up the artery. This is called Percutaneous Transluminal Coronary Angioplasty (PTCA). Success rate is 90%. NHC offers round-the-clock emergency PTCA for patients with ongoing heart attack.

The aorta is the largest artery in our body. Aortic dissection is caused by the disruption of the aortic wall allowing blood to flow between layers of the vessel wall. When origins of major branches from the aorta at the site of dissection get affected, it results in compromised blood flow to respective major organs. If the arteries to the heart or brain are affected, death, heart attack or stroke can result.

• Sudden, severe ripping chest or back pain. Pain may travel if there isextension of dissection

• Heart attack

• Stroke

• Heart failure (valves involved)

• Shock (blood trapped around the heart)

• For all patients with severe chest or back pain, especially patients with high blood pressure, a chest x-ray is needed

• Echocardiography

• CT angiography or MRI is needed to confirm diagnosis

1. Use of oral medications to reduce the blood pressure to prevent further extension of dissection.

2. If initial blood pressure is high and not controlled, intravenous medication is needed.

3. Dissection affecting initial part of the aorta will require surgery.

A localised abnormal widening of vessel wall due to weakening of the vessel wall.

Most serious complication arising is rupture of the aneurysm when it increases to a certain size. It becomes fatal if rupture happens in the aorta or brain.

• Usually clinically silent; diagnosed incidentally or when it ruptures

• Aortic neurysm causes deep diffuse chest pain, difficulty in swallowing, hoarseness

• Brain aneurysm causes headache

• Abdominal aneurysm: If large enough, aneurysm can be detected by examination as pulsatile mass

• Chest / abdomen aneurysm: Ultrasound, CT angiography, MRI

• Brain aneurysm: Diagnosed when ruptured and causes a stroke

1. Control blood pressure to reduce risk of expansion and rupture of aneurysm.

2. Surgical repair is needed when aneurysm reaches a certain size or is expanding rapidly.

3. Brain aneurysm: Immediate drainage of blood and surgery to save life and minimise brain damage.