Heart attacks are medical emergencies where every moment counts - dead heart muscle cells are lost forever. Anything that delays or complicates treatment increases the risk of death or long-term effects. In order not to waste time, those affected, their partners, friends or work colleagues should observe a few points. First of all, it is important not to get scared and hectic.
Emergency - that's the first thing you should do
- No panic! Those present should try to keep a reasonably cool head and think clearly. This is never easy in emergencies, where there is always time pressure.
- Call an ambulance immediately without hesitation! Even in the middle of the night, on Sundays and public holidays! Paramedics are responsible for emergencies. This is their everyday life, their usual work. Callers are not a burden to emergency doctors and do not keep them from more important things. There is no reason for restraint, waiting or being ashamed - at most valuable minutes are lost that can possibly save lives.
- Tell them straight away on the phone that they may have had a heart attack, i.e. an emergency.
- Don't drop the call. Sometimes the central control center asks further questions.
- Be sure to give your name, address and phone number.
- Never call your family doctor, friends or relatives first to be sure. In surveys, patients who took the route via their family doctor reached the hospital considerably later than those who came directly to the emergency doctor.
- Urge heart attack patients to go to the nearest appropriate hospital and not to a facility further away.
Another sensible course of action in an emergency
- Private individuals should never drive the person concerned to the hospital themselves - emergency doctors can often begin treatment in the rescue vehicle.
- If the patient's address is difficult to find, other bystanders should turn on the outside lights or meet the ambulance on the street.
- Those present should have a calming effect on the victim and avoid excitement. Even the notification that the emergency services are on their way can allay fears.
- Clothing that may be constricting should be loosened (eg, tight shirts, bras, ties, belts, and pants). An open window that lets fresh air into the room is also often helpful. A light blanket can prevent the patient from becoming too cold.
- If appropriate medications are available, they can help the patient - nitrates (two to three sprays or one to two chewable capsules) or acetylsalicylic acid (one tablet if the person does not vomit).
- Elevated torso positions are beneficial for conscious patients. You can sit or lie down, the upper body should be elevated with pillows.
- Unconscious patients should be placed in the recovery position. The head must lie slightly back. This opens the airways, making it easier to breathe. In addition, the mouth is then the lowest point of the head, so that the tongue does not fall down the throat, which can otherwise lead to death by suffocation.
- If you have experience with this, you can do a heart massage if you stop breathing. Everyone else should only do this if the rescue service asks and guides them to do so.
Acute hospital treatment
Despite all the time pressure, doctors first have to be sure that a heart attack has occurred. They check this suspicion immediately with an electrocardiogram (ECG). It is the quickest to detect heart attacks, but only those that have killed cells in all layers of the heart muscle wall. These ST elevation heart attacks (or STEMI) change the ECG curve characteristically. At the same time and a little later, blood samples are repeatedly taken. The infarction markers (troponin T and troponin I) can be used to detect those infarctions that only affect individual layers of the heart muscle and do not change the ECG curve (heart attack without ST elevation, NSTEMI). If there are no heart attack markers in the blood samples, it is not a heart attack but unstable angina pectoris. As far as their level of danger is concerned, STEMI and NSTEMI hardly differ. If there are still unanswered questions about the individual risk, concomitant diseases or causes, further examinations can take place.
Course of treatment
How the actual therapy proceeds depends primarily on the time: How quickly can a hospital be reached with a team that has experience with the most important intervention (coronary angiography with balloon dilatation) for heart attacks? This procedure usually takes place when the time between the first medical contact, normally with the emergency doctor, and admission to a suitable hospital is no more than two hours. This can take longer in rural areas or at night. The emergency doctor then carries out another treatment (lysis therapy) in the ambulance. Depending on the success, only controls (coronary angiography) or treatments (balloon dilatation) take place in the hospital.
- During coronary angiography (large heart catheter, angiocardiography), doctors usually make a small incision in the groin artery. There they insert a thin, flexible "tube" (catheter) and direct it to the heart vessels. Here they inject a contrast medium. A mobile X-ray system takes pictures from all sides. Specialists can use the images to see where there are constrictions or occlusions in the coronary arteries and how severely they impede blood flow. The function of the heart muscle, the heart valves and other parts can also be assessed.
- In balloon dilatation with a catheter attached to the heart (percutaneous transluminal coronary angioplasty, PTCA), doctors "repair" the narrowings they found during coronary angiography. If PTCA is necessary, it is always followed by coronary angiography. The first catheter tube serves as a guide, through which doctors push a balloon catheter to the heart - a tube with a small, deflated balloon at the tip. Once it has reached the constriction, the doctors inflate the balloon at high pressure, thereby squeezing deposits aside and widening the constrictions (balloon dilatation). To check the success, the doctors inject contrast media again and take pictures that they compare with the condition before the balloon dilatation.
- In the case of a balloon dilatation with stent implantation (stenting), the doctors support the expanded coronary artery with a small mesh tube (stent, usually made of metal). This prevents the elastic arterial walls from immediately contracting again and narrowing the vessel again.
- During a bypass operation, doctors create alternative routes for the blood. They take pieces of blood vessels from elsewhere in the body and use them to build diversions for narrowed or blocked stretches of vessels. In the case of an acute heart attack, the procedure is the exception because it requires longer preparation and is more complex. If there is no emergency, it sometimes has advantages over PTCA.
Drugs in acute treatment
Heart attack patients usually receive several medications during the acute phase - opiates (e.g. morphine) for the pain, oxygen ventilation and nitrates to improve the supply to the heart muscle, and acetylsalicylic acid (ASA) to prevent the formation of blood clots. In some cases, other anticoagulant and anti-inflammatory drugs such as clopidogrel, glycoprotein IIb/IIIa antagonists, heparin or similar are used to accompany coronary angiography, PTCA and lysis therapy. Beta blockers, ACE inhibitors, and other drugs may also be helpful in certain patients. Many are also given sedatives.
Long-term therapy after myocardial infarction
The worst is only behind you when the clogged coronary arteries are open again. The actual cause, mainly calcified arteries in the heart (coronary heart disease), still exists and with it an increased risk of further heart attacks. Affected people usually have to change their lifestyle and take medication permanently. This greatly reduces the risk of heart attacks and death. Both branches - lifestyle and medical treatment - are enormously important and complement each other. If you neglect one of them, you may not only give away quality of life, but also years of life.
Drugs in long-term treatment
The following active ingredients or substances from the following families are most commonly used:
- Acetylsalicylic acid, clopidogrel, or both in combination
- Beta blockers
- Statins (cholesterol lowering drugs)
- ACE inhibitors
In case of intolerance, other active ingredients are available. In addition, experts advise all patients to be vaccinated against influenza annually.
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| heart attack treatment |
Rehabilitation
Acute treatment in the hospital is followed immediately by medical rehabilitation, or rehabilitation for short. It has several aims and can consist of different courses. Movement therapy is intended to increase or restore physical performance; This reduces possible complaints and risks and improves the quality of life. Psychological one-on-one or group talks should help to reduce the "shock" of the heart attack and the associated fears. Patients learn to accept and cope with their illness. Special courses teach about legal matters (e.g. entitlements to benefits or subsidies) and prepare you individually for everyday life and professional life with the disease. Patients should become completely independent again if possible. Last but not least, training courses provide helpful knowledge about the disease, its background and its connection with lifestyle. Patients are instructed to live healthier lives, have regular check-ups and take all necessary medication as prescribed. After rehabilitation, check-ups such as stress ECGs are necessary at certain intervals.
Lifestyle
The lifestyle in industrialized nations favors the development of arteriosclerosis, high blood pressure and other risk factors that increase the risk of coronary heart disease, heart attacks, strokes and other cardiovascular diseases. Accordingly, a healthy lifestyle can significantly reduce these risks. All heart attack patients are therefore urged to eat a balanced diet, avoid or lose weight, exercise regularly, stop smoking and reduce other lifestyle risks. They usually receive the necessary knowledge and tips in rehab on how to incorporate useful behavior into their everyday lives. Heart sports groups are useful: fixed dates make it easier for many of those affected to discipline themselves for regular exercise. Training together is more fun than alone.