This Article Information Provided By: Cardio Specialist, Common Signs And Symptoms Of A Heart Attack Include:
- Chest pain or discomfort (angina) can manifest itself with a feeling of compression, compression, fullness, or pain in the center of the chest. In a heart attack, the pain usually lasts for a few minutes. It can increase and decrease in intensity.
- Nausea and vomiting
- Discomfort in the upper body, including arms, neck, back, jaw, or abdomen.
- Breathing difficulties
- Dizziness or fainting
- Cold sweat
- Women are less likely to have chest pain
Emergency Heart Attack Treatment
The American Heart Association and the American College of Cardiology recommends:
- If you think you have had a heart attack, call immediately (03). After the call (03), you need to chew the aspirin tablet. Be sure to tell the paramedic, then an additional dose of aspirin is not required.
- Angioplasty, also called percutaneous coronary intervention (CVD), is a procedure that must be performed within 90 minutes of the development of a heart attack. Patients suffering from a heart attack should be taken to a hospital equipped to perform PCI.
- Fibrinolytic therapy should be performed within 30 minutes of a heart attack if the center that performs CVD is unavailable. The patient should be transferred to the CVC ward without delay.
Additional prevention measures are needed to help prevent a recurrence of a heart attack. Before discharge, you should discuss with the hospital doctor:
- Control of blood pressure and cholesterol (when discharged prescribed statins, ACE inhibitors, beta-blockers).
- Aspirin and the antiplatelet drug clopidogrel (Plavix), which many patients should take regularly. Prasugrel (Effient) is a new drug that can be used as an alternative to clopidogrel for patients.
- Heart rehabilitation and regular exercise
- Weight normalization
- Smoking cessation
Introduction – Common Signs And Symptoms Of A Heart Attack
The heart is a complex organ of the human body. Throughout his life, he continually pumps blood, supplying through the arterial network oxygen and vital nutrients all the tissues of the body. To perform this strenuous task, the heart muscle itself needs enough oxygen-enriched blood, which is delivered to it through a network of coronary arteries. These arteries carry oxygen-enriched blood to the muscular wall of the heart (myocardial).
A heart attack (myocardial infarction) occurs when blood flow to the heart muscle is blocked, the tissue experiences oxygen starvation, and part of the myocardial dies.
Ischemic heart disease is the cause of heart attacks. Ischemic heart disease is the result of atherosclerosis, which prevents coronary blood flow and reduces the delivery of oxygen-enriched blood to the heart.
Heart attack (myocardial infarction) is one of the most severe outcomes of atherosclerosis. It can happen for two reasons:
- If atherosclerotic plaque develops a crack or rupture. Platelets linger in this area for sealing, and a blood clot (clot) is formed. A heart attack can occur if the blood clot completely blocks the passage of oxygen-enriched blood to the heart.
- If the artery becomes completely blocked due to the gradual increase in atherosclerotic plaque. A heart attack can occur if under-oxygenated blood passes through this area.
Stenocardia, the main symptom of coronary artery disease, is usually perceived as chest pain. There are two types of angina:
- Stable angina. It is predictable chest pain, which can generally be managed with lifestyle changes and the selection of certain medications such as low doses of aspirin and nitrates.
- unstable angina. This situation is much more complicated than stable angina and is often the intermediate stage between stable angina and heart attack. Unstable angina is part of a condition called acute coronary syndrome.
Acute Coronary Syndrome
Acute coronary syndrome (OCS) is a severe and sudden heart condition, which with the necessary intensive treatment, does not turn into a detailed heart attack. The acute coronary syndrome includes:
- unstable angina. Unstable angina is a potentially dangerous condition in which chest pain is constant, but blood tests do not show markers of a heart attack.
- Myocardial infarction without lifting the ST segment (not myocardial infarction). Diagnosed when blood tests and ECG detect a heart attack that does not capture the full thickness of the heart muscle. Artery damage is less severe than in a massive heart attack.
Patients diagnosed with acute coronary syndrome (OCS) may be at risk of a heart attack. Doctors analyze the patient’s medical history, various tests, and the presence of certain factors that help predict which patients with OCS are most at risk of developing a more severe condition. The severity of chest pain alone does not necessarily indicate the severity of the lesion in the heart.
Risk Factors – Heart Attack
The risk factors for heart attack are the same as those at risk of coronary heart disease. They include:
The risk of coronary heart disease increases with age. About 85% of people who die from cardiovascular disease are over the age of 65. In men, on average, the first heart attack develops at 66 years.
Men have a higher risk of coronary heart disease and heart attacks at an earlier age than women. The risk of cardiovascular disease in women increases after menopause and they begin to suffer more angina than men.
Genetic Factors And Family Heredity
Some genetic factors increase the likelihood of developing risk factors such as diabetes, high cholesterol, and high blood pressure.
Race And Ethnicity
African-Americans have the highest risk of cardiovascular disease due to their high incidence of high blood pressure, as well as diabetes and obesity.
Obesity and metabolic syndrome. Excess fat deposition, especially around the waist, can increase the risk of cardiovascular disease. Obesity also contributes to the development of high blood pressure, diabetes, which affect the development of heart disease. Obesity is particularly dangerous when it is part of metabolic syndrome, a prediabetic condition associated with heart disease.
This syndrome is diagnosed when there are three conditions from the following:
- Abdominal obesity.
- Low HDL cholesterol.
- High triglyceride levels.
- High blood pressure.
- Insulin resistance (diabetes or prediabetes).
High cholesterol. Low-density lipoprotein (LDL) is “bad” cholesterol responsible for many heart problems. Triglycerides are another type of lipids (fat molecules) that can be harmful to the heart. High-density cholesterol lipoprotein (HDL) is “good” cholesterol that helps protect against cardiovascular disease.
Doctors analyze the profile of “total cholesterol,” which includes measurements of LDL, HDL, and triglycerides. The ratios of these lipids can affect the risk of cardiovascular disease.
High blood pressure. High blood pressure (hypertension) is associated with the development of coronary heart disease and heart attack — average blood pressure figures below 120/80 mmHg. High blood pressure is generally considered to be blood pressure greater or equal to 140 mmHg. (systolic) or more or equal to 90 mm Hg. (diastolic).
Prehypertension is considered blood pressure with figures 120 – 139 systolic or 80 – 89 diastolic, it indicates an increased risk of hypertension.
Diabetes. Diabetes, especially for people whose blood sugar levels are not well controlled, significantly increases the risk of cardiovascular disease. Heart disease and strokes are the leading causes of death in people with diabetes.
People with diabetes also have a high risk of developing arterial hypertension and hypercholesterolemia, blood clotting disorders, kidney disease, and impaired nerve function, each of these factors can cause heart damage.
They have reduced physical activity. Exercise has several effects that benefit the heart and circulation, including affecting cholesterol and blood pressure and maintaining weight. People who lead a sedentary lifestyle are almost twice as likely to suffer heart attacks compared to people who exercise regularly.
Smoking. Smoking is the most critical risk factor for cardiovascular disease. Smoking can cause an increase in blood pressure, cause lipid metabolism, and make platelets very sticky, increasing the risk of thrombosis.
Although heavy smokers are most at risk, people who smoke only three cigarettes a day have a high risk of blood vessel damage, which can lead to the impaired blood supply to the heart. Regular exposure to secondhand smoke also increases the risk of cardiovascular disease in non-smokers.
Alcohol. Moderate drinking (one glass of dry red wine a day) can help increase the level of “good” cholesterol (HDL). Juice can also prevent blood clots and inflammation. In contrast, drunkenness harms the heart. Cardiovascular disease is the leading cause of death for alcoholics.
Diet. Diet can play an essential role in protecting the heart, especially by reducing food sources of trans fats, saturated fats, and cholesterol and limiting salt intake, which contributes to high blood pressure.
NSAIDs and COX-2 Inhibitors
All non-steroidal anti-inflammatory drugs (NSAIDs), except aspirin, are a risk factor for the heart. NSAIDs and COX-2 inhibitors may increase the risk of death in patients who have experienced a heart attack. The most significant risk develops at higher doses.
NSAIDs include over-the-counter drugs such as ibuprofen (Advil, Matrill) and prescription drugs such as diclofenac (Cataflam, Voltaren). Celecoxib (Celebrex), a COX-2 inhibitor available in the U.S., has been associated with cardiovascular risks such as heart attack and stroke. Patients who have had heart attacks should consult their doctor before taking any of these medications.
The American Heart Association recommends that patients who have or are at risk of heart disease primarily use non-drug pain relief methods (e.g., physical therapy, exercise, weight loss, to reduce the strain on the joints and heat or cold cure).
If these methods do not work, patients should take low doses of acetaminophen (Tylenol) or aspirin before using NSAIDs, the COX-2 celecoxib inhibitor (Celebrex) should be used last.
Heart attacks can lead to death, become a chronic condition, or lead to a full recovery. The long-term prognosis for life expectancy and quality of life after a heart attack depends on its severity, damage to the heart muscle, and the preventive measures taken after that.
Patients who have had a heart attack have a higher risk of re-offending. Although there are no tests that could predict whether another heart attack will occur, patients can avoid a second heart attack themselves if they follow a healthy lifestyle and follow treatment. Two-thirds of patients who have suffered a heart attack do not take the necessary measures to prevent it.
A heart attack also increases the risk of other heart problems, including heart rhythm disorders, heart valve damage, and stroke.
Individuals most at risk. A heart attack always has more severe consequences in some people, such as:
- People with heart disease or having multiple risk factors for cardiovascular disease.
- People with heart failure.
- People with diabetes.
- People on constant dialysis.
- Women are more likely to die of a heart attack than men. The risk of death is highest in young women.
Factors that occur during a heart attack and increasing severity.
The presence of these conditions during a heart attack may contribute to the deterioration of the prognosis:
- Arrhythmia (heart rhythm disorder). Ventricular fibrillation is a dangerous arrhythmia and one of the leading causes of early death from a heart attack. Arrhythmias are more likely to occur within the first 4 hours of a heart attack, and they are associated with high mortality. However, patients who are successfully treated have the same long-term prognosis as patients without arrhythmia.
- Cardiogenic shock. This hazardous situation is associated with slight blood pressure, little urine separation, and metabolic disorders. Trauma occurs in 7% of heart attacks.
- Heart blockage, the so-called atrioventricular (AV) blockage, is a condition in which the electrical conductivity of nerve impulses to the muscles in the heart is slowed or interrupted. Although heart blockage is dangerous, it can be effectively cured with a pacemaker and rarely causes any long-term complications in patients who have survived.
- Heart failure. The damaged heart muscle is unable to pump the blood necessary for the functioning of the tissues. Patients experience fatigue, shortness of breath, fluid retention occurs in the body.
Symptoms of a heart attack may be different. They can occur suddenly and be pronounced or can progress slowly, starting with mild pain. Symptoms may vary between men and women. Women are less likely than men to have classic chest pain and are more likely to experience shortness of breath, nausea or vomiting, back and jaw pain.
Common signs and symptoms of a heart attack include:
- Chest pain. Chest pain or discomfort (angina) is the main sign of a heart attack and can be felt as a feeling of compression, compression, fullness, or pain in the center of the chest. Patients with coronary artery disease with stable angina often experience chest pain that lasts a few minutes and then goes away. In a heart attack, the pain usually lasts for more than a few minutes, they may disappear, but then come back.
- Discomfort in the upper body. People who experience a heart attack may feel pain in their hands, neck, back, jaw, or stomach.
- Breathing difficulties may be accompanied by chest pain or be pain-free.
- Nausea and vomiting.
- Cold sweat.
- Dizziness or fainting.
The following symptoms are less common for a heart attack:
- Acute pain when breathing or coughing.
- Pain is mostly or just in the middle or bottom of the abdomen.
- Pain can be caused by touch.
- Pain can be caused by moving or pressing on the chest wall or arm.
- Pain that is constant and lasts for hours (do not wait a few hours if there is a suspicion that a heart attack has started).
- Pain is very short and lasts for a few seconds.
- Pain that spreads to the legs.
- However, the presence of these signs does not always rule out severe heart disease.
Some people with severe coronary artery disease may not have angina. This condition is known as pain-free ischemia. This is a dangerous condition because patients do not have the alarming symptoms of heart disease. Some studies show that people with pain-free ischemia have a higher risk of complications and mortality than patients experiencing angina pain.
People who experience symptoms of a heart attack should follow:
- For patients with angina – take one dose of nitroglycerin (a tablet under the tongue or in aerosol form) when symptoms appear. Then one more treatment every 5 minutes, up to three doses or until the pain is reduced.
- Call (03) or dial your local emergency number. This should be done first if three doses of nitroglycerin do not help relieve chest pain. Only 20% of heart attacks occur in patients with previously diagnosed angina. Therefore, anyone who develops symptoms of a heart attack should contact emergency services.
- The patient should chew aspirin (250 – 500 mg), which should be reported to the emergency service, as an additional dose of aspirin, in this case, should not be taken.
- A patient with chest pain should be immediately taken to the nearest emergency room, preferably by ambulance. It is not recommended to get there on your own.
When a patient with chest pains is admitted to the hospital, the following diagnostic steps are taken to determine heart problems and, if they are present, their severity:
- The patient should inform the doctor of all symptoms that may indicate heart problems or possibly other serious illnesses.
- Electrocardiogram (ECG) – recording of the electrical activity of the heart. It is a vital tool for determining whether chest pains are related to heart problems and, if so, how severe they are.
- Blood tests reveal an increase in the levels of certain factors (troponins and KFC-MB), which indicate heart damage (the doctor will not wait for the results before treatment, especially if he suspected a heart attack).
- Visual diagnostic methods, including echocardiography and perfusion scintigraphy, help to rule out a heart attack if there are any questions.
Electrocardiogram (ECG) measures and records the electrical activity of the heart, ECG prongs correspond to the reduction and relaxation of specific structures of different parts of the heart. Sure, prongs on the ECG are named inappropriate letters:
- R. R-waves are associated with atrial contractions (two chambers in the heart that receive blood from organs).
- The complex is associated with ventricular contractions (ventricles are the two main pumping chambers in the heart.)
- T and U. These waves accompany ventricular contractions.
Physicians often use terms such as PJ or PR interval. This is the time it takes to spread the electrical impulse from the atrium to the ventricles.
The most crucial thing in diagnosing and determining heart attack treatment tactics is the rise of the ST segment and the definition of the prong.
St segment rise: Heart attack. The increase of the ST segment is an indicator of a heart attack. It indicates that the artery of the heart is blocked, and the heart muscle is damaged to the full thickness. Develops myocardial infarction (myocardial infarction with the rise of ST-segment).
However, the rise of the ST segment does not always mean that the patient has a heart attack. Inflammation of the heart bag (pericarditis) is another cause of the increase in ST-segment.
Without lifting the ST segment develops angina and acute coronary syndrome.
The reduced or horizontal st segment involves conductivity disorders and the presence of cardiovascular disease, even if there is no angina at present. St segment changes occur in about half of patients with various heart diseases. However, in women, ST-segment changes can occur without heart problems.
In such cases, laboratory tests are needed to determine the extent of heart damage, if any. Thus, one of the following states can develop:
- Stable angina (blood test or other test results do not show any severe problems, and chest pain disappears). During this period, 25 to 50% of people with angina or pain-free ischemia recorded standard ECG rates.
- Acute coronary syndrome (OCS). It requires intensive treatment until it turns into a severe heart attack. OCS includes either unstable angina or myocardial infarction without lifting st-segment (not myocardial infarction). Unstable angina is a potentially dangerous event, with chest pain constant, but blood tests do not identify markers of a heart attack.
- In the case of non-infarction myocardial tests detect a heart attack, but the damage to the heart is less severe than in a posted heart attack.
An echocardiogram is a non-invasive method that uses ultrasound to visualize the heart. It is possible to determine the damage and mobility of areas of the heart muscle. Echocardiography can also be used as a physical exercise test to detect localization and damage to the heart muscle during illness or shortly after discharge from the hospital.
Radionuclide methods (stress test with thallium)
They allow visualizing the accumulation of radioactive indicators in the heart area. They are usually administered intravenously. This method will enable you to evaluate:
- The severity of unstable angina, when less expensive diagnostic methods are not valid.
- The severity of chronic coronary heart disease.
- The success of surgery for coronary heart disease.
- Has there been a heart attack?
- Localization and the extent of damage to the heart muscle during illness or shortly after discharge from the hospital after suffering a heart attack.
The procedure is non-invasive. This is a reliable method for various severe heart diseases and can help determine whether the damage has occurred as a result of a heart attack. Radioactive isotope thallium (or technetium) is injected into the patient’s vein. It binds to red blood cells and passes with blood through the heart.
The isotope can be traced to the heart using unique cameras or scanners. Images can be synchronized with the ECG. The test is carried out at ease and physical activity. If the damage is detected, the image is stored for 3 or 4 hours. Damage caused by a heart attack will be sustained during repeated scans, and the damage caused by angina will be leveled.
Angiography is an invasive method. It is used for patients whose angina is confirmed by stress tests or other purposes and for patients with the acute coronary syndrome. The course of the procedure:
- A narrow tube (catheter) is inserted into the artery, usually the arm or leg, and then carried through the vessels to the coronary arteries.
- The contrast agent is injected through a catheter into the coronary arteries and recorded.
- As a result, there are images of coronary arteries, where you can see obstacles to blood flow.
When heart cells are damaged, they secrete various enzymes and other substances into the bloodstream. Elevated levels of such markers of heart damage in the blood or urine can help detect a heart attack in patients with severe chest pain and help determine treatment tactics. Such tests are often performed in the emergency department or hospital for a suspected heart attack. The most commonly identified markers are:
- Troponins. Proteins of the heart troponin T and I are released when the heart muscle is damaged. These are the best diagnostic signs of heart attacks. They can help them diagnose and confirm a diagnosis in patients with OCS.
- creatininekinase of myocardial (KFC-MB). KFC-MB is a standard marker, but its sensitivity is less than that of troponin. Elevated levels of KFC-MB can be observed in people without cardiac pathology.
Treatments for heart attack and acute coronary syndrome include:
- Oxygen therapy.
- Relief of pain and discomfort with the use of nitroglycerin or morphine.
- Correction of arrhythmia (incorrect heart rhythm).
- Blocking further blood clotting (if possible) using aspirin or clopidogrel (Plavix) as well as anticoagulants such as heparin.
- Opening the artery in which the cow’s car was disturbed should be made as soon as possible by angioplasty or with the help of drugs that dissolve the clot.
- Beta-blockers, calcium channel blockers, or angiotensin-transforming enzyme inhibitors are prescribed to improve the functioning of the heart muscle and coronary arteries.
- Same for patients with both OCS and heart attack.
- Oxygen. It is usually fed through a tube into the nose or through a mask.
- Aspirin. The patient is given aspirin if it has not been taken at home.
Medications to relieve symptoms:
- Nitroglycerin. Most patients will receive nitroglycerin both during and after a heart attack, usually under the tongue. Nitroglycerin lowers blood pressure and dilates blood vessels, increasing blood flow to the heart muscle. Nitroglycerin is, in some cases, administered intravenously (returning angina, heart failure, or high blood pressure).
- Morphine. Morphine not only relieves pain and reduces anxiety, but also dilates blood vessels, increasing blood and oxygen flow to the heart. Morphine can lower blood pressure and ease heart function. Other drugs can be used.
Removing the barrier of the coronary cow: emergency angioplasty or thrombolytic therapy
In a heart attack, clots are formed in the coronary arteries, which prevent the coronary cow. Removal of clots in the arteries should be carried out as soon as possible; this is the best approach to improving survival and reduces the amount of damage to the heart muscle. Patients should be admitted to specialized medical centers as quickly as possible.
Standard Medical And Surgical Procedures Include:
- Angioplasty, also called percutaneous coronary intervention (CVD), is the preferred procedure for the emergency opening of arteries. Angioplasty should be performed promptly for patients with a heart attack, preferably within 90 minutes of arrival at the hospital. In most cases, a stent is placed in the coronary artery, which creates an internal frame and improves the passage of the coronary artery.
- Thrombolytics dissolve the clot and are standard medicines used to open arteries. Thrombolytic therapy should be carried out within 3 hours after the onset of symptoms. Patients who are admitted to a hospital unable to perform CVS should receive thrombolytic treatment and be transferred to a CVD center without delay.
- Coronary bypass surgery (ACS) is sometimes used as an alternative to CVD.
Thrombolytic or fibrinolytic drugs are recommended as an alternative to angioplasty. These drugs dissolve the clot or clot responsible for artery block and cardiovascular tissue death.
Generally speaking, thrombolysis is considered the right choice for patients with myocardial infarction in the first 3 hours. Ideally, these drugs should be given within 30 minutes of arrival at the hospital, unless angioplasty is performed. Other situations where thrombolytics are used:
- The need for long-term transportation.
- An extended period before the CVC.
- The failure of the CVC.
It should be avoided or used with great care of thrombolytics in the following patients after a heart attack:
- In patients over 75 years of age.
- If symptoms last more than 12 hours.
- People who have recently suffered trauma (especially traumatic brain injury) or surgery.
- People with aggravation of ulcers.
- Patients who have undergone prolonged cardiopulmonary resuscitation.
- When taking anticoagulants.
- Patients who have suffered a large cow’s loss.
- Patients with stroke.
- Patients with uncontrolled high blood pressure, especially when systolic pressure is above 180 mmHg.
Standard thrombolytic drugs are recombinant tissue activators of plasminogen (TAP): Alteplase (Actelisa) and Reteplase (Realize), as well as a new remedy for tenecteplase (Metalise). A combination of antiaggregate and anticoagulant therapy is also used to prevent clot growth and new formation.
Rules for the introduction of thrombolytics. The earlier thrombolytic drugs are given after a heart attack, the better. Thrombolytics are most active during the first 3 hours. They can still help within 12 hours of a heart attack.
Complications. A hemorrhagic stroke usually occurs on the first day and is the most severe complication of thrombolytic therapy, but fortunately, it happens rarely.
angioplasty and bypass surgery
The crate coronary intervention (CVD), also called angioplasty, and coronary bypass surgery is standard operations to improve coronary blood flow. They are known as revascularization operations.
- Emergency angioplasty / CVS is a standard procedure for heart attacks and should be performed within 90 minutes of its onset. Studies have shown that balloon angioplasty and stenting are not able to prevent cardiac complications in patients when they are carried out 3 to 28 days after a heart attack.
- Coronary bypass surgery is usually used as a routine operation, but can sometimes be performed after a heart attack, with unsuccessful angioplasty or thrombolytic therapy. It is generally performed for several days to allow the heart muscle to recover. Most patients are suitable for thrombolytic therapy or angioplasty (although not all centers are equipped for CVS).
Angioplasty / CVC includes the following steps:
- A narrow catheter (tube) is installed in the coronary artery.
- The vascular lumen is restored when inflating a small cylinder (balloon angioplasty).
- After the bottle is blown off, the opening of the vessel increases.
- To keep the artery open for a long time, a device called a coronary stent is an expandable tube made of a metal mesh that is implanted into the artery during angioplasty. The stent may consist of bare metal and can be covered with a particular drug, which is slowly released into the adjacent wall of the vessel.
- The stent restores the vascular lumen.
Complications occur in about 10% of patients (about 80% of them during the first day). The best results are achieved in hospitals with experienced staff. Women who have angioplasty after a heart attack have a higher risk of death than men — restenosis after angioplasty. Narrowing after angioplasty (restenosis) can occur within a year after surgery and requires a repeat of the CVC procedure.
Drug-coated stents, which are coated with sirolimus or paclitaxel, can help prevent restenosis. They may be better than a bare-metal stent for patients who have experienced a heart attack, but they can also increase the risk of blood clots.
It is essential for patients who have implanted stents with a drug coating, take aspirin, and clopidogrel (Plavix) at least one year after stenting to reduce the risk of blood clots. Clopidogrel, like aspirin, helps prevent platelet clumping.
If, for some reason, patients cannot take clopidogrel along with aspirin after angioplasty and stenting, they should be implanted with bare-metal stents without drug coverage. Prrazgrel is a new drug that is an alternative to clopidogrel.
Coronary bypass surgery (AX). It is an alternative to angioplasty in patients with severe angina, especially those who have two or more closed arteries. This is a very aggressive procedure:
- The chest is opened, the blood is pumped with the help of an artificial circulatory apparatus.
- During the main stage of the operation, the heart stops.
- Bypassing the closed sections of the arteries are shunts, which are taken during the process from the patient’s leg, or the arm and chest. Thus, blood enters the heart muscle on shunts bypassing closed areas of arteries.
Mortality in AX after a heart attack is significantly higher (6%) than when the operation is performed routinely (1-2%).
Treatment Of Patients With Shock Or Heart Failure
Profoundly ill patients with heart failure or who are in a state of cardiogenic shock (it includes lower blood pressure and other disorders) intensively treated and observed: give oxygen, inject fluids, regulate blood pressure, used dopamine, dobutamine, and other means.
Heart failure. Intravenously administered furosemide. Patients may also be given nitrates, and ACE inhibitors unless there is a sharp drop in blood pressure on the indications. Thrombolytic therapy or angioplasty can be performed.
Cardiogenic shock. Intra-oral balloon counterpulsation (WABC) can help patients with a cardiogenic shock when used in combination with thrombolytic therapy. A catheter with a balloon is used, which is inflated and descends in the aorta in certain phases of the heart cycle, thus raising blood pressure.
Treatment Of Arrhythmias
Arrhythmia is a heart rhythm disorder that can occur in conditions of oxygen deficiency and is a dangerous complication of a heart attack. Fast or slow heart rate is typical in patients with a heart attack, and usually, this is not a terrible sign.
Extrasystole or fast rhythm (tachycardia) can lead to ventricular fibrillation. This is a life-threatening arrhythmia, in which the ventricles of the heart contract very quickly, without providing sufficient cardiac release. The pumping action of the heart, which is necessary to maintain blood circulation, is lost.
I am preventing ventricular fibrillation. People who develop ventricular fibrillation are not always exposed to arrhythmia prevention, and today, there are no effective drugs to prevent arrhythmias during a heart attack.
- Potassium and magnesium levels should be monitored and maintained.
- The use of beta-blockers intravenously and orally can help prevent arrhythmia in some patients.
Treatment Of Ventricular Fibrillation:
- Defibrillators. Patients who develop ventricular arrhythmias are discharged with a defibrillator to restore their usual rhythm. Some studies show that implantable cardioverter defibrillators (ICDs) can prevent further. They are used in patients who still have a risk of recurrence of these arrhythmias.
- Antiarrhythmic drugs. Antiarrhythmic drugs include lidocaine, procainamide, or amiodarone. Amiodarone or another antiarrhythmic drug can be used later, to prevent subsequent arrhythmias.
Treatment of other arrhythmias. People with atrial fibrillation have a high risk of stroke after a heart attack and should receive warfarin-type anticoagulants (Coumadin). There are also bradyarrhythmias (prolonged rhythm disturbances) that often develop during a heart attack and can be treated with atropine or pacemakers.
Aspirin and other disaggregates anti-clotting drugs are used at all stages of heart disease. They are divided into anti-aggregates or anticoagulants. They are used along with thrombolytics, as well as for the prevention of heart attack. Anti-clotting therapy is associated with the risk of bleeding and stroke.
Antiplatelet drugs. They inhibit the binding of platelets in the blood and therefore help prevent thrombosis. Platelets are microscopic in size and disk shape. They are essential for blood clotting.
- Aspirin. Aspirin is an antiplatelet drug. Aspirin should be taken immediately after the onset of a heart attack. The aspirin tablet can either be swallowed or chewed. It is better to eat an aspirin tablet – it will speed up its effect. If the patient did not take aspirin at home, it would be given to him in the hospital.
Then it is necessary to make it daily. The use of aspirin in patients with heart attacks leads to a reduction in mortality. It is the most common disaggregate used in people with cardiovascular disease and is recommended to be taken daily at a low dose permanently.
- Clopidogrel (Plavix) – refers to the drugs thiopyridinin range; it is another antiplatelet drug. Clopidogrel is taken either immediately or after the percutaneous intervention and is used in patients with heart attacks, as well as after the beginning after thrombolytic therapy. Patients who have a drug-coated stent should take clopidogrel with aspirin for at least one year to reduce the risk of thrombosis.
Patients hospitalized for unstable angina should receive clopidogrel if they cannot take aspirin. Clopidogrel should also be prescribed to patients with unstable angina, for whom invasive procedures are planned. Even conservatively treated patients should continue taking clopidogrel for up to 1 year.
Some patients will need to take clopidogrel permanently. Prasugrel is a new thienopyridine that can be used instead of clopidogrel. It should not be used by patients who have suffered a stroke or transient ischemic attack.
IIb/IIIa receptor inhibitors. These powerful blood thinners, such as abciximab (Reopro), tyrophyban (Aggrastat). They are administered intravenously in the hospital, and can also be used in angioplasty and stenting.
Anticoagulants. They include:
- Heparin is usually prescribed during treatment, along with thrombolytic therapy for two days or more.
- Other intravenous anticoagulants can also be used – Bivalirudin (Angiomax), Fondaparinuks (Arikstra), and enoxaparin (Lovenokus).
- Warfarin (Kumadine).
When taking all these drugs, there is a risk of bleeding.
Beta-blockers reduce the need for the heart muscle for oxygen, slow down the heart rate, and reduce blood pressure. They are useful in reducing mortality from cardiovascular disease. Beta-blockers are often given to patients at the initial stage of their hospitalization, sometimes intravenously.
Patients with heart failure or who may develop cardiogenic shock should not receive intravenous beta-blockers. Long-term oral intake of beta-blockers for patients with symptomatic coronary heart disease, especially after heart attacks, is recommended in most cases.
These drugs include propranolol (Inderal), carvedilol (Korea), bisoprolol (Zebeta), acebutolol (Sekrol), atenolol (Tenormin), labetalol (Normodin), methoprolol, and esmolol (Breviblok).
Treatment of a heart attack. Beta-blocker metoprolol can be given within the first few hours after a heart attack to reduce damage to the heart muscle.
Preventive intake after a heart attack
Beta-blockers are taken orally on a long-term basis (as supportive therapy) after the first heart attack to help prevent repeated heart attacks.
Side effects of beta-blockers include fatigue, lethargy, vivid dreams and nightmares, depression, memory loss, and dizziness. They can lower HDL (“good” cholesterol). Beta-blockers are divided into drugs of non-selective and selective action.
Non-selective beta-blockers, such as carvedilol and propranolol, can reduce the smooth musculature of the bronchi, leading to bronchospasm. Patients with asthma, emphysema, or chronic bronchitis are not allowed to take non-selective beta-blockers.
Patients should not abruptly stop taking these drugs. A sudden cessation of beta-blockers can lead to a sharp increase in heart rate and increased blood pressure. It is recommended to reduce the dosage until the complete end of taking slowly.
Statins and other hypolipidemic drugs that lower cholesterol
After admission to the hospital for acute coronary syndrome or heart attack, patients should not interrupt the use of statins or other drugs, if the level of LDL cholesterol (“bad” cholesterol) is elevated. Some doctors recommend that LDL levels should be below 70 mg/dL.
Angiotensin-transforming enzyme inhibitors
Angiotensin enzyme inhibitors (ACE inhibitors) are essential drugs for the treatment of heart attack patients, especially for patients at risk of heart failure. ACE inhibitors should be prescribed on the first day to all patients with a heart attack if there are no contraindications.
Patients with unstable angina or acute coronary syndrome should receive ACE inhibitors if they have signs of heart failure or signs of decreased left ventricular release fraction according to echocardiography. These drugs are also widely used to treat high blood pressure (hypertension) and are recommended as first-line therapy for people with diabetes and kidney damage.
ACE inhibitors include captopril (Capoten), ramipril, enalapril (Vazot), quinaprril (Accupril), Benazeprril (Lotenzin), perindopril (Aceon) and lysinopril (Prinivil).
Side effects. Side effects of ACE inhibitors are rare but may include coughing, excessive blood pressure drop, and allergic reactions.
Calcium Channel Blockers
Calcium channel blockers can relieve the condition in patients with unstable angina, whose symptoms are not reduced when taking nitrates and beta-blockers or are used in patients who are not allowed to take beta-blockers.
Patients can reduce the risk of repeated heart attacks by following specific preventive measures that are explained when discharged from the hospital. Maintaining a healthy lifestyle, particularly a particular diet, is essential in preventing heart attacks and should be respected.
Blood pressure. Target blood pressure should be less than 130/80 mmHg.
LDL cholesterol (“bad” cholesterol) should be substantially less than 100 mg/dL. All patients who have had a heart attack should receive recommendations for taking statins before discharge from the hospital.
It is also important to control cholesterol by reducing saturated fat intake to less than 7% of total calories. It is necessary to increase the consumption of omega-3 fatty acids (they are rich in fish, fish oil) to reduce the rate of triglycerides.
Exercise. I am running time 30-60 minutes, seven days a week (or at least five days a week).
Weight loss. Combining exercise with a healthy diet rich in fresh fruits, vegetables, and low-fat dairy products helps to reduce weight. Your body mass index (BMI) should be 18.5-24.8. Waist circumference is also a risk factor for heart attack. The waist circumference of men should be less than 40 inches (102 cm) in women less than 35 inches (89 centimeters).
Smoking. It is categorically essential to quit smoking. Also, tobacco smoke (passive smoking) should be avoided.
Disaggregates. Your doctor may recommend that you take aspirin (75-81 mg) daily. If you have been implanted with a drug-coated stent, you should take clopidogrel (Plavix) or prasugrel (Efficient) along with aspirin for at least one year after surgery. (Aspirin is also recommended for some patients as primary prevention of heart attack).
Other drugs. Your doctor may recommend that you take ACE inhibitors or beta-blockers permanently. It is also essential to get vaccinated against influenza every year.
Rehabilitation – Physical rehabilitation
Physical rehabilitation is essential after suffering a heart attack. Recovery may include:
- Walking. The patient usually sits in a chair on the second day and begins to walk on the second or third day.
- Most patients have a low level of physical activity tolerance at an early stage of their recovery.
- After 8-12 weeks, many patients, even with heart failure, feel the benefits of exercise. Physical activity recommendations are also given when discharged.
- Patients usually return to work after about 1-2 months, although the timing may vary depending on the severity of the condition.
Sexual activity after a heart attack is accompanied by a slight risk and is generally considered safe, especially for people dealing with it regularly. The feeling of intimacy and love that accompanies healthy sex can help compensate for depression.
Depression occurs in many patients with OCS and heart attacks. Studies show that depression is the main predictor of mortality for both women and men. (One reason may be that patients with depression are less regularly taking their medications).
Psychotherapy, especially cognitive behavioral therapy, can be beneficial. For some patients, it may be advisable to take certain types of antidepressants.
Information provided by: Cardio Specialist