Diagnosis and Treatment for Heart Attack

 

 

In addition to talking with you and checking your heart rate and blood pressure, emergency room staff will usually do the following tests.

·        An electrocardiogram (ECG or EKG)to find out which of your coronary arteries is blocked and to monitor your heart rhythm.

·        A blood test, which can help determine how much damage there is by finding certain enzymes that have leaked from your damaged heart muscle cells into your bloodstream. Doctors usually look for enzymes called creatine kinase myocardial band (CK-MB), myoglobin, and cardiac troponin T and I, which are released when the heart muscle is damaged. Doctors may also look for fibrinogen and C-reactive protein (CRP) in the bloodstream.

·        A chest x-ray to see if your heart is enlarged or if your lungs are filled with fluid.

After your condition has stabilized, doctors may order more tests to find out how damaged your heart is.

·        A thallium stress test, also called a nuclear stress test, uses a radioactive substance that is injected into your bloodstream to show how blood flows through your arteries. Doctors can see if parts of the heart muscle are damaged or dead, or if you have a serious narrowing in an artery.

·        Echocardiography, which lets doctors see if there is damage to the heart muscle by watching the motion of the lower-left chamber (the left ventricle).

·        Coronary angiography, which is performed in the cardiac catheterization laboratory with mild sedation. Dye is injected into your bloodstream to give doctors an x-ray "movie" of heart action and blood flow through your valves and arteries (called an angiogram). Doctors can see the number of blockages that you have and how serious those blockages are. Doctors often use this test to find out which treatment option may be best for you.

 

 

The outcome of a heart attack depends on several factors:

·        Where the coronary blockage happens. Blockages on the left side of your heart are usually more dangerous.

·        Whether rhythm is disturbed. If the blockage also causes an irregular heartbeat called an arrhythmia, it may cause sudden death. Either fast beating called tachycardia or rapid, uncoordinated contractions called ventricular fibrillation may happen. Ventricular fibrillation prevents blood flow, which must be quickly restored through cardiopulmonary resuscitation (CPR) or electrical therapy (defibrillation).

·        Whether your heart is supplied by another blood source. Sometimes a person's body responds to a gradual blocking of an artery by widening another vessel that supplies blood to that same part of the heart. This makes what is called a collateral blood source. If this is the case, you will have less severe damage from the major blockage.

·        How soon you got help. In most cases, getting medical attention within an hour of the start of your attack reduces the amount of heart muscle you lose.

 

 

The goals of heart attack treatment are to return blood flow to your heart muscle, bring back a regular heartbeat, and give your heart time to recover.

The development of "clot busters" called thrombolytic agents (streptokinase, urokinase, tissue plasminogen activator) has increased survival rates for heart attack patients when these medicines are given as soon as possible after an attack. The term thrombolysis means to break up a clot, and that is exactly what these medicines do. In some cases, these medicines can break up a clot within minutes. To work best, they must be given as soon as possible after a heart attack.

You may also receive aspirin and blood-thinning medicines (anticoagulants) to stop clots from forming or growing in size. Also, oxygen may be given to increase the amount of oxygen in the blood still flowing through your heart. Painkillers may be used to reduce the pain. Some patients are also given medicines aimed at slowing their heart rate, opening and relaxing their blood vessels, and reducing the work of the heart.

Most patients respond well to these medicines. Those who do not respond well may need further emergency care, such as balloon angioplasty and stenting, coronary artery bypass surgery, or a related procedure.

Rest is important very early after a heart attack. But within a few days, you should be up and moving around, taking short walks, and getting other kinds of limited exercise. Studies have shown that the heart benefits from exercise, even after a heart attack.

Left Ventricular Aneurysms

Sometimes after a heart attack, an aneurysm forms in the heart's main pumping chamber, called the left ventricle. If a section of the heart wall becomes damaged after a heart attack, it causes scarring and the heart wall grows thinner and weaker. This may cause a ventricular aneurysm to form. The weakened area of aneurysm does not work well, which makes your heart work harder to pump blood to the rest of your body. Ventricular aneurysms may cause shortness of breath, chest pain, or an irregular heart beat (arrhythmia). If a ventricular aneurysm leads to congestive heart failure, left ventricular heart failure, or arrhythmia, your doctor may want you to have surgery.