Myocardial Infarction - Prevention and Treatment

A heart attack can already be prevented with simple measures. If there is still a heart attack, there are various complications and treatment options. We explain what prevention measures, types of therapy and possible complications of a heart attack exist.

Complications of a heart attack

In the acute stage of a heart attack, the following complications may occur:

  • Death from cardiovascular failure or malignant arrhythmias
  • Circulatory shock
  • Herzrhtythmusstörungen
  • Heart valve damage
  • Heart septal defect
  • Hemorrhage into the pericardium
  • embolism

After a heart attack can occur:

  • Renewed heart attack
  • heart failure
  • Arrhythmia
  • embolism
  • pericarditis

Treatment of acute myocardial infarction

The aim of treating acute myocardial infarction is to relieve the already damaged myocardium, to limit the extent of the infarction, to ensure the perfusion of the heart muscle, to prevent secondary complications and, ideally, to reopen the occluded vessel early. The following treatment options are available individually or in combination:

  • Blood thinning therapy with heparin and aspirin
  • Give a beta-blockers to relieve the heart muscle
  • Medicines for lowering blood pressure
  • Painkiller
  • sedative
  • Medication or electroshock therapy for arrhythmias
  • Diuretic drugs in heart failure
  • Oxygenation in the absence of oxygen
  • Artificial respiration with insufficient self-breathing
  • Cardiovascular stabilizing drugs in cardiovascular shock

Lysis therapy and cardiac catheterization

A reopening of the occluded infarct vessel can be achieved either by lysis therapy or balloon dilation in the context of cardiac catheterization. In the case of lysis therapy, the administration of a substance via the vein is able to dissolve blood clots in the coronary vessels.

However, lysis therapy can activate latent sources of bleeding in the organism, such as the brain, retina or gastrointestinal tract, and lead to life-threatening bleeding. In addition, the local efficacy of the lysis therapy on the infarct vessel can not be directly checked.

In contrast, the cardiac catheterization allows a direct representation of the coronary arteries and their constrictions in general, as well as the infarct-triggering vascular occlusion in particular. With modern balloon catheters, an attempt can be made in the same session to reopen the closed coronary vessel and thus normalize the blood circulation conditions.

Therapy after a heart attack

Unfortunately, this balloon dilatation is not always successful, and the procedure also involves other risks that have to be weighed against the risk of a purely anticipated strategy in individual cases. In addition, not all hospitals have the technical equipment and expertise to offer cardiac catheterization. For both the lysis therapy and the cardiac catheter procedure, the principle is that the sooner the heart attack treatment starts, the greater the chances of limiting the damage.

The choice of the appropriate procedure and timing in the course of a heart attack are the subject of intense scientific research. Just as important as the acute therapy is the long-term treatment. After surviving myocardial infarction, the basic problem of the disease, the calcification of the coronary arteries, is not resolved.

In order to reduce the risk of a renewed myocardial infarction, a control of the individual risk factors, consistent drug therapy, and possibly renewed cardiac catheter examinations with a balloon dilatation of still narrowed vessels or a bypass surgery are required.

In a bypass operation, the cardiac surgeon sewn veins from the patient's lower legs as vascular bridges over the narrowed coronary vessels as part of a large open-heart operation, thus partially normalizing the blood flow.

Preventive measures

Heart attack is the most serious complication of coronary heart disease. It is therefore crucial to raise awareness of the measures and behaviors that prevent vascular disease and heart attack in all people at risk of cardiovascular disease. Specifically, this means to prevent:

  • Weight regulation in overweight
  • Nicotine and alcohol abstinence
  • Treatment of blood pressure
  • Medicines and diet for diabetes, lipid metabolism disorder or gout
  • Regular physical training
  • Reduction of mental stress factors

Although compliance with these measures for prevention, especially in case of genetic stress, can not always protect against vascular disease and heart attacks, so in most cases, the course of the disease and myocardial infarction is still favorably influenced.

After a heart attack, a patient, even without complaints, should have regular check-ups at the doctor. Stress examinations such as exercise ECG, stress ultrasound examination or thallium scintigraphy can be used to detect indications of latent problems in the coronary vessels or an imminent myocardial infarction and to take countermeasures at an early stage.

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