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Heart attack

A myocardial infarction (heart attack) happens when one of the coronary arteries is suddenly blocked - leading to the death of part of the heart muscle. Myocardial infarction is more common in older people, and always constitutes a medical emergency. Prompt treatment may be able to limit the extent of the damage caused to the heart.

What is a heart attack?

The term heart attack - or myocardial infarction - refers to a sudden interruption in the blood supply to the heart, leading to the death of heart muscle tissue. Usually, a heart attack is the direct result of a blood clot blocking an already narrowed coronary artery - preventing the muscle cells from receiving a sufficient amount of oxygen. Most heart attacks are caused by coronary heart disease.

Acute myocardial infarction is often life-threatening, and is always a medical emergency. A heart attack can often cause dangerous arrhythmias, and approximately a third of patients will die before the emergency services have been notified.

According to WHO (World Health Organization) criteria, acute myocardial infarction is diagnosed if 2 of the following 3 criteria are satisfied:

What are the main symptoms?

The symptoms of a heart attack can vary depending on the patient's gender and the location of the heart attack (e.g. anterior wall or posterior wall myocardial infarction). Although chest pain with pain radiating to the arms is often referred to as the cardinal symptom of a heart attack, it can be completely absent - particularly in women. Furthermore, some heart attacks may only produce minor symptoms or none at all ("silent" heart attacks).

In many patients, however, heart attack is characterized by dramatic symptom presentation. Many heart attacks occur in the early hours of the morning and involve the following symptoms:

  • Severe chest pain lasting for a number of minutes and sometimes radiating to the arm, neck, lower jaw, abdomen or back.
  • Anxiety or feeling of impending doom
  • Sweating (cold sweat) and pallor
  • Nausea or vomiting
  • Shortness of breath
  • Cardiac arrhythmias
  • Patients with diabetes may only have mild symptoms and pain
  • Similarly, women tend to develop symptoms not typically associated with heart attack. Their symptoms may also be much milder.
[Translate to Englisch:] EKG-Befund bei Herzinfarkt - Immanuel Herzzentrum Brandenburg in Bernau
[Translate to Englisch:] Typischer EKG-Befund bei einem akutem Herzinfarkt der Herzvorderwand mit deutlich gehobenen ST-Strecken in den EKG-Ableitungen V2-V6

What are possible causes?

As with coronary heart disease, a heart attack is usually associated with a hardening of the arteries (atherosclerosis) near/around the heart. In many cases, an acute heart attack occurs when one of the narrowed arteries is blocked as a result of a blood clot.
Atherosclerosis of the coronary arteries develops over many years and is associated with a number of specific risk factors. These include: 

Diagnosis of heart attack

When symptoms are severe, physicians will immediately suspect a heart attack. The following can be used to confirm a suspected heart attack:

Treatment for heart attack

Emergency

If the above-named symptoms have been present more than 20 minutes, the emergency services should be contacted immediately.
A heart attack is a medical emergency. Prompt treatment may be able to limit the damage caused to the heart muscle ("time is muscle").
Place the patient in a semi-reclining position (upper body elevated), reassure the patient, and remove any restrictive clothing. 

Emergency treatment

Emergency treatment provided by the emergency services may include the administration of oxygen, morphine (for pain) and anticoagulants (blood thinning medication).

Very often, the emergency response team will also start an intravenous drip in order to administer medication so as to dissolve the blood clot inside the coronary arteries (referred to as thrombolytic therapy). Systemic thrombolytic therapy should only be administered by the emergency response team if the nearest cardiac catheterization laboratory is more than a 2-hour journey away.

Cardiac catheterization

Once at the hospital, many patients will be treated with catheter-based interventions. A cardiac catheterization laboratory is therefore essential.

Catheter-based procedures allow physicians to make a precise diagnosis and, in many cases a blocked coronary artery can be re-opened using an inflatable balloon (this is referred to as a balloon angioplasty).
This procedure usually involves the implantation of a stent to support the artery wall and keep it open. 

Bypass surgery
Some very specific cases may require emergency bypass surgery, for instance if a catheter-based procedure has been unsuccessful, and the patient is at high risk of suffering severe complications as a result of their heart attack.
This type of surgery can only be performed if the general health status of the patient allows it, which is why bypass surgery is usually performed some time after a heart attack.

Rehabilitation
Once a patient has recovered from their heart attack, they enter what is referred to as the rehabilitation phase of treatment, intended to encourage the patient to adopt a healthier lifestyle. In addition, the patient is started on a life-long course of medication to limit long-term damage to the heart muscle, and to reduce the risk of a repeat heart attack.

Where can I find out more about heart attacks?

General information

Deutsche Gesellschaft für Kardiologie (German Cardiac Society):
www.dgk.org

General information
Deutsche Herzstiftung (German Heart Foundation):
www.herzstiftung.de

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