Heart attack 5/6

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Click here for Multimedia Lecture on Heart Attack!

What is a heart attack?
How common is a heart attack?
What are the symptoms of a heart attack?
What should be done if a heart attack is suspected?
What happens when a heart attack patient arrives in the ER?
How does "clot buster" treatment compare with angioplasty?
Why is primary angioplasty and stent not used in every case?
What happens after the patient is admitted to the hospital?
What happens after the first day?
What are the complications of a heart attack?
What medications will be prescribed after discharge?

What happens after the patient is admitted to the hospital with a heart attack? As noted earlier, most patients who are admitted to an ER (emergency room) in the US are considered for treatment with a "clot buster" medication or emergency angioplasty (with or without a stent). The exact form of treatment has to be individualized on the basis of each case, location of the ER and the duration of time in getting the patient to a cardiac catheterization laboratory. In some cases, because of a patients age and coexisting disease (terminal cancer, etc.), the family and patient may decide to use neither approach.
The first 24 hours in the hospital are usually spent in a coronary care unit (CCU) where the patient's heart rhythm is continuously monitored and the diagnosis of a heart attack is confirmed by a series of EKGs and blood tests. Most deaths from heart attacks occur during the first 24 hours and close observation is usually best provided in a CCU. Here, the patient receives appropriate medications by mouth and through an intravenous line.

Panoramic View of a Coronary Care Unit (CCU) Room:
You may move your mouse within the picture to pan left and right or pause the rotation.

What are the possible complications of a heart attack and how are they managed? As noted earlier, the first 24 hours of a heart attack are the most critical. With the use of modern day interventions, the death rate from a heart attack has been brought down to around 5% in patients who are hospitalized with a heart attack. depending upon the location of the heart attack and the delay in seeking medical attention, the following complications may be seen:

Very slow heart beat or heart block (where electrical impulses from the upper chambers of the heart does not make it down to the lower ones). This is usually treated by using a temporary pacemaker.
Ventricular arrhythmias originating from the lower chambers of the heart. This usually responds to medications but may require an electrical shock to regulate. In some patients with serious and persistent irregular heart beats, an AICD (a specialized device that detects and corrects serious irregular heart beats and looks like a large pacemaker) may be needed to reduce the risk of sudden death).
Heart failure, where the pumping capability of the heart is significantly reduced by a large heart attack. This is more likely to occur in patients who have had one or more prior attacks. Heart failure (also known as congestive heart failure or CHF) is treated with oxygen and diuretics (a medication that increases the flow of urine and helps the patient get rid of excess fluids). Medications are also used to help reduce the workload of the heart and improve the strength of muscle contraction.
Shock may occur when a very large amount of heart muscle is damaged by a heart attack. It is a more severe form of heart failure. Depending upon the situation, this may be treated with intravenous medicines, insertion of an intra-aortic balloon pump It consists of a special balloon catheter that is inserted via the groin artery. The inflation and deflation of the balloon pump is timed by the patient's heart beat and helps support the circulation and gives the patient's heart to recover. The treatment of cardiogenic or heart shock may require that the pressure within the heart be monitored with the use of a special (Swan-Ganz) catheter. This is usually inserted through a little needle hole in the groin, or under the collar bone.

A Swan-Ganz catheter and temporary pacemakers may be inserted in a special procedure room that is equipped with x-ray equipment and is shown below. A Swan-Ganz catheter can also be inserted in the CCU room without the use of x-ray.

Recurrent closure of a coronary artery after it has been opened up with "clot buster" medication or emergency angioplasty. Such patients are usually taken to a cardiac cath lab on an emergency basis and the artery reopened. In some cases, emergency coronary bypass surgery may be needed. The video above shows a surgeon suturing a bypass graft to a coronary artery.

Other complications can include pericarditis (inflammation of the lining of the heart, heart rupture and a tear within the lower partition of the heart or of the muscle attached to a valve. The latter two complications usually require heart surgery for correction.