Heart Attack: Therapy

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Heart Attack: Therapy
Heart Attack: Therapy
Video: Heart Attack: Therapy
Video: Treatment of Heart Failure – Cardiology | Lecturio 2023, February
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Heart attack: therapy

In an acute heart attack, nothing counts as much as time. Every minute of the circulatory disorder in the coronary arteries damages the heart. The sooner those affected are treated, the better their chances of surviving the heart attack without any consequential damage. Therefore, optimal therapy initiation is of crucial importance. The calculation of time begins with the first signs, not just when you arrive at the hospital! This means: only if those affected, relatives or those present in the event of an emergency recognize the initial symptoms immediately and act correctly can unnecessary delays up to the hospital admission be prevented…

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  • Basic therapy in the ambulance
  • Basic therapy in the hospital
  • Reperfusion therapy
  • Bypass surgery
  • Long-term drug therapy
  • How are the costs going to be covered?

The aim of the therapy is to open the blocked blood vessel as quickly as possible (reperfusion therapy) or at least to keep the infarct area in the heart muscle as small as possible. The faster blood flow is restored, the less heart muscle tissue dies and the fewer complications there are.

Basic therapy in the ambulance

The heart should be relieved as quickly as possible. All forms of exertion and stress should be avoided. The following therapeutic measures reduce cardiac oxygen consumption and improve blood flow to the heart muscle:

  • horizontal transport and storage with the upper body raised 30 degrees,
  • adequate pain therapy (morphine),
  • Oxygen supply,
  • vasodilator and pain reliever drugs (nitrates),
  • anti-platelet drugs (clopidogrel, acetylsalicylic acid) and anticoagulant heparin to prevent thrombosis,
  • possibly beta blockers

Basic therapy in the hospital

  • Admission to a cardiac monitoring station,
  • psychological relief, possibly through administration of medication to reduce stress and anxiety (e.g. benzodiazepines),
  • Continued anti-coagulation (acetylsalicylic acid, clopidogrel, prasugrel, ticagrelor, heparin),
  • Continuation of pain therapy,
  • ACE inhibitors and beta blockers are used for patients with symptoms of heart failure.

Reperfusion therapy

The aim is to open the closed vessel again. A distinction is made between two types of reperfusion therapy, with the mechanical restoration of blood flow being referred to as the "gold standard":

Mechanical restoration of blood flow (PCI)

The primary cardiac catheter intervention (PCI, percutaneous coronary intervention) should ideally take place within two hours of the first medical treatment (e.g. by the family doctor or emergency doctor). Coronary angiography should be performed within 90 minutes of patients who come to the hospital with heart attack symptoms. As soon as the closed vessel is found, treatment is started immediately. Under X-ray control, a catheter with a balloon is pushed over the puncture site in the groin to the coronary arteries.

There is a so-called stent on the balloon. This metal framework is folded up and introduced into the blocked vessel section. The closed vessel is expanded by the balloon at the catheter tip and at the same time the stent is pressed against the vessel wall. In certain cases, the thrombus can also be aspirated. The stent is intended to prevent renewed closure.

In some stents, the metal grid is also coated with medication. These are delivered directly into the vasculature and increase the effectiveness of therapy. Due to the increased risk of stent thrombosis, patients must take anti-platelet medication for twelve months.

Medicinal restoration of blood flow (fibrinolysis)

Lysis therapy tries to dissolve the blood clot in the coronary artery with medication. The patient receives a substance via a venous access that reduces blood clotting for a certain period of time.

Thrombolysis should be performed as soon as possible - in any case within 120 minutes. In the case of long transport times, the emergency doctor can administer the lysis therapy in the ambulance, if necessary.

Bypass surgery

If it is not possible to restore the blood flow to the coronary arteries using a stent, the narrowed area can be surgically bridged. Bypass surgery is particularly useful for severe forms of coronary artery disease, such as when two or three coronary arteries are affected.

Arteries of the chest wall and superficial leg veins are used as bypass vessels to bridge the narrowed coronary vessels. The operation is performed under general anesthesia. During the procedure, the so-called heart-lung machine takes over the function of the heart and lungs for some time. The heart is "shut down" for a short time. When normal circulation is restored, the heart begins beating again, either alone or after stimulation with an electric shock.

Post-surgery monitoring takes place in a cardiac surgery intensive care unit. If the state of consciousness is normal again and the circulation is stable, follow-up treatment and immediate early mobilization take place on the normal cardiological ward.

Long-term drug therapy

To reduce the risk of re-infarction, risk factors such as smoking, poor diet and stress should be avoided. minimize. Already in the hospital, the patient receives medication for long-term therapy for the optimal setting of blood pressure, blood sugar and blood lipid values, especially:

  • Beta blockers: prevent the frequency of severe cardiac arrhythmias and optimize the work of the heart.
  • Platelet inhibitors ("platelet inhibitors"): reduce the risk of thrombosis.
  • Statins: lower the “bad” LDL cholesterol. Well-adjusted cholesterol (LDL below 100 mg / dl) reduces mortality and reinfarction rates by 30 percent.
  • possibly ACE inhibitors or AT-II receptor blockers: These blood pressure drugs prevent the enlargement and expansion of the left heart.

How are the costs going to be covered?

The acute therapy takes place in the hospital and is billed to the hospital costs that are covered by social insurance. The patient has to pay a daily contribution to the costs.

For more information, see What does a hospital stay cost?

Further medication treatment at home takes place by prescription from the general practitioner or from the specialist in cardiology. Basically, your doctor or the outpatient clinic will settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

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