Heart Attack (myocardial infarction) and Rehab

Heart attack acute life threatening

The heart attack, also called myocardial infarction by doctors, is an acute life-threatening condition that arises from the complete occlusion of a coronary artery. The resulting lack of oxygen and nutrients causes muscle tissue to die. Only a quick surgical or medicinal intervention can reopen the closed blood vessel and protect the affected muscle cells from the infarction. If a person suffers a heart attack, the risk of sudden cardiac death from cardiac arrhythmias or cardiogenic shock from heart failure increases enormously.

Heart attack: general

Around 300,000 people with a heart attack are admitted to hospital emergency rooms in USA every year. Almost half of the patients die immediately. The heart attack leads the statistics of the causes of death . Women often experience non-specific symptoms such as abdominal pain or vomiting, so the infarction can be misjudged. The risk of death is accordingly higher for women than for men. A typical time of day for a heart attack is early morning. Scientists blame the rise in various hormones in the blood for this. Due to their effect, the heart beats faster and the blood pressure rises after the resting phase at night.

Heart attack: causes and risk factors

In most cases, a heart attack is based on arteriosclerosis. The narrowing of the coronary arteries due to fat-related, calcified plaques (deposits) on the walls more and more prevents blood flow. If a blood clot forms on an uneven part of the vessel wall, a heart attack can follow. With increasing age, the risk of heart disease also increases. Women are particularly at risk after menopause.

Known risk factors are:

  • nicotine consumption
  • high blood pressure
  • Diabetes mellitus
  • overweight
  • passive lifestyle
  • high blood lipid levels
  • stress
  • Heart attacks in the family
  • previous heart attack
  • known arteriosclerosis

Heart attack: appearance/symptoms/course of the disease

A heart attack is an unforeseen event for most patients. The main symptom is a sudden, violent pain behind the breastbone, which can radiate into the left arm, chin and upper abdomen. There may be a feeling of pressure and tightness in the chest. Many patients are scared to death and breathless, sweating and vomiting. Women feel the pain in the upper abdomen and complain of a general feeling of being unwell. In diabetics, the pain due to nerve damage is often very weak. Doctors speak of a “silent infarction”.

Heart attack: examinations and diagnosis

Diagnosing a heart attack is not always easy. Too many symptoms can occur together. If the doctor has a first suspicion, he usually begins the diagnosis with an EKG (electrocardiogram). The heart flow curve shows typical changes in an infarction and can be carried out quickly. During the course, the doctor monitors the heart action with the EKG in order to quickly identify possible cardiac arrhythmias. The physical examination usually shows increased blood pressure and a fast pulse. A therapy attempt with a nitroglycerin spray to dilate the vessels does not improve the pain or only insignificantly. The patient may pass out and, in extreme cases, suffer cardiac arrest.

laboratory tests

Various cardiac enzymes and other parameters increase in the blood after a heart attack. The doctor can provide information on the timing and extent of the infarction with a blood test. Troponin T and Troponin I react right at the beginning of an infarction. During the course, the doctor repeats the determination of the values ​​in order to assess the course. Damage to the heart muscle can also be estimated using the values ​​of creatine kinase, a muscle enzyme.

Imaging examinations

  • Echocardiography is an ultrasound examination of the heart. It provides the examiner with information about the heart function and can be used as a follow-up during and after a heart attack.
  • The cardiac catheter (coronary angiography) places a greater strain on the patient, but combines the diagnosis with the optimal therapy. The examining doctor pushes a catheter to the heart through a large blood vessel in the groin or elbow. A contrast agent administered shows the coronary arteries with their constrictions and occlusions in the X-ray image. The doctor can now expand a closed vessel with a balloon directly on site and use a so-called stent to keep the vessel open.
  • Magnetic resonance imaging (MRI) and computer tomography (CT) provide information about the extent of a heart attack, but are more used for monitoring the course. In acute cases, the process usually takes too long.

Heart attack: treatment, therapy & rehab

An acute heart attack is usually treated in hospital for one to two weeks. The faster the emergency doctor reaches the patient and the patient reaches the emergency room, the more muscle tissue can be saved. Every minute counts here. It is optimal to start therapy in the first 1.5 hours after the onset of symptoms in order to achieve a complete opening of the blocked vessel. The treatment of first choice for a heart attack is a surgical expansion of the coronary arteries with a catheter in the cardiac catheterization laboratory (balloon dilatation) and the use of a stent (vascular ring made of stainless steel) to keep the constriction open. If there is no cardiac catheterization laboratory within reach, the doctor can first dissolve the vascular blockage with medication. Thrombolysis uses drugs like acetylsalicylic acid (ASA), Clopidogrel and heparin to restore blood flow. If the lysis is insufficient, the patient should be transferred to a clinic with a cardiac catheterization laboratory. If necessary, a bypass is used to bypass the constriction in the blood vessel. The infarct patient spends the first days in the intensive care unit. The ECG and blood pressure are continuously monitored, the build-up of nutrition begins and physiotherapists guide the patient to the first mobilization.

Rehabilitation after a heart attack

If the time in the acute clinic is over, the treating doctors recommend every heart attack patient to stay in a specialized rehabilitation clinic. The way back to everyday life is outpatient or inpatient and those affected learn how they can possibly avoid another heart attack. The so-called follow-up treatment, rehabilitation or rehabilitation for short is available to every patient who has had a heart attack. Either health insurance or pension insurance covers the costs. Social workers will also advise you in the hospital and provide help with applying for rehab.

What to expect in a rehabilitation clinic after a heart attack

A large team of doctors, physiotherapists, occupational therapists, nutritionists, social workers and psychotherapists works in a rehabilitation clinic. Your very personal treatment will be put together just for you. The doctor treating you is guided by your medical history, your personal risk factors for another heart attack, your fitness and other pre-existing diseases. Over a period of three to four weeks, you will learn everything you need to know about heart attack. In one-on-one talks or group meetings, you will deal with topics such as healthy eating, sports, risk factors for a heart attack and the return to everyday life and work.

Physiotherapy in rehab

One of the most important areas in rehab after a heart attack is physiotherapy or physiotherapy. Endurance training and strength training support the health of the affected heart and increase performance. For example, light gymnastics, swimming, bicycle ergometry, walking and running are common. The training is always adapted to the individual situation of the patient. In addition to physical activity, the physiotherapist also attaches importance to learning various relaxation methods that can help reduce stress. Autogenic training or Jacobson muscle relaxation can be helpful here.

Health education in rehab

Those who are well acquainted with their illness and its risk factors have a better chance of not having another infarction. A theoretical nutritional consultation combined with practical exercises in the clinic’s own kitchen can make the step into a healthy life easier. Information on the topics of smoking and obesity, as well as the practical instructions on smoking cessation and weight loss open the eyes of many affected people to a new lifestyle. As part of health education, the importance of taking heart medication regularly is discussed and explained in an understandable manner.

Psychotherapy in rehab

In order to prevent depression or reactive fears after a heart attack, therapists in rehabilitation offer you talks in a single setting or in a group. Here, too, you can get help with smoking cessation or similar concerns. The follow-up treatment includes body and soul.

Social-medical advice in rehab

After a heart attack, your entire professional life may be in question. Specially trained social workers are at your side, advise you on your professional opportunities and can also give you answers to financial questions. Social workers are also good contacts for family members.

Back in everyday life after rehab

When the rehabilitation measure is over, you have the task of taking the new attitude towards life into everyday life. Patience and consistency are now important. Join a cardiac sports group near you. Together with other infarct patients, under the supervision of a doctor, you remain active in sports and regularly deepen your knowledge of your illness. Joint relaxation exercises and an exchange of experiences round off the therapy.

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