Many people have heard or read that over 60,000 people die each year from infarcts of various types. Infarction is one of the most common causes of hospitalization in Germany and among the leading causes of death. A large part of the population thinks of the word infarction only in terms of the best known, the heart attack. However, what exactly is an infarction, what causes it and how do doctors treat it?
What is an infarction?
Infographic on the anatomy and causes of cardiovascular diseases such as heart attack. Click image to enlarge. An infarction is the death of the body’s own tissues due to a lack of oxygen. This occurs due to the lack of oxygen-rich blood in the affected tissue and the supplying blood vessels. Just as it can be caused by a lack of inflow, infarction can also be triggered by a lack of outflow of blood, since the accumulated blood volume also prevents renewed inflow. Often, infarction is understood to mean only heart attack. However, the occlusion of an artery is also possible in the retina or the optic nerves of the eye. The outflow of blood through the veins of a tissue can also cause an infarction. In addition, embolisms are a frequently observed cause. These are particles of varying composition that are washed in with the blood. Such vascular occlusions can be fat, oxygen (trapped air bubbles) or blood clots. Endogenous and foreign substances are possible. Emboli are always very problematic for the body and the affected tissues and in severe cases may even need to be surgically removed to avoid further complications.
Causes
First of all, an infarction is due to a lack of blood flow. Blood supplies our body with nutrients and with oxygen. If oxygen is delayed or does not reach an organ or tissue association at all, tissue may die as a result. This can be the tissue of a muscle, a detoxification organ or an optic nerve. Whenever a tissue dies completely due to lack of oxygen, it is an infarction. The bones, brain, spinal cord or tissues of the lungs can also suffer an infarction. The best known is the infarction of the heart muscle. Vascular occlusions often precede the undersupply of oxygen. In this respect, a causal relationship can be established with vascular embolisms, thromboses and the general occlusion of supplying arteries. Infarctions as a result of infections are also known. In most cases, however, it is disturbances in the outflow or inflow of oxygenated blood that cause the infarction.
Typical or common forms
- Heart attack
- Brainstem infarction
- Stroke
- Splenic infarction
- Mesenteric infarction
- Pulmonary infarction
- Ocular infarction (visual fall)
Symptoms, complaints and signs
Depending on the affected area of the body, a heart attack causes different symptoms. Typical of a heart attack are severe chest pain, often radiating to the left arm, upper abdomen or lower jaw, usually accompanied by sweating, nausea, dizziness and fear of death. In women, dyspnea, a feeling of pressure in the chest, and upper abdominal pain are often prominent; the characteristic chest pain is much less pronounced. Pulmonary infarction is characterized by sudden onset of severe pain in the rib area, accompanied by shortness of breath and difficulty breathing. Coughing reveals bloody sputum. The symptoms caused by a splenic infarction are referred to by physicians as “acute abdomen“: there is massive pain, mainly in the left upper abdomen, which intensifies on inhalation and often radiates into adjacent areas. This is often accompanied by fever, nausea and vomiting. In the early stages, a mesenteric infarction is manifested by stabbing or cramping abdominal pain, often accompanied by nausea, vomiting, and bloody diarrhea. After a less painful phase of several hours, the symptoms intensify again, and the massive intestinal damage can subsequently lead to circulatory failure. Signs of paralysis, impaired vision and speech, sensory disturbances, impaired vision and clouding of consciousness may be signs of a stroke; in the case of brainstem infarction, the entire body may be affected by paralysis.
Diagnosis and course
Anyone with known cardiac or circulatory problems is a patient at risk for a heart attack. Permanent high blood pressure, problems with sugar metabolism such as diabetes, or higher-than-average cholesterol levels are already common diagnostic clues to the development of infarcts. Well-known methods of checking for infarcts in affected organs include ECG, measuring the currents in the heart muscle and its vessels, measuring blood pressure, blood and cholesterol levels, as well as computer tomography if a pulmonary infarct is suspected or measuring so-called infarct markers in the blood. Infarct markers are substances in the blood that indicate that blood clots have broken down and are therefore a clear indication that such clots are present. There are also nuclear medicine procedures such as MRI or pulmonary scintigraphy, which helps determine the blood flow and ventilation conditions of the lungs to provide clues to any vascular occlusions that may be present.
Complications
Basically, the complications of an infarction depend on the type of infarction and the organ affected. For example, after a myocardial infarction, cardiac arrhythmias, left ventricular failure, rupture of the papillary muscle or chorda tendinea, and rupture of the myocardium (myocardial rupture) form possible complications. In addition, early pericaritis, an inflammation of the pericardium, may occur. In the further course, complications such as late pericarditis and myocardial pericarditis (perimyocarditis) are also conceivable. In mitral regurgitation, a heart valve, namely the mitral valve, fails. A septic infarction can result in blood poisoning (sepsis). This is potentially fatal and must therefore be treated professionally. Another complication of septic infarction is peritonitis. The loss of fluid that accompanies peritonitis can cause further discomfort. If the pleura or pleura becomes inflamed, the patient usually suffers from severe pain that increases and decreases with breathing. The patient usually feels sick and listless and has a fever. In addition, after various types of infarction, an infarct aneurysm can form, in which a sac forms in the wall of a blood vessel or the heart wall. Thrombi can form in such a bulge, which can break loose and obstruct blood flow, potentially leading to another infarction. It is also possible for large amounts of blood to pool in an aneurysm and consequently be missing from the bloodstream.
When should you see a doctor?
A heart attack must always be treated by a doctor. Anyone who repeatedly notices symptoms such as chest pain or heart palpitations should consult their family doctor and have this clarified. If the symptoms increase or become more frequent, this indicates a serious heart disease that could lead to a heart attack. A visit to the doctor is indicated at the latest if the complaints affect the well-being or cause anxiety. Other warning signs that require immediate clarification are a decrease in physical performance or breathing difficulties. Individuals suffering from heart disease should see a doctor immediately with any unusual symptoms. If symptoms such as a twinge in the heart area, paralysis in the left arm or neck pain develop, the emergency physician must be called. In the event of severe symptoms or even a heart attack, first aid measures must be administered until the emergency medical services arrive. If a heart disease has been diagnosed, regular check-ups by the doctor are necessary. The right contact person is the family doctor or a cardiologist. In case of doubt, the emergency medical service can be contacted.
Treatment and therapy
In most cases, therapy for infarcts always promises success if it is started as soon as possible after the infarct is noticed. However, an infarct is not always recognized as such right away. In the case of a so-called stroke – the cerebral infarction – the therapy is very extensive and can take months or years. Intensive inpatient treatment and possibly surgery are usually used to monitor blood values and breathing. Excreted metabolic products are examined by the laboratory for indications. Cholesterol-lowering drugs help normalize blood levels, and physiotherapy trains the brain to compensate for the function of dead tissue if possible.In the case of ocular infarction, the doctor will check for the presence of arterial or venous ocular infarction. He can try to open the occluded vessel by special massage. The blood flow can be normalized by injecting agents that promote blood flow. This is done by outpatient surgery on the eye after local anesthesia. Laser or cold therapy avoids the increase of eye pressure if necessary.
Outlook and prognosis
An infarction has an unfavorable prognosis. Without immediate intensive medical care, the condition is fatal. The prospect of survival is tied to the general health of the affected person, the possibility of initial care by persons present, and the intensity of the infarction. The affected person himself is subject to an emergency and in most cases is not able to independently initiate measures for self-help or the immediate calling of a physician. Therefore, the people in the immediate vicinity are called upon to help. The better they are trained to deal with an emergency situation, the better the chances of survival for the person concerned. If a rescue team is alerted without delay and first aid measures are initiated immediately, the affected person has a good chance of surviving the condition. If intensive medical care is provided within an hour or two, the chances of survival increase. Long-term consequences are to be expected for every infarct suffered and survived. Disorders of the musculoskeletal system, limitations of cognitive performance, functional disorders or paralysis can occur. Despite rehabilitation measures, targeted training and comprehensive medical care, some complaints remain lifelong. With a healthy lifestyle, a stable psyche and the cooperation of the patient, many symptoms can be alleviated. However, complete freedom from symptoms very rarely occurs, even under favorable circumstances.
Aftercare
Myocardial infarction is a serious condition for which consistent follow-up is very important. The most important factor in follow-up care is regular check-ups with the treating physicians such as the cardiologist or internist, but also with the family doctor. A possibly implanted pacemaker must be checked as well as the structure and function of the heart muscle. This can be checked with ECG and ultrasound as well as other imaging techniques such as MRI and CT. Restoration of exercise capacity is also a factor in follow-up care. There are special cardiac sports groups for heart attack patients with specially trained rehabilitation sports instructors. Patients can also postpone exercise themselves by engaging in well-dosed activities such as walking or cycling, although it is important to consult with a physician to avoid overtaxing oneself. A healthy lifestyle with a cholesterol- and calorie-conscious diet, sufficient drinking and stress reduction, as well as abstaining from nicotine and alcohol, also helps to make the aftercare of the infarct optimal. Attention should also be paid to getting enough sleep. Those who also have to deal with an infarct from a psychological point of view can incorporate self-help groups into their personal aftercare. A visit to a psychologist can also be helpful if the shock of the infarction is deep-seated in the person affected or the fear of a relapse noticeably restricts the quality of life. Distraction in company can also help in this context.
Prevention
Cardiovascular problems are the most common sign of a risk of heart attack. Therefore, it is better not to smoke as a member of this risk group. Alcohol in moderation and a diet of fresh fruits and vegetables does good and keeps you fit. Exercise in the fresh air and in nature also promotes the mobility of the veins and arteries. The body likes to walk regularly. Twice a week is the minimum amount of exercise for a body to stay healthy. In addition, drinking pure water is preferable to stimulants. At the very least, the amount of water intake should far exceed that of coffee, alcohol or soft drinks. All this is important for blood circulation, metabolism and vascular health.
Here’s what you can do yourself
A heart attack, regardless of which organ is affected, is a medical emergency. The patient or first responders must call 911 immediately. The most common is a heart attack. The best self-help measure for an impending heart attack is to correctly interpret the signs and consult a physician immediately.A heart attack is often heralded by chest pain that moves into the left arm, feelings of anxiety and pressure behind the breastbone. High-risk patients in particular should not play down such symptoms and should see a doctor immediately. Risk groups include, in particular, overweight people, smokers and people with high blood pressure. Avoiding these risk factors in combination with a healthy diet and sufficient exercise can prevent a heart attack. If an acute heart attack is imminent, the patient should not lie flat until the emergency services arrive, but rather sit in an armchair. This reduces the volume pressure in the chest and relieves the heart. This effect can be further enhanced by the so-called Hauffe’s arm bath. Here, the patient places the left arm or, if necessary, both arms in a basin of water, the temperature of which should be about 35 degrees Celsius. Then hotter water is slowly added until the temperature of the water rises to about 40 degrees Celsius. That bath increases blood flow in the arms, thus redirecting blood from the chest to the extremities, providing momentary relief to the heart.
