A heart attack occurs when one or more coronary arteries (coronaries) become blocked, causing damage to the tissue in the area of the heart muscle that is not supplied with oxygen. If this part of the tissue is without oxygen for a long time, the damage cannot be reversed. This leads to a scarring of the tissue, which then can no longer contract. In order to prevent another heart attack in the consequence, various drugs are prescribed. In order to prevent a new clotting of the blood, clopidogrel and ASA are usually prescribed.
Direct consequences
Immediately after the treatment of the infarct, patients remain in either an intensive care unit or an intermediate care unit (IMC) for monitoring purposes. Depending on the size of the affected area, a contraction disorder of the heart occurs after the infarction. This can lead to functional insufficiency of the heart, i.e. cardiac insufficiency.
In the case of infarcts that affect not only a part of the heart wall, but once through the entire thickness of the heart muscle layer, the destruction of the tissue can lead to a tear in the heart wall. If, after a heart attack, the heart is too badly damaged to be fully functional again immediately, those affected are often first put into an artificial coma. During this time, their body temperature is slightly reduced, which means that the body uses less energy and is thus put into a kind of resting mode.
The person is also artificially ventilated. Since comatose patients have to be monitored well on a permanent basis, they are given several accesses to the vessels in the hospital. One of these accesses is usually located in a vein in the arm, while one access is located directly in front of the right atrium.
This access is the so-called central venous catheter (ZVK). During the coma, the patient is also given circulation-regulating medication. After the patient has awakened from the coma, he/she must remain in the intensive care unit for some time and then spend a few days to weeks in the intermediate care unit (IMC) for further monitoring.
Because the voluntary musculature can no longer be controlled in a coma, temporary urinary and fecal incontinence occurs during the coma. Therefore, patients are given bladder catheters. Since the patients are of course also unable to feed themselves, they are fed through a stomach tube.
It is also possible to administer the nutrients through a vein, but since it is often desirable to maintain good bowel movement, the stomach tube is more suitable for this purpose. All these measures serve the regeneration of the heart, because it does not have to expend as much energy during the time of the artificial coma as it does in everyday life. In this way the area damaged by the heart attack can recover better.
However, the artificial coma also has some consequences. Especially if it lasts longer, many bodily functions are temporarily lost. After a long time, which is only spent lying down, the muscles, for example, have to get used to their work again.
The lungs and respiratory muscles must also be trained again. The heart, too, must first regenerate during its recovery break and then be gently introduced to the new requirements. Depending on the severity of the heart attack, the lungs can suffer various consequential damages.
If a person has to be put into an artificial coma because of a heart attack, mechanical ventilation creates the risk of infection, which can even lead to pneumonia. Pneumonia can develop during the coma, i.e. also during ventilation, or even a few days after waking from the coma. Weaning from ventilation is another problem.
Patients are often asked to do specific breathing exercises after waking up in order to accelerate the weaning from the ventilator. On the other hand, a lack of blood circulation during the time of the infarction itself can cause damage. Cardiac rhythm disturbances during the infarction can also cause problems.
If blood clots form in the right ventricle during the heart attack, they can enter the blood vessels of the lungs and cause pulmonary embolism, which can also be life-threatening. Here again, the consequences depend strongly on the severity and individual situation and are not the same for every patient.Since the performance of the heart decreases at least temporarily during a heart attack, the brain is often not sufficiently supplied with blood, oxygen and other nutrients during this time. However, the brain is particularly susceptible to oxygen deficiency.
After only a few minutes, the first (sometimes irreversible) damage becomes apparent. Furthermore, heart attacks often cause cardiac rhythm disturbances. The heart no longer beats regularly and the pumping action of the heart is no longer coordinated.
This causes turbulence of the blood in the heart. These can result in small blood clots that can then be pumped into the brain. There they can clog a blood vessel and lead to a stroke.
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