Diagnosis heart attack
The pillars of myocardial infarction diagnostics consist of the survey: This tripartite diagnostic scheme serves to confirm an existing myocardial infarction. The World Health Organization (WHO) defines the presence of a myocardial infarction as the case when at least two of the three criteria mentioned above are present in the patient.
- The angina pectoris symptomatology (pressure and tightness in the chest) of the patient
- In typical ECG changes and
- The detection of myocardial infarction – markers in the blood (proteins troponin I and T).
What diagnostic measures are taken in case of a heart attack?
Blood lipid levels, heart disease (coronary artery disease, atherosclerosis), previous heart attacks, age, family history of heart disease Family history (interview with the patient for symptoms) Pain, stabbing in the heart area Radiating pain in the stomach, upper abdomen, left arm, back, between the shoulder blades, etc. Feeling of pressure, tightness in the chest Nausea, vomiting Shortness of breath Drop in performance, low exercise tolerance, fatigue Dizziness, fainting Strong sweating Risk profile:
- Anamnesis (questioning the patient about symptoms) Pain, stabbing in the heart area Radiating pain in the stomach, upper abdomen, left arm, back, between the shoulder blades, etc. Feeling of pressure, tightness in the chest Nausea, vomiting Shortness of breath Drop in performance, low exercise tolerance, fatigue Dizziness, fainting Strong sweating Risk profile:
- Pain, stinging in the heart area
- Radiating pain in the stomach, upper abdomen, left arm, back, between the shoulder blades, etc.
- Feeling of pressure, tightness in the chest
- Nausea, vomiting
- Shortness of breath
- Loss of performance, low load capacity, fatigue
- Dizziness, fainting spells
- Strong sweating
- Risk profile:
- ECG
- Blood values LDH Troponin T CK-MB Myoglobin
- LDH
- Troponin T
- CK-MB
- Myoglobin
- Pain, stinging in the heart area
- Radiating pain in the stomach, upper abdomen, left arm, back, between the shoulder blades, etc.
- Feeling of pressure, tightness in the chest
- Nausea, vomiting
- Shortness of breath
- Loss of performance, low load capacity, fatigue
- Dizziness, fainting spells
- Strong sweating
- Risk profile:
- LDH
- Troponin T
- CK-MB
- Myoglobin
Cardiological guidelines deviate slightly from the WHO definition.
They assume a myocardial infarction if there are typical changes in the ECG, a so-called ST segment elevation, and the patient has symptoms of a reduced oxygen supply to the heart muscle cells (myocardial ischemia) in the form of chest pain. If these two clinical signs are detected, the patient can promptly and without delay receive a revascularization measure (reopening of closed or narrowed coronary arteries) to correct the reduced oxygen supply (ischemia) of the heart. In this case, it is not necessary to wait for the result of the blood test for the myocardial infarction markers to legitimize revascularization.
At the beginning of the diagnosis, the patient’s medical history (anamnesis) is taken, with the focus on the acute symptoms, and a physical examination of the patient is performed. In the acute phase of a heart attack, most patients complain of very severe chest pain, they are cold sweaty, anxious and restless. As a second diagnostic step to determine a myocardial infarction, the echocardiogram (ECG) is used as an instrumental examination.
The ECG makes the electrical conduction processes of the heart muscle action visible, which are the same and unmistakable in every person in a healthy state. By altering the typical, healthy ECG image, different, pathological states of the heart can be detected, including a heart attack. With its help, the extent of the myocardial infarction, its localization and the age of the infarction can be determined. In 80% of all myocardial infarction cases there are changes in the course of the ECG curve. This is called ST-segment elevation (S and T are typical points of an ECG heart recording), which is caused by the death of the heart muscle cells.
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