A heart attack can already be prevented with simple measures. If a heart attack nevertheless occurs, there are various complications and options for treatment. We explain what measures exist for prevention, what types of therapy exist, and what possible complications exist for a heart attack.
Complications of a heart attack
In the acute stage of a heart attack, the following complications may occur:
- Death from cardiovascular failure or malignant arrhythmias.
- Circulatory shock
- Herzrhtythmusstörungen
- Heart valve damage
- Cardiac septal defect
- Hemorrhage into the pericardium
- Embolism
After a heart attack can occur:
- Renewed heart attack
- Heart failure
- Cardiac arrhythmias
- Embolisms
- Pericarditis
Treatment of acute myocardial infarction
The goal of treatment of acute myocardial infarction is aimed at relieving the already damaged myocardium, limiting the extent of the infarction, ensuring blood flow to the myocardium, preventing secondary complications and, ideally, reopening the occluded infarct vessel at an early stage. For this purpose, the following treatment options are available individually or in combination:
- Blood-thinning therapy with heparin and aspirin.
- Administration of a beta-blocker to relieve the heart muscle
- Medication to lower blood pressure
- Painkillers
- Sedatives
- Medication or electroshock therapy for arrhythmias.
- Diuretic medications for heart failure.
- Oxygen administration for oxygen deficiency
- Artificial respiration in case of insufficient self-breathing
- Circulatory stabilizing drugs in case of circulatory shock
Lysis therapy and cardiac catheterization.
Reopening of the occluded infarct vessel can be achieved either by lysis therapy or balloon dilatation during cardiac catheterization. Lysis therapy involves the administration through the vein of a substance capable of dissolving blood clots in the coronary arteries. However, lysis therapy can activate latent sources of bleeding in the organism, such as in the brain, retina or gastrointestinal tract, and lead to life-threatening bleeding. In addition, the local efficacy of lysis therapy on the infarct vessel cannot be directly verified. In contrast, cardiac catheterization allows direct visualization of the coronary vessels and their constrictions in general, and of the infarct-causing vessel occlusion in particular. With modern balloon catheters, an attempt can be made in the same session to reopen the occluded coronary vessel, thereby normalizing the blood flow conditions.
Therapy after myocardial infarction
Unfortunately, even this balloon dilatation is not always successful, and the procedure also carries other risks that must be weighed against the risk of a purely wait-and-see strategy in individual cases. In addition, not all hospitals have the technical equipment and professional expertise to offer cardiac catheterization. The principle that applies to both lysis therapy and cardiac catheterization is that the earlier treatment begins in the event of a heart attack, the greater the chances of limiting the damage. The choice of the appropriate procedure and the right time in the course of a heart attack are the subject of intensive scientific research. Long-term treatment is just as important as acute therapy. After a heart attack has been survived, the basic problem of the disease, the calcification of the coronary vessels, has not been eliminated. In order to reduce the risk of a new heart attack, control of the individual risk factors, consistent medication therapy and, if necessary, renewed cardiac catheter examinations with balloon dilatation of still narrowed vessels or even bypass surgery are necessary. In bypass surgery, veins from the patient’s lower legs are sewn as vascular bridges over the narrowed coronary arteries by the cardiac surgeon as part of major open-heart surgery, partially restoring blood flow to normal.
Preventive measures
Myocardial infarction represents the most serious complication of coronary artery disease.It is therefore of central importance to raise awareness among all people who are burdened with risk factors for cardiovascular diseases about the measures and behaviors they can adopt to prevent vascular diseases and heart attacks. Specifically, for prevention, this means:
- Weight regulation in case of overweight
- Abstinence from nicotine and alcohol
- Treatment of hypertension
- Medication and diet for diabetes, dyslipidemia or gout.
- Regular physical training
- Reduction of psychological stress factors
Although compliance with these preventive measures, especially in the case of genetic burden, can not always protect against vascular disease and heart attacks, in the vast majority of cases, the course of the disease and the frequency of heart attacks is still favorably influenced. After a heart attack, a patient should have regular check-ups with a doctor, even without symptoms. Stress tests such as exercise ECG, stress ultrasound examination or thallium scintigraphy can detect indications of latent problems with the coronary arteries or an impending heart attack, and countermeasures can be taken at an early stage.
