Myocardial Infarction (Heart Attack): Therapy

Suspicion of myocardial infarction: call 911 immediately! (Call number 112)

General measures

Adjustment of existing underlying diseases (e.g., diabetes mellitus, hyperuricemia/gout, hypercholesterolemia/elevated cholesterol blood levels, homocysteinemia/elevated homocysteine blood levels, etc.) to optimal levels.
Optimal dental hygiene! – poor dental hygiene can lead to gingivitis (inflammation of the gums) or periodontitis (inflammation of the tooth bed) and subsequently infectious pathogens can penetrate through the oral cavity, which can promote atherosclerosis (arteriosclerosis, hardening of the arteries)
Nicotine restriction (refraining from tobacco use) including passive smoking – active smokers should participate in a smoking cessation program!
- Smokers who suffer a myocardial infarction at age younger than 50 years can reduce their risk of dying in the next 10 years by 65% by abstaining from tobacco products.
Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
Aim for normal weight!Determination of BMI (body mass index, body mass index) or body composition using electrical impedance analysis.
- BMI ≥ 25 → participation in a medically supervised weight loss program.
Leisure activities and intimate life
- Sauna: A Finnish proverb says: “The sauna is the pharmacy of the poor”. It reduces the risk of sudden cardiac death (PHT), has a beneficial effect on ventricular arrhythmias (cardiac arrhythmias originating in the ventricle/potentially life-threatening; rate of ventricular tachycardia ↓), and improves NYHA stage (scheme for grading heart failure/heart failure; BNP levels ↓). Furthermore, sauna has a positive effect on systolic and diastolic blood pressure. The frequency of angina pectoris attacks (“chest tightness”; sudden pain in the heart area) decreases.Conclusion: For patients after a myocardial infarction (heart attack), sauna does not appear to be dangerous. According to the American Heart Association, stable patients can return to sexual activity after ten days.
- Sports: see below sports medicine
- Intimate life: Blood pressure only increases to 160/90 mmHg during the sexual act, and pulse rate to 120/min – after which it takes only two to three minutes for heart rate and blood pressure to recover. For patients who can perform moderate physical activity (energy expenditure of 3 to 5 METs* ) without experiencing angina, dyspnea (shortness of breath), cyanosis (blue discoloration of the skin), arrhythmias, or ST-segment depression (may indicate insufficient blood flow to the myocardium/cardiac muscle) can have sex pleasurably. The same is true for patients with NYHA stages I and II and for implantable cardioverter defibrillator (ICD; pacemaker) wearers.
Review of permanent medication due topossible impact on the existing disease.
Avoidance of psychosocial stress:
- Stress

* Metabolic equivalent of task (MET); 1 MET ≡ energy expenditure of 4.2 kJ (1 kcal) per kilogram of body weight per hour).

Conventional nonsurgical therapeutic methods

Reperfusion therapy – this aims to restore blood flow to the heart. There are two common procedures for this:
- Thrombolysis
  - This procedure is used to dissolve a blood clot (= thrombolysis) that has clogged a coronary vessel and thus caused the myocardial infarction. For this purpose, a thrombus-dissolving drug is administered. This therapy is best administered within the first six hours after an infarction, before the heart muscle tissue is irreversibly damaged. However, even after 12 hours, there may still be benefit from the therapy.
- Percutaneous coronary intervention or percutaneous coronary intervention (abbreviation PCI; synonym: percutaneous transluminal coronary angioplasty, PTCA; percutaneous transluminal coronary angioplasty)Note: In acute STEMI (ST-elevation myocardial infarction; myocardial infarction causing ST-segment elevation on the electrocardiogram (ECG)), coronary revascularization should be performed within 60 minutes of diagnosis in the emergency department!
  - In the acute stage, acute PTCA can be performed. This is a procedure to dilate (widen) stenotic coronary vessel areas (narrowed coronary vessel areas).A catheter with a balloon is inserted through an artery in the groin (femoral artery) or forearm (radial artery) to the heart. At the stenosis (narrowing) of the coronary vessel, the balloon is expanded so that the narrowing is removed and blood flow is again possible, and a stent is inserted. This is a small tube that keeps the blood vessel open.

Vaccinations

The following vaccinations are advised:

Flu vaccination
Pneumococcal vaccination

Regular checkups

Regular medical checkups

Nutritional medicine

Nutritional counseling based on nutritional analysis
Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
- A total of 5 servings of fresh vegetables and fruit daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
- Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
- High-fiber diet (cereals and cereal products (oats and barley products), whole grains, legumes, pectin-rich fruits such as apples, pears and berries).
Observance of the following special dietary recommendations:
- Avoidance of:
  - Excessive calorie intake and high-fat diet (high intake of saturated fat).
  - Red meat, ie muscle meat of pork, beef, lamb, veal, mutton, horse, sheep, goat, and processed meat products.
  - Trans fatty acids (produced by:
    - Industrial fat hydrogenation (fat hydrogenation) of vegetable oils.
    - Heating and frying of oils at high temperatures
- Diet rich in:
  - Vitamins (vitamin B6, B12, folic acid, C).
  - Trace elements (selenium)
  - Omega-3 fatty acids (marine fish)
  - Secondary plant compounds (eg beta-carotene).
  - Further micronutrients (L-carnitine, coenzyme Q10).
Selection of appropriate food based on the nutritional analysis
See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
Detailed information on nutritional medicine you will receive from us.

Sports Medicine

Endurance training (cardio training) and strength training (muscle training).
After myocardial infarction defined bicycle ergometer training under pulse control.For all stable patients, at least five training sessions of 30 minutes at an exhaustion of the heart rate reserve of 60-70% (= intensity of the load).Heart rate reserve (according to Karvonen) = (Maximum heart rate – resting heart rate) x intensity of the load + heart rate at rest Maximum heart rate (MHF, HFmax) = 220 – ageCaution! At very high load, there is a re-increase in mortality (death rate).
Cardiovascular prevention: regular yoga exercises have almost the same protective effect as 30 minutes of daily endurance exercise.
Chinese martial art Tai Chi Chuan (TCC) may be suitable as a rehabilitation program. In one study, tai chi exercise was shown to be associated with an increase in maximal oxygen uptake (VO2 max) in patients with recent myocardial infarction. This effect is significant because patients in the postmyocardial phase (time after myocardial infarction) have a decrease in functional capacity, which manifests as a decrease in VO2 max.
Preparation of a fitness or training plan with appropriate sports disciplines based on a medical check (health check or athlete check).
Detailed information on sports medicine you will receive from us.

Psychotherapy

Psychotherapy if necessary
Detailed information on psychosomatics (including stress management) can be obtained from us.

Rehabilitation

The hospital stay is followed by exercise-based rehabilitation, either inpatient or outpatient, depending on the situation as decided by the physician. Part of the rehabilitation should be a cognitive behavioral therapy