Treatment

The treatment of an infarction depends very much on the time of day. If a patient comes in for treatment immediately after the infarct, a stent is usually placed in the occluded vessel during an angiography of the coronary vessels. If it is not possible to expand the vessel again with a stent, the dissolution of the blood clot is initiated with medication.

It is important to note that under no circumstances should the dissolution of the clot by medication take place before a planned angiography. As a prophylaxis, ASA is given for life and in the first year after the infarct, prasugrel or clopdiogrel is also given. This drug combination inhibits the so-called thrombocytes, which are also responsible for blood clotting.

If further blood clots are suspected in the left ventricle, an additional anticoagulation with coumarins, for example with Marcumar®, can be administered. If a dysrhythmia occurs during a heart attack, it must first be clarified what type of dysrhythmia is involved. If atrial fibrillation occurs, cardioversion can be used to try to bring the heart back into the right rhythm.

Cardioversion is a procedure in which the heart is stimulated by an external electrical impulse to move in the “right” rhythm again. If this procedure cannot be used or the attempts fail, the heart can also be brought back into rhythm with an antiarrhythmic drug such as amiodarone. To prevent the problem of rhythm disturbance from reoccurring, beta-blockers are usually administered to prevent the heart from losing its rhythm by beating too fast.

Cardiac arrhythmias are the most common complications of a heart attack. In the case of heart failure, i.e. weak cardiac performance, drugs for dehydration, so-called diuretics, are given first. It is very important to pay special attention to the electrolyte potassium.

Since a lack of potassium and too much potassium have a negative effect on the heart and can also cause cardiac arrest, it is important to adjust the dehydrating medication very precisely. If the heart failure is more advanced, additional medication is used to strengthen it. It is also important to make sure that sufficient volume is administered.

Diuretics can cause a high loss of water, which must be compensated for in moderation. However, care must also be taken here not to give too much water, as this can lead to backwater in the lungs. The psychogenic consequences of a heart attack can usually not be influenced by medication, but only by a change in behaviour. Patients who stop all their activities for fear of a new heart attack should urgently talk to their doctor about it, so that he can try to take away their fears by showing them possible changes in behaviour to improve the situation. Psychotherapy can also be helpful for very frightened people.