Consequences of the heart attack
introduction
To a Heart attack it comes through the closure of one or more Coronary arteries (Coronaries), thereby it occurs in the area of Heart musclesthat is not supplied with oxygen to one Damage to tissue. If this part of the tissue is left without oxygen for a long time, the damage cannot be reversed. This creates a Scarring of the tissuewhich can then no longer contract. A wide variety of medications are prescribed to prevent another subsequent heart attack. So that the blood does not clump again, mostly Clopidogrel and ASS prescribed.
Direct consequences
Immediately after the treatment of infarct the patients stay for the time being monitoring either in an intensive care unit or on one Intermediate Care Station (IMC).
Depending on the size of the affected area, there may be one after the infarction Contraction disorder of the heart. This can lead to a functional insufficiency of the heart, so come a heart failure.
In infarctions that not only affect a part of the heart wall, but that go through the entire thickness of the heart muscle layer, it can lead to the destruction of the tissue Tear in the wall of the heart come.
Artificial coma
If, after a heart attack, the heart is too damaged to be fully functional again immediately, the affected person is often first put into an artificial coma. During this time, your body temperature is regulated down a little, which means that the body uses less energy and is put into a kind of rest mode. In addition, the person is artificially ventilated.
Since comatose patients have to be constantly monitored well, they are given multiple accesses to the vessels in the hospital. One of these accesses is usually in a vein on the arm, while one is located directly in front of the right atrium. This access is the so-called central venous catheter (CVC). The patient is also given circulatory medication during the coma. After the patient has awakened from the coma, he or she must remain in the intensive care unit for some time and then spend a few days to weeks in the intermediate care ward (IMC) for further monitoring.
Because the voluntary muscles can no longer be controlled in a coma, temporary urinary and fecal incontinence occurs during the coma. Urinary catheters are therefore placed in the patient.
Since the patients naturally cannot feed themselves either, they are fed via a gastric tube. It is also possible to administer the nutrients through an access point in the vein, but since it is often desirable to maintain good bowel movement, the gastric tube is more suitable for supply.
All these measures serve to regenerate the heart, because it does not have to use as much energy during the time of the artificial coma as in everyday life. In this way, the area damaged by the heart attack can recover better.
However, the artificial coma also has some consequences. Many bodily functions are temporarily lost, especially when it lasts longer. For example, after a long period of time that is only spent lying down, the muscles first have to get used to their work. The lungs and respiratory muscles must also be trained again. The heart, too, must first regenerate itself in its recovery break and then be carefully introduced to the new requirements.
Read more on this topic at: Artificial coma
Direct consequences for the lungs
Depending on the severity of the heart attack, the lungs can suffer different types of consequential damage.
If a person has to be put into an artificial coma because of a heart attack, it happens mechanical ventilation increases the risk of infectionthat even degenerate into pneumonia can. Pneumonia can develop during a coma, including ventilation, or a few days after waking up from the coma. Weaning from ventilation also poses problems. Frequently, after waking up, patients should do targeted breathing exercises in order to accelerate weaning from the ventilation device.
The other is through a insufficient blood flow during the time of the infarction even damage possible. Also Heart rhythm disorders during the heart attack can cause problems. If namely meanwhile, blood clots form in the right ventricle, these can get into the vessels of the lungs and there Pulmonary embolismwhich can also be life-threatening.
Direct consequences for the brain
Here, too, the consequences are heavily dependent on the severity and the 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 inadequately supplied with blood, oxygen and other nutrients during this process. The brain is however particularly prone to lack of oxygen. The first (sometimes irreversible) damage can be seen after just a few minutes. Furthermore, heart attacks often cause cardiac rhythm disorders. The heart no longer beats regularly, and the heart's pumping action is no longer coordinated. This causes swirling of the blood in the heart. These can be small Blood clots which can then be pumped into the brain. There they can clog a vessel and thereby lead to you stroke.
Illustration of a heart attack
Heart attack (HI)
Myocardial infarction (MI)
- Healthy coronary artery
(Coronary artery)
Coronary artery - Occluded artery
Atherosclerotic plaque
with blood clot (Thrombus) - Fat deposits (plaque)
- Blood clot -
thrombus - Healthy muscle tissue
- Coronary artery right -
Coronary artery dextra - Pericardium -
Pericardium - Left coronary artery -
Left coronary artery - Destroyed muscle tissue
(Infarct area with cell death)
Typical areas of pain in a heart attack:
Woman - chest, upper abdomen, neck,
Lower jaw, spine, back,
NAN rule (nose - arm - navel)
Man - chest, stomach,
Emanation in the arm and shoulder,
Lower jaw, back
An overview of allhe images by Dr-Gumpert can be found at: medical illustrations
Long-term consequences
Depending on that Triggers the heart attack and the Age of the patient, the therapy is designed. It also orientates itself on the Long-term consequences. One possible side of the long-term consequences of a heart attack is that mental stress which is caused by the life-threatening situation. Fear of a new heart attack triggered by stress and the resulting withdrawal from physical activity not only fuel the patient's fears, but also the risk of a new heart attack due to less exercise.
One caused by a heart attack Heart failure can also Restrictions in movement of patients. If the heart failure (heart failure) is so severe that the heart's pumping capacity is restricted, it can lead to a Backlog in the lungs and to one Water retention in the legs come (Leg edema). Against the water in your lungs and legs you can diuretic drugs (Diuretics) are given.
Since myocardial infarction occurs mainly in arteriosclerotic vessels, these patients should start with their Blood lipid levels let determine. High levels of fat in the blood increase the risk for arteriosclerosis solid. In addition, patients should have a Weight reduction consider, as this reduces the stress on the heart and blood vessels. When patients have less body mass and theirs Blood pressure lower, the heart has to pump against less resistance and can thus be spared. Are suitable for weight reduction for health reasons no crash diets. Rather, it is advised to go through Exercise and a change in diet to decrease. A Mediterranean diet with very little or no fried foods is recommended. Also the consumption of red meat such as beef and pork should be reduced.
For patients who have had a heart attack, they are often lifelong Medication need to take to prevent another heart attack. Even though it was a few years ago, patients should continue to take the prescribed medication if there were no significant changes in the risk profile. In general, the medication should not be discontinued without consulting the attending physician.
Another complication of the heart attack can be Cardiac arrhythmias be. So that it doesn't become a life-threatening one Ventricular fibrillation the patient should be thoroughly examined before leaving the hospital.
Long-term consequences for the psyche
In the acute situation of a heart attack, there is usually a strong feeling of pressure and tightness in the chest. In addition, people often experience extreme fear of death during a heart attack. As a result, the heart attack is a very drastic experience that can often not be dealt with so quickly. This fear, which can sometimes turn into persistent panic, should be treated in rehabilitation after a heart attack.
Furthermore, many people face everyday problems after a severe heart attack that can suddenly become seemingly insurmountable obstacles. The body is less resilient, you have to get used to your new limits. Here, too, careful testing under medical guidance (for example in a cardiac sports group or a rehabilitation program) is recommended. In this way, your own abilities can gradually be assessed again.
The fear of consequential damage or a new heart attack also plays a major role.
Another psychological consequence can be recurring complaints in the chest area, which to the patient feel like the symptoms of a heart attack without any organic causes for these symptoms being found. These symptoms are therefore part of psychosomatics. Here, too, rehabilitation can help to develop a better body awareness in order to be able to differentiate between organic and psychosomatic pain.
Long-term effects on the lungs
It can also cause a heart attack as a result of a long term Heart failure come. In this case it is the heart is no longer able to pump enough blood through the circulation and it comes to one Backlog of blood in the pulmonary vessels. This makes oxygen exchange difficult between air and blood. It can also damage the lung tissue.
treatment
The Treatment of a heart attack strongly depends on the point in time. A patient comes immediately after the infarction in treatment, is usually at one Coronary angiography Stent placed in the closed vessel. If it is not possible to widen the vessel again with a stent, it will medication to dissolve the blood clot set in motion. It is important here that the drug-based decomposition of the clot must under no circumstances take place before a planned angiography.
To prophylaxis becomes ASS given for life and also in the first year after the infarction Prasugrel or Clopdiogrel. This drug combination inhibits the so-called Plateletswhich are also responsible for blood clotting. If more blood clots are suspected in the left ventricle exists, can additionally still an anticoagulant with coumarins for example with Marcumar® take place.
If it becomes a part of the heart attack Rhythm disturbance comes, it must first be clarified what type of arrhythmia it is. When it comes to one Atrial fibrillation can come with a Cardioversion trying to get the heart back into the right rhythm. Cardioversion is a procedure in which the heart passes over a Power surge is stimulated from outside to move again in the "correct" rhythm. If this procedure cannot be used or the attempts fail, the heart can also medicate one Antiarrhythmic such as Amiodarone be brought back into rhythm. So that the problem of the arrhythmia does not recur, are usually Beta blockers administered to prevent the heart from beating too quickly. Cardiac arrhythmias are the most common complications of a heart attack.
At a Heart failure, i.e. a weak cardiac output, are initially Drugs called diuretics for drainage given. It is very important to pay particular attention to the electrolyte potassium is respected. Because a lack of potassium and too much potassium have a negative effect on the heart and also one Cardiac arrest it is important to adjust the diuretic medication very precisely. In the case of more advanced heart failure, drugs are also used to strengthen it. It is also important that sufficient volume is given. Due to the diuretics it can become a high water loss come, which must be balanced in moderation. However, care must be taken here that not too much water is given, otherwise it will lead to you Backlog in the lungs can come.
The psychogenic consequences heart attack, can usually not be influenced by drugs, but only by changing behavior. Patient facing fear You should urgently discuss this with your doctor before you have a new heart attack so that he can try to alleviate these fears by pointing out possible fears Behavior changes to improve the situation, can take. For very scared people, one can psychotherapy be helpful.
How can you prevent another heart attack?
When preventing a new heart attack, the first thing to do is medical advice and drug treatment in the foreground. Acute problems in the work of the heart (for example heart rhythm disorders) must be treated with medication. To avoid impending heart failure, you can Beta blockers, Calcium channel blockers or other drugs are given. Also Diuretics (Water tablets) relieve the heart.
Furthermore is a Diet change often helpful. The Mediterranean cuisine (low-fat meat, vegetable fats, lots of vegetables) is particularly recommended, as is low-salt dishes. Attention should be paid to a diet that has a positive effect on blood lipid levels. Also Body training can be helpful. After a heart attack, this should initially be done under strict medical supervision (for example in a rehabilitation or cardiac sports group).
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