Internal Medicine

Prognosis after myocardial infarction

Cardiac arrhythmias

Early complications that can occur during the first 48 hours after a heart attack make the time immediately after the heart attack the most dangerous time for the patient.

In 95-100% cases occur after the heart attack Cardiac arrhythmias that can range from extra ventricular beats to fatal ventricular fibrillation. Likewise, it can lead to atrial fibrillation or a drastic drop in the Heart rate (Bradycardia) come. The early administration of beta blockers, which stabilize the heart rate, can reduce the risk of ventricular fibrillation and mortality.

Left heart failure

A Left heart failure (left heart failure) occurs in 1/3 of patients with myocardial infarction and is usually present when more than 15-20% of the heart muscle cells in the left ventricle have perished. After ventricular fibrillation, the heart's failure to pump is the second most common cause of death after a heart attack. Drug therapy relieves the heart by reducing the so-called preload and afterload.

The Preload is the stretching state of the left heart before the ventricular contraction (systole / tensing of the myocardial cells) and is also determined by the filling situation of the venous and pulmonary circulation (Cardiovascula). To reduce the preload, give Nitro preparations.

The Afterload is decisively influenced by the prevailing blood pressure in the vascular system. To relieve the heart, increased blood pressure values must be reduced and / or the pumping work of the heart improved. To achieve this, you administer ACE inhibitors (antihypertensive effect) and / or Catecholaminesthat increase cardiac output (increase cardiac output).

Other complications

Other possible complications of heart attack are:

Infarct pericarditis (inflammation of the Heart sac)
a tear in the heart wall (heart wall rupture) with pericardial tamponade (blood accumulation in the pericardium) as well
arterial and venous embolisms (diseases caused by blood clots that clog blood vessels, e.g. pulmonary embolism)

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Pericarditis

The Pericarditis (Pericarditis) occurs in 10-15% of infarct patients and is given to the patient on 2-3. Day after the heart attack due to new pain in the Rib cage deliberately. This pain lasts for 1-2 days.

Of the Rupture of the heart wall (Rupture of the heart wall) with subsequent blood leakage is associated with acute symptoms of shock. The drop in blood pressure and the drop in cardiac output are threatening.

In the Pericardial tamponade Blood collects in the pericardium, which exerts increased mechanical pressure on the heart chamber.The filling of the ventricle is hindered, so that the stroke volume (the amount of blood ejected by the heart in systole) decreases and the acute state of shock occurs. The patients need immediate surgical treatment to prevent them from dying.

embolism

Emboli, i.e. Blood clots (thrombi) carried into the bloodstream can shoot into the arterial vascular system after a heart attack and e.g. cause a stroke by blocking a vessel in the brain. The risk of developing thrombi in the heart is particularly increased if rhythm disturbances occur during the heart attack and the coagulation is activated due to the changed flow rate of the blood.
The times of stasis (standing of the blood column) in arrhythmias often result in thrombi in the atrium, which detach from the heart wall and can be flushed out.

Aneurysm from the heart

Later complications that can occur with some delay to the infarction are Cardiac wall aneurysms, Dressler's syndrome and relapses (repeated heart attacks).

A Aneurysm of the heart is a sack-like expansion of the heart wall in the area of the heart attack area, in which muscle cells have died. At the affected area the movement of the heart wall is disturbed and im EKG shows a persistent ST segment elevation.
Consequences of these heart changes can be an increasing pump failure of the heart, arrhythmia of the heart and embolisms that can form on the restricted mobility of the heart wall due to changes in blood flow.

A surgical procedure to remove the aneurysm is indicated if the heart's pumping failure progresses, thrombus formation occurs despite drug clotting, or if cardiac arrhythmias occur repeatedly.

Dressler syndrome

The Dressler syndrome is an autoimmune process in which the patient develops pericarditis 6-8 weeks after the heart attack. The body forms antibodies against its own heart muscle cells, these antibodies can be detected in the blood.
There are signs of infection: The patient has fever and the inflammation mediators in the blood are increased. Autoimmune pericarditis is treated with analgesic and anti-inflammatory drugs such as acetylsalicylic acid (e.g. aspirin ®) or indomethacin (e.g. Indomethacin Sandoz ®) treated. With a severe course of the disease can cortisone given to reduce inflammation.

forecast

2/3 of patients with myocardial infarction die in the pre-hospitalization phase, i.e. the time before arrival at the hospital, whereby the most common cause of death ventricular fibrillation is. The risk of fatal cardiac arrhythmias is highest immediately after the infarction - it is therefore important to provide the patient with efficient therapy as quickly as possible.
Left ventricular failure (Left heart failure) as a complication of myocardial infarction represents a significant risk factor for dying after the infarction: With increasing left heart failure, the mortality rate in heart attack patients increases.

The Long-term prognosis of the CHD patient (Patient with constricted coronary arteries = coronary heart disease) is influenced by various factors.

Extent of left heart weakness (degree of heart failure) or the size of the submerged heart muscle area that can no longer perform physiological wall movement during heart contraction
Consist Angina pectoris pain or if signs of ischemia are triggered in the exercise ECG, the patient's prognosis worsens.
Cardiac arrhythmias with a reduced adaptability of the heart rate to the current stress situation are to be interpreted as a sign of a deterioration in prognosis.
As the number of affected vessels increases, the patient's risk of death increases. The worst prognosis has a vasoconstriction, which is located on the stem of the vessel (near the aortic outlet).
If risk factors are still present after the infarction, the CHD proceeds (coronary heart disease) and the risk of a new heart attack increases.

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