Heart attack

The best treatment to minimise follow-up complications

The good news: For many years, the number of deaths due to a heart attack and their relative frequency in Germany has been declining. Nevertheless, 320,000 patients with unstable chest pain and “little” heart attacks as well as 127,000 patients with “big” heart attacks are treated in hospitals.

At Schoen Clinic, our heart specialists offer you a comprehensive treatment: from the first emergency care to the transition to rehabilitation.

Causes & symptoms

What is a heart attack?

The term heart attack describes the cell death of heart muscles due to a prolonged circulatory disorder. An acute occlusion occurs here in one or several coronary vessels or a vessel branch. As a result of the vascular occlusion, the heart muscle tissue is no longer supplied with enough oxygen and dies. This results in a scar on the heart. 

There are three types of heart attack:

  • Unstable chest pain (“precursor” of the heart attack)
  • Heart attack without typical ECG changes
  • Heart attack with typical ECG changes

This distinction is important for specialists, since the type and time of the required treatment depends on this.

Heart attack: Contributing causes

Heart attacks do not come out of the clear blue, but rather they have a pre-history. A heart attack is preceded by a so-called atherosclerosis of the coronary vessels: These are more or less constricted by fatty, partially calcified deposits on the vessel walls. Platelets are deposited at damaged parts of the vascular wall and eventually form a blood clot. They gradually clog the vessel so that no blood can flow through it. Part of the heart muscles are no longer supplied with oxygen - this results in an acute heart attack. 

Risk factors:

  • Smoking
  • Being overweight
  • High blood pressure
  • Increased blood lipid values
  • Diabetes mellitus
  • Lack of movement

High blood pressure leads to a thickening and stiffening of the heart muscle, which impairs the hearts pumping ability. The left ventricle in particular is no longer elastic enough to fill with a sufficient amount of blood.

During a “big” heart attack, the cause is a complete vascular occlusion. During a “small” heart attack, the vascular occlusion is incomplete. 

Men in particular are affected by acute heart attacks.

Heart attack symptoms: common signs

Scientific studies have shown that around 80 per cent of men and women noticed a heart attack due to a (usually severe) pain in the chest region lasting for 20 minutes. In most patients, this pain radiates to the left arm. In addition, the body releases the stress hormones adrenaline and noradrenalin as well as the vasoconstrictive angiotensin. The heart’s pumping function is also made difficult by tachycardia. 

Other possible comorbidities:

  • Feeling of faintness
  • Cold sweat
  • Paleness
  • Nausea
  • Vomiting

If more than 30 per cent of the heart muscles fail, there is usually a heart failure. In diabetes patients, the infarction may be silent, i.e. without the typical pain symptoms. Then patients complain more about shortness of breath.

If blood accumulates in the lungs due to the reduced pumping performance, fluid may accumulate in the lung tissue. Gas exchange is hindered so that not enough oxygen is absorbed. The life-threatening accumulation of fluid is referred to as pulmonary oedema. If the lung is listened to, then a bubbling noise is heard.

Diagnostics

Diagnosis: How a heart attack is detected

The diagnosis is initially based on the symptoms present, but the typical signs may be missing, especially in women.

One reliable aid for making a diagnosis is the electrocardiogram (ECG) which can be used to measure the heart’s electrical activity. Our consultants can thus determine with a high probability whether there is an occlusion of a coronary vessel. The ECG can also indicate whether there was a recent heart attack. If the symptoms or the result of the ECG are not conclusive, special laboratory values (“troponins”) are measured, which can rule out a heart attack. In this case, in addition to the resting ECG, a stress test (such as an exercise ECG) can be carried out to estimate the likelihood of coronary heart disease.


However, not all heart patients can be correctly assessed with this method. That is why a further diagnostic measures are carried out with a conspicuous exercise ECG for women. One option is the stress echocardiography: Here an ultrasound examination of the heart is performed while the patient is physically exercising. Movement disorders and failures of the affected parts of the heart can be detected here. Other methods that we use include magnetic resonance imaging (MRT) and computed tomography of the heart.