Heart attack symptoms

Heart Attack Symptoms

The main point and symptoms of a heart attack given below:

1. Breast pain or discomfort (angina) can be manifested by a feeling of compression, contraction, fullness or pain in the middle of the breast. When a heart attack occurs, the pain usually lasts for a few minutes and can increase and decrease in intensity.
2. Upper body discomfort, including arms, neck, back, jaw or stomach.
3. Difficulty breathing.
4. Nausea and vomiting.
5. Cold sweat.
6. Dizziness or fainting.
7. Women are less likely to have chest pain.
8. Emergency treatment for heart attack

The Heart’s Organization Says.

1. If you think you have a heart attack, call right away (03). After the call (03), you should chew the aspirin pill. Be sure to inform the nurse, then no additional dose of aspirin is required.
2. Angioplasty, also called percutaneous coronary surgery (PEI), is a procedure that should be performed within 90 minutes of the heart attack. Patients suffering from a heart attack must be taken to a hospital equipped to perform PCI.
3. Fibrinolytic therapy should be performed within 30 minutes of the heart attack if the center that performs the PCI is unavailable. The patient must be transferred to the PCI ward without delay.

Secondary prevention of heart attack

Additional prevention measures are needed to help prevent a repeat heart attack. You should talk to your inpatient provider before you leave:

1. Blood pressure and cholesterol monitoring (statins, ACE inhibitors, beta-blockers are prescribed upon discharge).
2. Aspirin and clopidogrel (Plavix) antiplatelet agent, which many patients should take on a regular basis. Prasugrel (Effiant) is a new drug that can be used as an alternative to clopidogrel for patients.
3. Heart rehabilitation and regular exercise.
4. Normalization of weight.
5. Stop smoking.

Introduction

The heart is a complex organ of the human body. It pumps blood all the time throughout its life, supplying all the tissues of the body with oxygen and vital nutrients through the arterial network. To accomplish this demanding task, the heart muscle itself needs enough oxygenated blood to be delivered to it through the coronary artery network. These arteries carry oxygenated blood to the muscle wall of the heart (myocardium).

A heart attack (myocardial infarction) occurs when the blood supply to the heart muscle is blocked, the tissue is oxygen-deprived and part of the myocardium dies.

Coronary heart disease causes heart attacks. Coronary heart disease is the end result of atherosclerosis, which prevents coronary blood flow and reduces the delivery of oxygenated blood to the heart.

Heart attack

Heart attack (myocardial infarction) is one of the most serious outcomes of atherosclerosis. It can happen for two reasons:

1. If a crack or rupture develops in an atherosclerotic plaque. Platelets linger in this area to seal and form a blood clot. A heart attack can occur if the blood clot completely blocks the passage of the oxygenated blood to the heart.
2. If the artery becomes completely blocked due to the gradual increase in atherosclerotic plaque. A heart attack may occur if the blood that is not sufficiently rich in oxygen passes through this area.

Angina

1. Stenocardia, a major symptom of coronary artery disease, is generally perceived as chest pain. There are two types of angina:
2. Stable angina. It is a predictable chest pain that can usually be controlled with lifestyle changes and the selection of certain medicines, such as low doses of aspirin and nitrates.
3. unstable angina. This situation is much more serious than stable angina and is often an intermediate stage between stable angina and heart attack. Not stable’s angina is segment of a state known as acute coronary syndrome.

Acute coronary syndrome

Acute Coronary Syndrome (ACS) is a severe and sudden condition of the heart that does not turn into a developed heart attack with the necessary intensive treatment. Acute coronary syndrome includes:

unstable angina. Unstable angina is a potentially serious condition in which chest pain is permanent, but blood tests do not show the markers of the heart attack.

Myocardial infarction without elevation of the ST segment (not a myocardial Q-infarction). Diagnosed when blood and ECG tests detect a heart attack that does not capture the full thickness of the heart muscle. Arterial damage is less severe than a large heart attack.

Patients diagnosed with acute coronary syndrome (ACS) may be at risk of heart attack. Doctors analyze the patient's medical history, various tests, and the presence of certain factors that help predict which patients with ACS are most at risk of developing more severe conditions. The severity of chest pain alone does not necessarily indicate the severity of heart disease.

Risk factors

Risk factors for a heart attack are the same as those for coronary heart disease. These include:

Age

The danger of coronary heart sickness enlarges Accompanied by age. About 85% of people who die of cardiovascular disease are over 65 years old. In men, on average, the first heart attack develops at 66 years of age.

Sex

Men have a greater risk of developing coronary heart disease and heart attacks at an earlier age than women. Women's risk of cardiovascular disease increases after menopause, and they begin to suffer from angina more than men.

Genetic factors and family heredity

Some genetic factors increase the likelihood of the development of risk factors such as diabetes, increased cholesterol levels and high blood pressure.

Race and ethnicity

African-Americans have the highest risk of cardiovascular disease because of the high incidence of high blood pressure, diabetes and obesity.

Medical prerequisites

Obesity and metabolic syndrome. Excessive deposition of fat, especially around the waist, can increase the risk of cardiovascular disease. Obesity also contributes to the development of high blood pressure, diabetes, which affects the development of heart disease. Obesity is particularly dangerous when it is part of a metabolic syndrome, a pre-diabetic condition associated with heart disease.

This syndrome is diagnosed when there are three conditions listed below:

1. Abdominal obesity.
2. Low HDL cholesterol levels.
3. High level of triglycerides.
4. High blood pressure.
5. Insulin resistance (diabetes or pre-diabetes).
6. High cholesterol levels. Low-density lipoproteins (LDL) are "bad" cholesterol and are responsible for many heart problems.
7. Triglycerides are another type of lipid (fat molecule) that can be harmful to the heart. High-density lipoproteins of cholesterol (HDL) are "good" cholesterol that helps protect against cardiovascular disease. 
8. Doctors analyze the "total cholesterol" profile, which includes measurements of HDL, HDL and triglycerides. The ratios of these lipids can affect the risk of cardiovascular disease.

High blood pressure. High blood pressure (hypertension) is associated with coronary heart disease and heart attack. Normal blood pressure figures are below 120/80 mmHg. A high blood pressure is usually considered to be a blood pressure greater than or equal to 140 mmHg. (systolic) or more or equal to 90 mmHg. (diastolic). Predypertension is considered to be arterial pressure with the numbers 120 - 139 systolic or 80 - 89 diastolic, it indicates an increased risk of hypertension.

Diabetes. Diabetes, especially for people whose blood sugar levels are not well controlled, significantly increases the risk of cardiovascular disease. In fact, heart disease and strokes are the leading causes of death in people with diabetes. People with diabetes also have a high risk of developing hypertension and hypercholesterolemia, blood clotting disorders, kidney disease, and impaired nerve function, each of which can lead to heart damage.

Lifestyle factors

Reduced physical activity. Exercise has a number of effects that benefit the heart and blood circulation, including cholesterol and blood pressure levels and weight maintenance. People who lead sedentary lives are almost twice as likely to suffer from heart attacks as people who regularly do sports.

Smoking. 

Smoking is the most important risk factor for cardiovascular disease. Smoking can cause increased blood pressure, disturb lipid metabolism and make platelets very sticky, increasing the risk of thrombosis. Although avid smokers are most at risk, people who smoke only three cigarettes a day have a high risk of blood vessel damage, which can lead to a disruption of the blood supply to the heart. Regular exposure to secondhand smoke also increases the risk of cardiovascular disease in non-smokers.

Alcohol. Moderate alcohol consumption (one glass of red dry wine per day) can help to increase "good" cholesterol (HDL) levels. Alcohol can also prevent blood clots and inflammation. In contrast, drinking is harmful to the heart. In fact, cardiovascular diseases are the leading cause of death for alcoholics.

Diet.

Diet can play an important role in protecting the heart, especially by reducing the sources of trans-fats, saturated fats and cholesterol and by limiting salt intake, which contributes to high blood pressure.

NSAIDs and COX-2 inhibitors

All non-steroidal anti-inflammatory drugs (NSAIDs), except aspirin, are a risk factor for the heart. NSAIDs and COX-2 inhibitors can increase the risk of death in patients who have experienced a heart attack. The greatest risk develops at higher doses.

NSAIDs include over-the-counter drugs such as ibuprofen (Advil, Motril) and prescription drugs such as diclofenac (Kataflam, Voltaren). Celluxibus (Celibrex) COX-2 inhibitor, which is available in the US, has been associated with cardiovascular risks such as heart attacks and strokes. Patients who have had heart attacks should consult their physician before taking any of these drugs.

The Heat organization says that patient who are at danger of this disease first use no-drug pain relief methods. If these methods do not work, patients should take low doses of acetaminophen (Tylenol) or aspirin before using NSAIDs, COX-2 Celebrex inhibitor should be used last.

Prognosis

Heart attacks can be fatal, chronic or cause complete recovery. The long-term prognosis for the duration and quality of life after a heart attack depends on the severity of the attack, the damage to the heart muscle and the preventive measures taken afterwards.

Although there are no tests that can predict whether another heart attack will occur, patients can avoid a repeat heart attack themselves if they maintain a healthy lifestyle and follow treatment. Two-thirds of patients who have had a heart attack do not take the necessary measures to prevent it.

Heart attack also increases the risk of other heart problems, including heart rhythm disorders, heart valve damage and stroke.

People at greatest risk. Heart attack always has more serious consequences for some people, such as

1. The elderly.
2. People with heart disease or with several risk factors for cardiovascular disease.
3. People with heart failure.
4. People with diabetes.
5. People with constant dialysis.

The risk of death is highest for young women.

Factors that occur during a heart attack and increase severity.

The presence of these conditions during a heart attack may contribute to a worsening of prognosis:

1. Arrhythmia (heart rhythm disorder). Ventricular fibrillation is a dangerous arrhythmia and a major cause of early death from heart attack. 
2. Arrhythmias are more common during the first 4 hours of a heart attack and are associated with high mortality. 
3. However, patients who are successfully treated have the same long-term prognosis as patients without arrhythmia.

Cardiogenic shock.

This very dangerous situation is related to very low blood pressure, low urine separation and metabolic disorders. Shock occurs in 7% of heart attacks.

A heart block, the so-called atrioventricular (AV) block, is a condition in which the electrical conductivity of the nerve impulses to the muscles in the heart slows down or is interrupted. Although heart block is dangerous, it can be treated effectively with a pacemaker and rarely causes any long-term complications in patients who survive.

Heart failure.

A damaged heart muscle is unable to pump the blood necessary for tissue functioning. Patients experience fatigue, shortness of breath, and fluid retention in the body.

Symptoms

They may occur suddenly and be severe or may progress slowly, starting with mild pain. Symptoms may differ between men and women. Women are less likely than men to have classic chest pain, and are more likely to experience shortness of breath, nausea or vomiting, back and jaw pain.

The main point symptoms of a Heart Attack that is.

Breast pain. Breast pain or sore throat (sore throat) is a major sign of heart attack and can be felt as a feeling of compression, contraction, fullness or pain in the middle of the breast. Patients with coronary artery disease, with stable angina, often experience chest pain that lasts several minutes and then goes away. When a heart attack occurs, the pain usually lasts for more than a few minutes and may disappear but then return.

Upper body discomfort. People who have a heart attack may feel discomfort in their hands, neck, back, jaw or stomach.

1. Difficulty breathing may be accompanied by chest pain or painless.
2. Nausea and vomiting.
3. Cold sweat.
4. Dizziness or fainting.
5. The following symptoms are less common in heart attacks:
6. Acute pain in breathing or coughing.
7. Pain’s remain in center or lower abdomen.
8. Pain that can be caused by touching.
9. Pain that can be caused by moving or pressing the chest wall or arm.
10. Pain, which is permanent and lasts for several hours (do not wait for several hours if there is a suspicion that a heart attack has begun).
11. Pain, which is very short and lasts for a few seconds.
12. Pain that extends to the legs.
13. However, these signs do not always rule out serious heart disease.
14. Painless ischemia

Some people with severe coronary artery damage may not have angina. This condition is known as painless ischemia. This is a dangerous condition because patients do not have the alarming symptoms of heart disease. Some studies show that people with painless ischemia have a greater risk of complications and death than patients with angina.

What to do with a Heart Attack:

People who experience symptoms of heart attack should do the following:

1. For patients with angina, take one dose of nitroglycerine (a tablet under the tongue or in aerosol form) when symptoms appear. Then another dose every 5 minutes, up to three doses or until the pain is reduced.
2. 
   
3. Call (03) or dial your local emergency number. This should be done first if three doses of nitroglycerine do not help relieve chest pain. Only 20% of heart attacks occur in patients with previously diagnosed angina. this is for, who prepare symptoms of a heart attack should touch the emergency services
4. 
   
5. The patient should chew aspirin (250 - 500 mg), which should be reported to the emergency service, as an additional dose of aspirin in this case does not need to be taken.
6. The patient with chest pain should be taken immediately to the nearest emergency room, preferably by ambulance. It is not recommended to get there by yourself.
7. 
   
8. Diagnostics
9. When a patient with chest pain is admitted to the hospital, the following diagnostic steps are taken to identify heart problems and, if present, their severity:
10. The patient must inform the doctor of any symptoms that may indicate a heart problem or other serious illness.
11. 
    
12. Electrocardiogram (ECG) is a record of electrical activity in the heart. It is a key tool for determining whether chest pains are related to heart problems and, if so, how serious they are.
13. Blood tests reveal elevated levels of certain factors (troponins and CFC-MB) that indicate heart failure (the doctor will not wait for results before starting treatment, especially if he or she suspects a heart attack).
14. 
    
15. Visual diagnostic techniques, including echocardiography and perfusion scintigraphy, help to avoid a heart attack if there are any questions.

Electrocardiogram (ECG)

An electrocardiogram (ECG) measures and records the electrical activity of the heart, and the ECG teeth correspond to the contraction and relaxation of certain parts of the heart. Certain ECG teeth are called corresponding letters on the ECG:

Р. P-waves are associated with atrial contractions (two chambers in the heart that receive blood from organs).

QRS.

The complex is associated with ventricular contractions (ventricles are the two main pumping chambers in the heart.)

T and U. These waves accompany the ventricular contractions.

Doctors often use terms such as PQ or PR interval. This is the time it takes to spread electrical impulses from atria to the ventricles.

The most important thing in the diagnosis and definition of heart attack treatment tactics is to raise the ST segment and tooth Q.

ST segment elevation: Heart attack. ST segment elevation is a measure of heart attack. It indicates that the heart's artery is blocked and the heart muscle is damaged to the full extent. Q-infarction of the myocardium (myocardial infarction with ST-segment elevation) develops.

However, the rise of the ST segment does not always mean that the patient has a heart attack. Inflammation of the heart bag (pericarditis) is another reason for the increase in the ST segment.

Without ST segment elevation, angina and acute coronary syndrome develop.

A reduced or horizontal ST segment implies conduction disorders and cardiovascular disease, even if there is no current angina. Changes in ST segment occur in about half of patients with various heart diseases. However, in women, changes in the ST segment can also occur without heart problems. In such cases, laboratory tests are necessary to determine the extent of heart damage, if any. Thus, one of the following conditions may develop:

1. Stable angina (blood tests or other tests do not show any serious problems and the chest pain disappears). 
2. During this period, 25 to 50% of people with angina or painless ischemia have normal ECG values.
3. Acute coronary syndrome (ACS). It requires intensive treatment before it becomes a heart attack. PAC includes either unstable angina or myocardial infarction without ST-segment elevation (not Q myocardial infarction). 
4. Unstable angina is a potentially serious event, with constant chest pain, but blood tests do not detect markers of the heart attack. 
5. Blood tests do not reveal a heart attack with a Q-fart myocardial infarction, but the damage to the heart is less serious than with a heart attack unfolded.

Echocardiogram (Echocardiogram)

Echocardiogram is a non-invasive method that uses ultrasound to visualize the heart. You can determine the damage and mobility of the heart muscle. Echocardiography can also be used as an exercise test to detect localization and extent of heart muscle damage during illness or shortly after discharge from hospital.

Radionuclide methods (thallium stress test)

Allows you to visualize the accumulation of radioactive indicators in the heart. They are usually injected intravenously. This method allows you to evaluate:

1. Severity of unstable angina when less expensive diagnostic methods are not effective.
2. Severity of chronic ischemic heart disease.
3. Success of the operation in case of coronary heart disease.
4. Did you have a heart attack?
5. Localization and extent of damage to the heart muscle during illness or soon after discharge from hospital after a heart attack.

The procedure is non-invasive. It is a reliable method for various severe heart conditions and can help determine if a heart attack injury has occurred. A radioactive thallium isotope (or technetium) is injected into the patient's vein. It binds to the red blood cells and passes through the heart. The isotope can be traced back to the heart using special cameras or scanners. Images can be synchronized with the ECG. The test is carried out at rest and during exercise. If damage is detected, the image is saved for 3 or 4 hours. Damage caused by a heart attack will be preserved by rescanning and damage caused by angina will be leveled out.

Angiography

Angiography is an invasive method. It is used for patients in whom angina is confirmed by stress tests or other methods and for patients with acute coronary syndrome. The course of the procedure:

A narrow tube (catheter) is inserted into the artery, usually the arms or legs, and then passed through the vessels to the coronary arteries.

The contrast agent is injected through a catheter into the coronary arteries and recorded.

As a result, images of the coronary arteries appear, where you can see obstacles to blood flow.

Biological markers

When heart cells are damaged, they release various enzymes and other substances into the bloodstream. Elevated levels of these markers of heart damage in the blood or urine can help to detect a heart attack in patients with severe chest pain and help determine treatment strategies. These tests are often performed in the emergency department or hospital if a heart attack is suspected. The most commonly identified markers are the markers:

1. Troponins. Heart troponin T and I proteins are released when the heart muscle is damaged. These are the best diagnostic signs of heart attacks. 
2. They can help diagnose and confirm the diagnosis in patients with PACs.
3. Myocardial creatine kinase (CKK-MB). CFC-MB is a standard marker, but is less sensitive than troponin. 
4. Elevated levels of QCF-MB may be observed in people without heart disease.

Treatment

Treatment methods for heart attack and acute coronary syndrome include

Oxygen therapy.

Pain and discomfort relief with nitroglycerine or morphine.

Correction of arrhythmia (irregular heart rhythm).

Blocking further blood clotting (if possible) with aspirin or clopidogrel (Plavix) and anticoagulants such as heparin.

The opening of the artery in which the cow's flow has been disturbed should be done as soon as possible by performing an angioplasty or by using medication that dissolves the clot.

Beta-blockers, calcium channel blockers or angiotensin converting enzyme inhibitors are prescribed to improve heart muscle and coronary artery function.

Immediate interventions

The same for patients with both OCC and heart attack.

Oxygen. It is usually delivered through a tube to the nose or through a mask.

Aspirin. The patient is given aspirin if it has not been taken at home.

Medicines to relieve symptoms:

1. Nitroglycerine. Most patients will get nitroglycerine both during and after a heart attack, usually under the tongue. Nitroglycerine reduces blood pressure and dilates blood vessels, increasing the blood flow to the heart muscle. Nitroglycerine is sometimes injected intravenously (recurrent angina, heart failure or high blood pressure).
2. Morphine. Morphine not only relieves pain and reduces anxiety, but also dilates blood vessels, increasing the flow of blood and oxygen to the heart. Morphine can reduce blood pressure and make heart work easier. Other drugs can also be used.

Trombolytics

Platelets or fibrinolytics are recommended as an alternative to angioplasty. These drugs dissolve the clot, or clot, responsible for arterial block and cardio-muscular tissue death.

Generally speaking, thrombolysis is considered a good choice for patients with myocardial infarction in the first 3 hours. Ideally, these medications should be given within 30 minutes of arriving at the hospital if no angioplasty is performed. Other situations where thrombolytics are used:

1. The need for long transportation.
2. Long period of time before PCI.
3. Failure of the EEQ.
4. Thrombolytics should be avoided or used with great care in the following patients after a heart attack:
5. In patients over 75 years of age.
6. If symptoms last longer than 12 hours.
7. Pregnant women.
8. People who have recently experienced trauma (especially craniocerebral injury) or surgery.
9. People with an exacerbation of ulcer disease.
10. Patients who have undergone prolonged cardiopulmonary resuscitation.
11. When taking anticoagulants.
12. Patients who have suffered a large cow loss.
13. Patients with stroke.
14. Patients with uncontrolled high blood pressure, especially when systolic pressure is above 180 mmHg.

Standard platelets are recombinant tissue plasminogen activators (TAP): Alteplase (Aktelize) and Reteplaza (Retailize), as well as new tenekteplase (Metalize). It also uses a combination of antiplatelet and anticoagulant therapy to prevent increased clotting and the formation of new ones.

Rules for the administration of thrombolytics. The earlier the platelets are given after a heart attack, the better. Platelets are most effective during the first 3 hours. They can still be helpful within 12 hours of a heart attack.

Complications. Hemorrhagic stroke usually occurs on the first day and is the most serious complication of thrombolytic therapy, but fortunately this rarely happens.

Revascularization procedures: angioplasty and bypass

1. Percutaneous coronary intervention (PCI), also called angioplasty, and coronary artery bypass are standard operations to improve coronary blood flow. They are known as revascularization surgeries.
2. Emergency angioplasty/PCI is a standard procedure for heart attacks and should be performed within 90 minutes of its onset. Studies have shown that balloon angioplasty and stenting are unable to prevent heart complications in patients when performed 3 to 28 days after a heart attack.
3. Coronary artery bypass is usually used as a routine operation, but can sometimes be performed after a heart attack, in case of unsuccessful angioplasty or thrombolytic therapy. It is usually performed within a few days to allow the heart muscle to recover. Most patients, on the other hand, are suitable for thrombolysis or angioplasty (although not all centres are equipped for PCI).

Angioplasty / PCI includes the following steps:

1. A narrow catheter (tube) is installed in the coronary artery.
2. Vessel lumen is restored when a small cylinder (balloon angioplasty) is blown up.
3. After deflating the tank, the vessel lumen increases.
4. To keep the arterial lumen open for a long time, a device called a coronary stent is used - an expandable metal mesh tube that is implanted into the artery during angioplasty. The stent may consist of naked metal or may be coated with a special product that is slowly released into the adjacent wall of the vessel.
5. The stent restores the lumen of the vessel.

Complications occur in about 10% of patients (about 80% of them during the first day). The best results are achieved in hospitals with experienced staff. Women who have undergone angioplasty after a heart attack have a higher risk of death than men. Restenosis after angioplasty. Narrowing after angioplasty (restenosis) may occur within a year of surgery and requires a repeat of the PCI procedure.

Medically coated stents that are coated with syrolimus or paclitaxel can help prevent restenosis. They may be better than a bare metal stent for patients who have experienced a heart attack, but they may also increase the risk of blood clots.

It is important for patients with medically coated stents to take aspirin and clopidogrel (Plavix) for at least 1 year after stenting to reduce the risk of clotting. Clopidogrel, like aspirin, helps prevent platelet adhesion. If, for some reason, patients cannot take clopidogrel along with aspirin after angioplasty and stenting, naked metal stents should be implanted without medication. Prasugrel is a new drug that is an alternative to clopidogrel.

Coronary bypass surgery (CABS). It is an alternative to angioplasty in patients with severe angina, especially those with two or more closed arteries. This is a very aggressive procedure:

1. The chest opens and the blood is pumped by an artificial circulatory system.
2. During the main stage of the operation, the heart stops.
3. Bypassing closed arterial areas, shunting is sewn on, which is taken from the patient's leg or arm and chest during the operation. In this way, the blood flows to the heart muscle via the shunt, bypassing the closed arterial areas.

Mortality in ASCH after a heart attack is significantly higher (6%) than when the operation is performed routinely (1-2%). How and when it should be used after a heart attack remains controversial.

Treatment of patients with shock or heart failure

Severely ill patients with heart failure or who are in cardiogenic shock (it includes lowering blood pressure and other disorders) are intensively treated and monitored: give oxygen, inject liquids, regulate blood pressure, use dopamine, dobutamine and other means.

Heart failure. Intravenous administration of furosemide. Patients may also be given nitrates and ACE inhibitors if there is no dramatic decrease in blood pressure as indicated. Platelet therapy or angioplasty may be performed.

Cardiogenic shock. Intra-aortic balloon counter-pulsation (IABC) can help patients with cardiogenic shock when used in combination with thrombolytic therapy. A balloon catheter is used that is inflated and lowered in the aorta during certain phases of the cardiac cycle, thus increasing blood pressure. Angioplasty can also be performed.

Treatment of arrhythmias

Arrhythmia is a heart rhythm disorder that can occur in conditions of oxygen deficiency and is a dangerous complication of a heart attack. Fast or slow heart rhythms are common in patients with heart attacks and are not usually a dangerous sign.

Extracystole or very fast rhythm (tachycardia) can lead to ventricular fibrillation. This is a life-threatening arrhythmia in which the ventricles of the heart contract very quickly, without providing sufficient cardiac output. The pumping action of the heart required to maintain blood circulation is lost.

Prevention of ventricular fibrillation. People who develop ventricular fibrillation are not always subject to arrhythmia prevention and there are no effective drugs to prevent arrhythmias during a heart attack.

Potassium and magnesium levels must be controlled and maintained.

The use of beta blockers intravenously and orally can help prevent arrhythmias in some patients.

Treatment of ventricular fibrillation:

1. Defibrillators. Patients who develop ventricular arrhythmias are discharged with an electric current defibrillator to restore normal rhythm. Some studies show that implantable cardioverter defibrillators (ICDs) can prevent further cardioversion and are used in patients who still have a risk of recurring arrhythmias.
2. Antiarrhythmic drugs. Antiarrhythmic drugs include lidocaine, procainamide or amiodarone. Amiodarone or other antiarrhythmic drug can be used later to prevent subsequent arrhythmias.
3. Treatment of other arrhythmias. People with atrial fibrillation have a high risk of stroke after a heart attack and should receive anticoagulants such as warfarin (Kumadin). There are also bradyarrhythmias (very slow rhythm disorders), which often develop with a heart attack and can be treated with atropine or pacemakers.

Medicines

Aspirin and other disaggregants Anti-clotting drugs are used in all stages of heart disease. They are divided into antiagregants or anticoagulants. They are used along with thrombolytics, as well as for the prevention of heart attack. Anti-clotting therapy is associated with the risk of bleeding and stroke.

Antiplatelet drugs. They inhibit platelet adhesion in the bloodstream and therefore help prevent thrombosis. Platelets are very small in size and shape. They are important for blood clotting.

Aspirin. 

Aspirin is an antiplatelet drug. It will be take’s fastly after the heart’s attack. An aspirin tablet can be swallowed or chewed. It is better to chew the aspirin tablet - it will speed up its action. If the patient has not taken aspirin at home, it will be given to him at the hospital, then it should be taken daily. The use of aspirin in patients with a heart attack leads to a reduction in mortality. This is the most common disaggregant used in people with cardiovascular diseases and it is recommended to take it daily in a low dose on a regular basis.

Clopidogrel (Plavix) is a thienopyridine drug, another antiplatelet drug. Clopidogrel is taken either immediately or after percutaneous intervention, and is used in patients with heart attacks, as well as after the beginning of thrombolytic therapy. Patients who have a drug-eluting stent implanted should take clopidogrel with aspirin for at least 1 year to reduce the risk of thrombosis. Patients hospitalized for unstable angina should receive clopidogrel if they cannot take aspirin. Clopidogrel should also be prescribed for patients with unstable angina, for whom invasive procedures are planned.

 Even conservatively treated patients should continue with clopidogrel up to 1 year. Some patients will need to take clopidogrel on a permanent basis. Prasugrel is a new thienopyridine that can be used instead of clopidogrel. It should not be used by patients who have suffered a stroke or a transient ischemic attack.

IIb/IIIa receptor inhibitors. These are powerful blood thinners, such as Abciximab (Reopro), Thyrofiban (Agrastat). They are administered intravenously in the hospital, and can also be used for angioplasty and stenting.

Anticoagulants. These include:

1. Heparin is usually prescribed during treatment together with thrombolytic therapy for 2 days or more.
2. Other intravenous anticoagulants can also be used - Bivalirudin (Angiomax), Fondaparinux (Arikstra) and enoxaparin (Lovenox).
3. Warfarin (Kumadin).
4. There is a risk of bleeding when taking all these drugs.

Beta-blockers

Beta-blockers reduce the oxygen requirement of the heart muscle, slow down heart rate and reduce blood pressure. They are effective in reducing mortality from cardiovascular disease. Beta-blockers are often given to patients at the initial stage of their hospitalization, sometimes intravenously. Patients with heart failure or who may develop cardiogenic shock should not receive intravenous beta-blockers. Long-term oral administration of beta-blockers for patients with symptomatic coronary heart disease, especially after heart attacks, is recommended in most cases.

These drugs include propranololol (Inderal), carvedilol (Koreg), bisoprolol (Zebeta), acebutololol (Sectral), atenolol (Tenormin), labetalol (Normodine), metoprolol, and esmololol (Breviblock).

Treatment of heart attack. Metoprolol beta-blocker can be given within the first few hours after a heart attack to reduce heart muscle damage.

Preventive treatment after a heart attack. Beta-blockers are taken orally on a long-term basis (as maintenance therapy) after the first heart attack to help prevent recurrence of heart attacks.

Side effects of beta-blockers include fatigue, sluggishness, vivid dreams and nightmares, depression, memory loss and dizziness. They can reduce PDL ("good" cholesterol) levels. Beta-blockers are divided into non-selective and selective drugs. Non-selective beta-blockers, such as carvedilol and propranololol, can reduce smooth bronchial muscles, resulting in bronchospasm. Patients with bronchial asthma, emphysema or chronic bronchitis are contraindicated to taking non-selective beta-blockers.

Patients should not stop taking these drugs abruptly. Sharp stops of beta-blockers may lead to a sharp increase in heart rate and blood pressure. It is recommended to slowly reduce the dosage until the complete cessation of administration.

Statins and other hypolipidemic drugs that reduce cholesterol levels

After admission to hospital for acute coronary syndrome or heart attack, patients should not stop taking statins or other medications if their LDL cholesterol (bad cholesterol) is elevated. Some physicians recommend that LDL levels should be below 70 mg/dL.

Angiotensin converting enzyme inhibitors

Angiotensin converting enzyme inhibitors (ACE inhibitors) are important drugs for treating patients who have had a heart attack, especially those at risk of heart failure. ACE inhibitors should be prescribed on the first day to all patients with a heart attack unless there are contraindications. Patients with unstable angina or acute coronary syndrome should receive ACE inhibitors if they show signs of heart failure or signs of reduced left ventricular ejection fraction according to echocardiography. These drugs are also widely used to treat high blood pressure (hypertension) and are recommended as a first-line therapy for people with diabetes and renal damage.

ACE inhibitors include captopril (Capothen), ramipril, enalapril (Vasotec), quinapril (Accupril), benazepril (Lotensin), perindopril (Aceon) and lysinopril (Prinivil).

Side effects. Side effects of ACE inhibitors are rare, but may include coughing, excessive blood pressure drop and allergic reactions.

Calcium channel blockers

Calcium-channel blockers can alleviate the condition in patients with unstable angina, whose symptoms do not decrease with nitrates and beta-blockers, or are used in patients who are contraindicated with beta-blockers.

Secondary prevention

Patients can reduce the risk of a repeat heart attack by following certain preventive measures, which are explained upon discharge from the hospital. A healthy lifestyle, in particular a certain diet, is important in preventing heart attacks and must be respected.

LDL cholesterol (bad cholesterol) should be significantly less than 100 mg/dL. All patients who have had a heart attack should be advised to take statins before being discharged from hospital. It is also important to control cholesterol levels, reducing saturated fat intake by less than 7% of total calories. It is necessary to increase the consumption of omega-3 fatty acids (rich in fish and fish oil) to reduce triglycerides.

Exercise. Duration of 30-60 minutes, 7 days a week (or at least 5 days a week).

Weight loss. The combination of exercise with a healthy diet rich in fresh fruit, vegetables and skimmed dairy products helps to reduce weight. Your body mass index (BMI) should be 18.5-24.8. Your waist circumference is also a risk factor for heart attack. Men's waist circumference should be less than 40 inches (102 cm) for women than 35 inches (89 centimeters).

Smoking.
It is absolutely important to quit smoking. Tobacco smoke (secondhand smoke) should also be avoided.

Disaggregants.
Your doctor may recommend that you take aspirin (75-81 mg) on a daily basis. If you have had a medically-coated stent implanted, you should take clopidogrel (Plavix) or prasugrel (Effient) along with the aspirin for at least 1 year after surgery. (Aspirin is also recommended for some patients as a primary prevention of heart attack.)

Other medicines. Your doctor may recommend that you take ACE inhibitors or beta-blockers on a regular basis. It is also important to get flu shots every year.

Rehabilitation. Physical rehabilitation

What things include in Rehabilitation:

1. Walking. The patient usually sits in the chair on the second day and starts walking on the second or third day.
2. Most patients have low tolerance for exercise at an early stage of recovery.
3. After 8-12 weeks, many patients, even those with heart failure, feel the benefits of exercise. Exercise recommendations are also given at discharge.
4. Patients usually return to work after about 1-2 months, although the timing may vary depending on the severity of the condition.
5. Sexual activity after a heart attack is associated with very low risk and is generally considered safe, especially for people who deal with it regularly. The feeling of intimacy and love that comes with healthy sex can help compensate for depression.

Emotional rehabilitation

Depression occurs in many patients, with OCC and heart attack. Studies show that depression is a major predictor of mortality for both women and men. (One reason may be that depressed patients take their medications less regularly.)

Psychotherapy, especially cognitive behavioral therapy, can be very helpful. For some patients, it may be appropriate to take certain types of antidepressants.