Emergency treatment for AMI (acute myocardial infarction)

Treatment of acute myocardial infarction is emergency treatment, as quickly as possible from the onset, with the aim of reducing the area of myocardial necrosis and preventing complications. The amount of muscle that dies from lack of blood can be reduced by dissolving clots in the coronary arteries and restoring blood circulation.

At the onset of pain, if you already have this medicine in your treatment, place one tablet of **NITROGLYCERIN** under the tongue at the onset of symptoms. If the pain does not go away, take 2 more tablets at 5-minute intervals.

If the symptoms have not gone after 15 minutes, call an ambulance immediately! Warning! Do not take Nitroglycerin if it has not been prescribed by your doctor (because there are diseases that can be aggravated by taking this medicine!).

At the hospital emergency department, the diagnosis is specified by clinical examination and electrocardiogram, then the patient is transported to special units called Infarct Center, where coronary surveillance is performed and specific monitoring and treatment of acute myocardial infarction is started.

The treatment consists of:

•  Setting up a venous line;
•  Continuous patient monitoring; (blood pressure, electrocardiogram, general condition);
•  Collection of emergency tests;
•  Oxygen therapy;
•  Sublingual nitroglycerin and intravenous infusion;
•  Analgesics (algocalmin, mialgin);
•  Aspirin (and possibly clopidogrel), heparin;
•  Fibrinolytic treatment (if the patient presents to the hospital less than 12 hours after the onset of acute myocardial infarction) with streptokinase or other thrombolytics. The role of these drugs is to dissolve blood clots and restore normal blood flow through the coronary arteries. The size of the area of heart muscle that has suffered the infarct can be decreased if the flow is restored very early. But time is of the essence! If delays occur, the benefit of the method is diminished;

Another treatment option for reopening the coronary artery involved in acute myocardial infarction is coronary angioplasty of the artery involved in myocardial infarction (in centers where there is a catheterization laboratory).

Treatment is continued with heparin, beta-blockers (e.g. metoprolol), aspirin and possibly clopidogrel, as well as other drugs that improve heart function, depending on the patient's situation. The treatment of anxiety (common in patients with acute myocardial infarction in the first 24-48 hours) consists of the drugs: diazepam, alprazolam, hydroxyzine.

What you need to remember is that the medical treatment is not identical for all patients presenting with myocardial infarction, it is different depending on the patient's clinical condition, the location of the myocardial infarction, the occurrence or absence of complications.

Normally, the patient with AMI stays 24-48 hours in the coronary unit (in uncomplicated cases) and is then transferred to the second stage - the post-myocardial infarction follow-up wards.

Healing the heart

Doctors now know more about the heart's healing process, and as a result patients receive better early care after myocardial infarction, and the time they need to rest has been shortened.

In common cases, when the remaining blood flow in the coronary arteries is good, the healing process starts quickly. The portion of heart muscle that has suffered permanent damage will be replaced by a scar.

Myocardial infarction can leave certain sequelae, which are variable and depend on:

•  Infarct size;
•  If it's a first heart attack or a recurrence;
•  Condition of the coronary arteries as a whole.

The after-effects can be minimal in the following cases: many patients agree to give up smoking, exercise, lose weight, and recover very well within a few months of the heart attack.

There is also the possibility of sequelae:

•  Heart failure that causes difficulty breathing;
•  Persistent angina pectoris;
•  Heart rhythm disturbances.

These problems need to be spotted as soon as possible - their appearance after a heart attack should refer you to your cardiologist! Depending on the results, the doctor will adapt the treatment.

Convalescence and rehabilitation

Everyone recovering from acute myocardial infarction has two main goals:

•  Developing a plan to restore his abilities to live as close to a normal life as possible;
•  Control risk factors to reduce the possibility of a repeat heart attack.

In the absence of complications, patients should not remain in bed for more than 12 hours. Daily activity should be resumed progressively, on an individualized basis, depending on the patient's general condition, age and physical capacity.

Stage 1 (days 1-2)

During the first day, the patient remains in bed and can feed himself/herself with the help of a support table. Full assistance with toileting. With help, he/she will perform passive movements of arms and legs.

On the second day, the patient can sit on the edge of the bed or in an armchair for 1-2 hours a day. He/she can actively move his/her hands/feet for 5-10 minutes a day.

Stage 2 (days 3-4)

The patient may toilet and dress, but in a sitting position. They may sit in a chair or armchair as often as they wish and walk around the ward.

On the fourth day, the patient can take a standing or sitting shower (using a chair reduces anxiety and fear of falling). Take supervised walks of 50-100 m several times a day.

Stage 3 (days 5-7)

The patient can walk about 100 m 3 times a day. Can shave or wash head (activities involving raising arms above the head). Can walk up/down stairs under supervision.

The best results are usually achieved when more than one person is involved in the recovery program. The family should be understanding and actively participate in the patient's program. But a family that is overly protective or has too high expectations of how quickly the patient will recover can delay progress. It's the doctor who recommends progressive increases in activity, exercise and treatment.

Externalization

The timing of discharge varies depending on the patient's condition, the types of treatment performed. Prior to discharge, patients receive clear recommendations about treatment, diet and physical activities allowed. Some activities that were previously possible may be limited after the heart attack. However, for most patients adaptations are possible and they can resume their active life satisfactorily, including returning to work where appropriate.

Recommendations on discharge

Initially, it is advisable to avoid strenuous physical exertion, lifting heavy weights, rest several times a day. As time goes by, you will be able to do more activities, depending on how you tolerate them.

You should avoid any activity that causes angina chest pain!

It's important to always have Nitroglycerin tablets on hand to use if you need them.

A long-term plan will include ways to reduce the risk factors that could lead to repeat heart attacks.

Quitting smoking for good is essential! In patients who stop smoking, the risk of heart disease decreased significantly over the following years.

The right diet is also of major importance. It includes lower fat and cholesterol intake. First and foremost, fat intake from meat and dairy should be reduced. Adding fresh fruit and vegetables to the diet is beneficial. In some situations, lowering blood cholesterol requires the use of medication. In hypertensive patients, salt intake should be reduced at the same time.

Exercise, and physical activity in general, is an extremely important factor in recovery after heart attack. It is important to ask your doctor about the level of exercise you can do. You'll be put in touch with specialists in rehabilitative cardiology who will guide you in this. Under their supervision, in the cardiac rehabilitation department, your physical activity will be monitored and guided for the best possible physical recovery. Discuss this without inhibitions with your doctor.

Sexual activity can be resumed only after a stress test in hospital. Sexual activity is considered to be resumed when the patient is able to climb two flights of stairs without problems.

Other essential steps to take to lower your cardiovascular risk in the future are: controlling high blood pressure, diabetes and dyslipidemia (if present), controlling your weight and avoiding stress. After a heart attack or with angina pectoris, it is not enough to take medication. They can be ineffective if you don't also fight risk factors: obesity, smoking, diabetes, high blood pressure, dyslipidemia, sedentary lifestyle!

The drug treatment you receive on discharge should be long-term. It will contain several classes of essential medicines, which should not be discontinued without the advice of your specialist.

Any dose or regimen adjustments should only be made with the advice of your doctor!

Medical check-ups after a heart attack

After an acute myocardial infarction or even after the onset of angina pectoris, patients should have regular cardiology check-ups.

These are essential for:

•  Monitoring the progression of coronary artery disease (chest pain, fatigue, choking, etc.);
•  Monitoring the control of the risk factors discussed (weight, blood pressure, diabetes, cholesterol, physical activity);
•  Exercise stress testing to assess myocardial response to exercise.

It is very important to discuss with your cardiologist the schedule of check-ups you will have at your hospital or polyclinic.

Overweight or obese people have a higher risk of developing cardiovascular disease even when they have no other risk factors. Excess weight caused by fat forces the heart to work harder and unbalances cholesterol and glucose levels in the blood.

How can you find out if you are overweight or obese?

To find this out, experts use two indicators: BMI (Body Mass Index) and WC (abdominal circumference):

BMI (Body Mass Index) is an official indicator of ideal body weight for a given height. Body Mass Index helps to determine a person's weight group, the degree of obesity, as well as the number of kilograms a person needs to lose or gain to reach their ideal weight. It is a method that can be used by both men and women between the ages of 18 and 65. To find your BMI, use the following tool: the Body Mass Index calculator from BMI-Club.

Interpreting Body Mass Index

Formula to calculate Body Mass Index (BMI)=weight(kg)/[height(m)]2

•  BMI under 18.5 - underweight
•  BMI 18.51 - 24.99 - normal weight
•  BMI between 25 - 29.99 - overweight
•  BMI between 30 - 34.99 - grade 1 obesity
•  BMI between 35 - 39.99 - grade 2 obesity
•  BMI over 40 - grade 3 obesity (morbid obesity)

AC (Abdominal Circumference) - excess fat can accumulate in many parts of the body. The most harmful is the fat that deposits in the abdominal region. This is quantified using this parameter. It is very easy and simple to measure your abdominal circumference using a centimeter (tailor's) tape that you put around your abdomen.

Depending on the value, you can find out whether you are at risk or not. People at risk are:

•  Men over 95 cm height
•  Women over 80 cm

Control your blood pressure!

High blood pressure often progresses silently, with no signs or symptoms to alert patients to the presence of the disease. For this reason, it is important to measure blood pressure (BP) at regular intervals. Blood pressure is characterized by 2 values. The first - higher - is called systolic blood pressure, the second - lower - is called diastolic blood pressure. The difference between the 2 values should be about 40 - 50 mmHg.

The length of hospitalization depending on the patient's condition is:

Your future

The future depends on the risk of new coronary and myocardial lesions and the sequelae of those that have already occurred.

Heart disease has a particular image in the general population. It is often seen as a disease of active people with a stressful and responsible life, or a disease of people who have overindulged throughout their lives.

No, heart disease is not the prerogative of stressed and overloaded people. No, coronary heart disease is not necessarily a dramatic and disabling disease.

It is rather a disease that you can do something about, but only by adopting a healthy lifestyle and following the medical advice you receive. The main goal that you can set for yourself may be to live a more harmonious and healthier life than before your acute myocardial infarction, and this goal can certainly be achieved!