All About Heart Attack Part 2

Diagnosis
If a man over 35 or a woman over 50 complaining of chest pain, usually considered the possibility of a heart attack.

Diagnosis of heart attacks could be strengthened by performing the following checks:

    ECG
    When a suspected heart attack, the ECG is the initial diagnostic examination of the most important. Some abnormalities can be seen on the EKG, depending on the size and location of heart damage.
    Blood tests
    Blood tests done to determine the levels of certain enzymes. CK-MB enzyme normally found in heart muscle and released into the blood when heart damage occurs. Elevated levels of this enzyme would appear within 6 hours after a heart attack and persist for 36-48 hours. Enzyme levels are usually checked at the time of patient admission and every 6-8 hours during the next 24 hours.
    Echocardiogram
    Echocardiogram will describe the reduced movement of a portion of the wall of the left ventricle (heart chamber that pumps blood throughout the body), which is an indication of damage from a heart attack.
    Radionuclide imaging
    Depiction of the radionuclides could indicate reduced blood flow to one part of the heart muscle, which is indicative of scar tissue (dead tissue) from a heart attack.


TREATMENT
A heart attack is an emergency. Half the deaths from heart attack occur within the first 3-4 hours after the occurrence of symptoms. The sooner help is given, the more likely the patient can be helped.

A person suspected of having a heart attack is usually treated in the cardiac care unit, and to assess the damage to the heart, performed close monitoring of cardiac rhythm, blood pressure, and the amount of oxygen in their blood.

Early Treatment
Usually be given aspirin tablet should be chewed. This medication will reduce the formation of blood clots in the coronary arteries.

Beta-blockers are given to slow the heart rate and so the heart does not work too hard to pump blood throughout the body. Oxygen is often administered through a facemask or a small tube that is inserted into the nostrils. By administering oxygen, the oxygen in the blood pressure will increase so that more oxygen to the heart and heart damage can be minimized.

If a blockage in a coronary artery can be overcome, then the heart tissue can be saved. Blood clots in the arteries can often be dissolved with thrombolytic therapy, by giving streptokinase, urikinase, and tissue plasminogen activator. To be effective, the drug is administered intravenously within 6 hours after the symptoms of a heart attack, because if it is more than 6 hours, some damage will persist in nature.

Early treatment improves blood flow in 60-80% of patients and can minimize damage to heart tissue. Aspirin (to prevent blood clot formation of platelets) or heparin (stop bleeding) can increase the effectiveness of thrombolytic therapy.

Thrombolytic therapy can cause bleeding, so it is usually not given to people who:
- Gastrointestinal bleeding,
- Have severe high blood pressure,
- New stroke,
- The new surgery.

Elderly patient who does not have the above-mentioned circumstances, can safely undergo thrombolytic therapy. Some hospitals using angioplasty or coronary artery bypass surgery soon after a heart attack. Nitroglycerin can relieve pain by reducing the workload of the heart, and is usually given intravenously at first.

If a drug used to increase coronary artery blood flow is also not succeeded in reducing the symptoms of a heart attack, usually given an injection of morphine. Morphine is also a sedative and reduces the workload of the heart.

Continued treatment
Someone who had suffered a heart attack, had to undergo bed rest in a quiet room for several days because of excitement, physical activity and emotional stress can aggravate heart. Stool softeners and laxatives can be used to prevent constipation.

Anxiety and depression often occur after a heart attack. Severe anxiety can overload the heart, so that given a sedative. ACE-inhibitors are routinely administered to reduce heart enlargement, which often occur after a heart attack.


Prognosis
Most patients who survive for several days after a heart attack may experience complete recovery, but about 10% die within 1 year. Deaths occurred within the first 3-4 months, especially in patients who re-experiencing angina, ventricular arrhythmias, and heart failure.


REHABILITATION
Cardiac rehabilitation is an important part in the healing process. Staying in bed for more than 2-3 days will cause the cessation of physical activity and sometimes lead to depression and a sense of dependency.

On the third or fourth day after the heart attack, patients are gradually trained to sit, passive activities, walking to the bathroom and engage in activities that do not cause stress (eg reading). After 3-6 weeks, the patient must gradually increase its activity. If no shortness of breath and chest pain, normal activity can be re-done after about 6 weeks.


PREVENTION
As far as possible to reduce the factors that cause coronary artery disease, especially those that can be changed by the patient:

    Stop smoking,
    Lose weight,
    Controlling blood pressure,
    Lowering blood cholesterol levels by diet or with medication, and
    Doing regular exercise.