Diagnosis called heart attack: what is the treatment and referral of the patient?

An acute myocardial infarction is a sudden-onset condition in which the heart muscle dies as a result of a lack of blood supply to the heart muscle.

How and where is a heart attack patient treated?

Myocardium is the name given to the heart muscle that produces regular contractions of the heart. This ensures blood flow through the blood vessels.

Damaged heart muscle does not perform its full function of pumping blood through the vascular system. The consequence is a serious threat to life.

An acute myocardial infarction, together with unstable angina and sudden death due to impaired blood supply to the heart muscle, forms the so-called acute coronary syndrome.

The fate of patients with a myocardial infarction depends to a large extent on the function of the left ventricle of the heart. Therefore, it is important that the blood vessels supplying this muscle are opened as quickly as possible.

The typical and most common symptoms of myocardial infarction are:

• chest pain that is compressive or constricting in nature
• the pain usually spreads to the left side of the body, particularly the shoulder, neck or jaw
• a feeling of lack of air
• a feeling of vomiting or vomiting itself
• sweating, pallor, anxiety and fear of death

You can read more about acute coronary syndrome, the symptoms that indicate an acute myocardial infarction, and the diseases that can mimic a heart attack in our magazine article, First Aid for Myocardial Infarction.

In the phase from the onset of the heart attack to the appropriate treatment, first aiders and, of course, the emergency medical services play an important role.

Lay first aid is also important, including the provision of specialist care by calling the ambulance service.

What to do if a heart attack is suspected

If you suspect anything, put the person in a comfortable position and try to calm them down. Call the emergency medical services. Ventilate, loosen the clothing around the neck or waist.

Answer the emergency operator's questions calmly and willingly. Although they may seem unnecessary or bizarre, this is important information that will best determine the best course of action and treatment for the patient.

If the patient is being treated for coronary artery disease, he or she is probably also taking medications such as anopyrine and nitroglycerin. Administration of these medications may be beneficial, but some risk may occur with low blood pressure.

Nitroglycerin belongs to a group of drugs called nitrates. These cause blood vessels to dilate, causing a significant drop in pressure. Therefore, their administration is inappropriate when the pressure is below 90 mmHg systolic (heart) pressure. Otherwise, there could be a significant drop in blood flow to the brain and subsequent collapse.

Other possible causes of chest pain

How to get professional help

Members of the emergency medical services team and emergency operators follow professional guidelines. Based on their recommendations, the priority in myocardial infarction is to minimise as much as possible the time from the onset of the infarction to the time it takes for the affected vessel to clear.

This is the so-called total ischaemic time.

The medical history is important and should be brief and focused. The patient should be asked about the nature, spread and duration of the pain he or she is experiencing.

One of the most important investigations is the ECG recording, which significantly influences the course of treatment and the patient's referral. However, it is also important to examine basic vital signs such as blood pressure, pulse, respiration, oxygenation status, blood sugar and temperature.

Last but not least, information about the patient is also essential. We are talking about the so-called medical history. Allergies, age, what the patient is being treated for and previous history of heart attack or stroke are important pieces of information that determine the next course of action.

Referring a patient with a myocardial infarction

Information such as the ECG picture, duration of pain, estimated time of transfer and the patient's condition are decisive for the referral of the affected patient. Depending on the circumstances, the options are: cardiac centre, local hospital or local hospital with subsequent transfer to a cardiac centre.

The transfer of the patient to a specific medical facility depends on many factors.

Cardiac centre

A cardiac centre is a specialised healthcare facility that is comprehensively equipped to treat acute myocardial infarction. This facility may otherwise be called a PCI centre. PCI stands for percutaneous coronary intervention.

Translated, this acronym stands for medical intervention on the affected blood vessels that supply the heart muscle. In simpler terms, the procedure of making the affected blood vessel patent and restoring blood flow through it.

In order to be transferred and admitted to a cardiac centre, the patient must meet certain criteria. The time interval between the onset of the heart attack and the expected time of the procedure should not exceed 120 minutes. The ECG must show findings that are consistent with those for an acute myocardial infarction.

The patient's condition and other relevant information must be consulted with the appropriate physician at the cardiac centre. Based on the ECG picture and other relevant information, he/she will recommend referral and, if necessary, specify treatment.

Air medical services are also used to speed up patient transport and reduce the aforementioned ischemic time. However, the flight conditions must be suitable.

Local hospitals

If the patient cannot be transported within a certain time interval, the patient can be transferred to a catchment hospital. Here, treatment - so-called fibrinolysis - is administered. Subsequently, again after consultation with the cardiac centre, transport is possible for the purpose of making the blood vessel patent, usually within 24 hours. However, even in this case, everything depends on the circumstances and the patient's condition.

Any chest pain should be monitored and investigated in a healthcare facility. If the patient has some chest discomfort but no ECG findings or other signs of a heart attack, the patient is usually transferred to a catchment hospital for observation and investigation.

The district physician

In some cases, a myocardial infarction may have an uncharacteristic or silent course. This is particularly the case in the elderly or in patients with diabetes. Therefore, it may be that the patient does not take his condition as seriously and chooses to manage his condition through his district doctor or the doctor on call.

In this case, it is of great help if the doctor has an ECG machine at his disposal. He can diagnose the heart attack and ensure that the whole management of rapid transfer to the cardiac centre is started.

Of course, any delays, whether at the GP's surgery, the internal medicine department or the emergency department, are undesirable. Therefore, if in any doubt, call the emergency medical services.

Not all pain has to mean a heart attack. Still, any chest pain should be investigated in a medical facility.

Read also an interesting magazine article.