Detect and treat heart attacks

A heart attack is life-threatening. By which symptoms you can recognize it, how the infarction occurs, what the therapy looks like

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Heart attack - in short

A heart attack is usually caused by coronary artery disease - i.e. arteriosclerosis of the coronary arteries. The heart attack can cause typical symptoms such as severe pain behind the breastbone, tightness in the chest, shortness of breath and nausea - or it can even be completely painless. The faster a patient is properly cared for, the more heart muscle can be saved. Therefore, in case of any doubt, always dial 112 and alert the ambulance service!

Definition: what is a heart attack?

Heart muscle cells die in a heart attack. The cause is usually the acute occlusion of a coronary artery, a so-called coronary artery. Three such vessels supply the front, side and back walls of the heart muscle with blood. If the blood flow cannot be restored quickly, the heart muscle cells in the supply area of ​​the blocked artery will die after two to four hours at the latest. This makes myocadic infarction a life-threatening event.

Circulatory disorders of the heart muscle, primarily heart attacks, are the cause of around 20 percent of all deaths in Europe. In recent years, however, the likelihood of dying in hospital from an acute heart attack has decreased in Germany: it is still six to ten percent.

Myocardial infarction: occlusion of a coronary artery

© W & B / Mills / Sczcesny / Neisel

causes

The heart attack is usually based on arteriosclerosis (calcification of the vascular wall) of the coronary arteries. Doctors refer to this and the resulting symptoms as coronary artery disease (CHD).

Due to the damaging effect of certain risk factors (e.g. increased blood lipids, smoking, diabetes mellitus, high blood pressure etc.) on the cells of the inner wall of the blood vessels, so-called plaques form in the coronary arteries. These are deposits that mainly contain cholesterol, calcium and inflammatory cells and are covered with a fine connective tissue cap towards the bloodstream.

A distinction is made between different closing mechanisms of a coronary artery:

  • Plaque rupture:

The so-called plaque rupture is the mechanism that most often leads to vascular occlusion. The fine connective tissue cap tears through inflammatory processes within the plaque. The platelets (thrombocytes) flowing by in the blood recognize this tear and, like a wound in the skin, cover it up within a very short time with a blood clot. This clot closes the blood vessel.

  • Plaque erosion:

In about a third of the cases it is not a tear in the plaque surface but a so-called plaque erosion that is the cause of the blood clot formation and the vascular occlusion. A blood clot builds up on a damaged plaque surface.

  • Myocardial Infarction with Non-Narrowed Coronary Arteries (MINOCA):

Angiography does not show any constriction of the coronary vessels in about 14 percent of patients with changes in the cardiac output (ECG) that are typical of myocardial infarction and symptoms that match a myocardial infarction. Doctors refer to this phenomenon as myocardial infarction with non-obstructive coronary arteries (MINOCA). Several causes are discussed for this, for example a spasm of the coronary arteries (conronary spasm) or a blockage caused by a blood clot that has been dragged out (coronary artery embolism).

To put it simply: This is how a heart attack develops

How much myocardial tissue is at risk of dying when a coronary artery is closed depends in particular on whether, for example, a larger vessel or only a smaller branch is closed. The dead heart muscle cells are gradually replaced by scar tissue. If larger areas of the heart muscle are affected and scarred, this restricts the function of the heart - this leads to cardiac insufficiency. It is not uncommon for potentially dangerous irregularities in the heart rhythm (ventricular extrasystoles and ventricular tachycardias) to cause additional problems.