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Heart Attack - every second counts

Heart attack is usually a consequence of changes in the cardiac arteries (arteriosclerosis), in which the blood vessels are constricted by fatty deposits (plaques). The main cause of a heart attack is the rupture of one of these plaques within a large coronary artery. This can result in a blood clot, which in turn clogs an essential blood vessel and thereby interrupts the blood flow to the heart muscle.

The part of the heart muscle supplied by the artery receives no blood and thereby no oxygen, and it dies off. The result is an impairment of the pump function of the heart and danger of a fatal cardiac arrest. 

Numerous heart attack symptoms

The symptoms that occur during a heart attack are multi-faceted. Typically there occurs for more than 15 minutes a heavy pressure and tightness or burning pain in the chest. The pains can radiate to the neck area, the arms, the shoulders or the upper stomach. The pain often triggers anxiety, causing increased strain and thereby becoming more intense. The heart chest pain is often accompanied by sweating, nausea or vomiting, lack of air, irregular heartbeat, and paleness in the face.  

The aforementioned symptoms often serve as warning signals, indicating heart disease weeks or months beforehand. Those who take these seriously and contact a medical professional on time can potentially steal a march on the heart attack. 

In rather rare cases, a heart attack can occur like a 'out of the blue'. (Photo: Unsplash)

The danger of cardiac arrest through ventricular fibrillation

Until the ambulance get there, heart attack victims should not be left alone and should be laid with their upper body raised, on a bed, sofa, or on the floor. This position relieves the heart and makes breathing easier. Relief can also be achieved through the opening of tight clothes, ties or bras. 

In the first hour the danger of cardiac arrest by ventricular fibrillation is highest. Only rapid resuscitation by bystanders or the rescue service can prevent death or severe brain damage in this case. The first rapid clinical examination by the emergency doctor at the scene includes taking blood pressure and listening to the heart and lungs. The victim is connected to an ECG, and heart rate, heart rhythm, oxygen saturation and blood pressure are monitored.

After the operation, the affected person is monitored in intensive care for a few days. (Photo: Uganda Heart Institute)

The emergency doctor introduces pharmaceutical first-line treatment

In the acute situation drug treatment aims to optimize oxygen supply to the heart, to combat pain, to release clots, and to prevent further blood clotting. The ambulances are usually excellently equipped for first aid, so treatment can usually be initiated here. The rescue personnel head for the nearest hospital equipped for this type of emergency. If the hospital does not have the necessary equipment, a transfer to a cardiology centre is arranged as quickly as possible.

Stent implantation as the first option and bypass surgery as the alternative

In hospitals, the first goal of the treating physicians is to prevent an attack from spreading and to achieve reopening (reperfusion) of the blocked coronary vessel. If the appropriate equipment is available, a so-called percutaneous coronary intervention (PCI) with balloon dilatation and stent implantation is usually initiated. In this procedure, after the coronary vessels have been widened, a vessel support (stent) is placed at the constricted site via balloon to prevent further blockages.

If the coronary arteries are narrowed over long sections, the medics will also consider bypass surgery. This involves bypassing the blockage with a piece of another blood vessel. However, stent implantations have become more important in recent years. Today, they are performed 2.5 times more frequently in Uganda than bypass operations.

Rehabilitation is indispensable

After a successful acute treatment, the patient is monitored in the intensive care unit for a few days and receives further treatment with medication. The hospital stay, the duration of which depends on the severity of the heart attack and the course of the treatment, is followed by rehabilitation in a clinic or in an outpatient therapy centre.

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