[Acute myocardial infarct. A changing clinical picture]
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1Abteilung Innere Medizin III, Schwerpunkt Kardiologie, Medizinische Universitätsklinik Freiburg i.Br.
Insights
An integrated program for acute myocardial infarction (heart attack) surveillance and treatment significantly lowers mortality. This approach includes prehospital care, intensive hospital treatment, and rehabilitation, improving survival and quality of life.
Area of Science:
- Cardiology
- Emergency Medicine
Context:
- Acute myocardial infarction (heart attack) is a leading cause of death, often resulting from coronary artery thrombosis and ventricular fibrillation.
- Early fatalities are common, with death frequently occurring within one hour of symptom onset.
Purpose:
- To outline an integrated program for the surveillance and treatment of acute myocardial infarction (heart attack).
- To highlight the benefits of early intervention, including prehospital care, intensive care, and rehabilitation, in reducing infarct mortality.
Summary:
- The program integrates mobile prehospital care, intensive hospital treatment, and rehabilitation to manage acute coronary attacks.
- Key interventions include early antiarrhythmic treatment, myocardial reperfusion via fibrinolysis, and round-the-clock availability of coronary angiography and interventions like percutaneous transluminal coronary angioplasty or bypass surgery.
- Strict adherence to indications ensures the safe and effective application of these acute-stage treatments.
Impact:
- The integrated program markedly lowers infarct mortality, significantly reducing both mortality and morbidity associated with acute myocardial infarction.
- It leads to a remarkable improvement in life expectancy and quality of life for patients who have experienced a heart attack.
Abstract:
Acute myocardial infarction is a major complication of stenosing coronary artery disease and constitutes the most frequent single cause of death. It is caused by thrombotic occlusion of one of the major epicardial coronary arterial branches in most cases. Sudden death due to ventricular fibrillation is responsible for the majority of early fatalities. In 60% of all fatal infarcts, death occurs within 1 h of the onset of pain. The final extension of myocardial necrosis is reached within 2-4 h. An integrated programme has therefore been developed for the surveillance and treatment of patients suffering acute coronary attack; it has been shown that it can markedly lower infarct mortality. It includes mobile prehospital care, intensive care treatment in the hospital, and rehabilitative procedures for application during reconvalescence. Early antiarrhythmic treatment and myocardial reperfusion via fibrinolysis are the main therapeutic procedures in the earliest stage. In hospital an operating room and an operating team must be available round the clock for the performance of coronary angiography followed by percutaneous transluminal coronary angioplasty or bypass surgery, which can be safely carried out in the acute stage providing the indications are strictly observed. Mortality and morbidity can be significantly lowered and both life expectancy and quality of life can be remarkably improved.