The major symptom is chest pain, usually at rest and persistent. There is also often sweating, paleness or feeling nauseous. Pain can extend to the arms, neck or teeth. In some cases there may be difficulty breathing (heart failure) or loss of consciousness.
How is affected by the condition ?
There is a greater incidence as people grow older. It is more frequent in men than in women before menopause, but the other main risk factors are tobacco, diabetes, obesity, cholesterol, high blood pressure and family history of ischemic heart disease
The main test is an electrocardiogram. Also a blood test for troponin, an enzyme that is released when there is myocardial involvement. Emergency catheterisation to restore coronary flow may be required. Cardiac catheterisation consists of inserting a catheter into the coronary artery to view the obstruction and try to fix it.
If you observe symptoms compatible with a myocardial infarction it is essential that you immediately call 112 and do not go to A&E by your own means. 112 will assess you, send a team to perform a diagnosis, will begin treatment and will take you safely to hospital
Treatment depends on if there are ECG signs to indicate that there is complete occlusion of a major coronary artery. In this case, treatment is aimed at resuming coronary flow as a matter of urgency. Every minute that passes without opening the artery, the infarct becomes larger. This is normally done through cardiac catheterisation and the implantation of a stent. The 112 teams take the patient directly to the Haemodynamic Unit, where the artery is opened, without going via A&E. When a delay is expected for catheterisation (e.g. a long distance to the hospital), the 112 team may administer a fibrinolytic drug (which dissolves in part or completely the blood clot that has interrupted the coronary flow). When there are no signs of complete coronary occlusion on the ECG, emergency catheterisation is not performed. In any case, treatment to inhibit the formation of a blood clot is an essential part of the treatment.
The severity of an infarct, as that of a fire, depends essentially on how far it has spread. This determines its impact on survival and quality of life. Bigger infarcts may lead to the appearance of heart failure and arrhythmias and require specific treatment. In all cases, medication to prevent a blood clot is advised. The control of risk factors and participation in a cardiac rehabilitation programme are very beneficial to help the patient return to their normal life.
Several research programmes are working to find treatments that might reduce the consequences of coronary occlusion, either by making the infarct smaller or avoiding progression after heart failure and arrhythmias. It will, however, be years before this approach becomes a reality in day-to-day clinical care.
Electroencephalography, blood test, coronary catheterisation.
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