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“НАШЕ ЖИТТЯ”, БЕРЕЗЕНЬ 2012 WWW. UNWLA.ORG 33 HOW HEART ATTACKS ARE TREATED AT THE HOSPITAL by Ihor Magun, MD, FACP If you are experiencing symptoms that may indicate a true heart attack, the emergency room is where you will arrive and be evaluated. Knowing what will be done and recommended may alleviate some of the anxiety and prepare you for what to ask or to expect. If you are truly having a h eart attack, time is paramount. With each passing minute, cardiac tissue deteriorates and begins to die , quite litera l- ly . The goal is to restore blood flow to the affected area as soon as possible. After obtaining vital signs such as blood pressure, pulse , and temperature, you will have blood drawn, an intravenous drip will be started, oxygen will be administered, you will be placed on a cardiac monitor to observe your cardiac tra c- ings, and you will have an electrocardiogram. The electrocardiogram is a critical component in the evaluation and frequently determines the trea t- ment algorithm chosen. However, in u p to fifty percent of the cases, it turns out to be non - diagnostic, and oth er things such as blood tests are needed to guide further treatment. Blood tests can determine if there has been “ death ” of heart muscle. These te sts are ta k- en repeatedly at various specific times. The qua n- tity of heart muscle in the blood test can give an indication of the extent of suspec ted injury. It is possible for the first test obtained to be complet e- ly normal and for subsequent tests to come out positive. This is why several blood tests are nece s- sary to obtain accurate information for proper manag ement. In the event that the electro cardiogram shows one of two scenarios, very specific trea t- ment recommendations are followed. (The card i- ogram can show a significant number of scen a- rios, but the following are the most common .) There are two major ele ct o- cardiographic presentations: ST - segment elevation and non - S T - segment elevation. Management of either presentation is dictated very explicitly , with a precise protocol followed . A crucial factor in any situation is the amount of time a patient has b een having chest pain . I t really helps if the pain hasn’ t lasted for more than three hour s. If you present with a n ST - elevation at a hospital without more invasive in terventional c a- pabilities and you cannot be transferred to a ho s- pital that can perform th ese interventions within 90 minutes, the first medical contact should i n- clude treatment with a cl ot - busting therapy wit h- in 30 mi nutes of hospital presentation, unless there i s a specific contraindication. Med ications are also initiated and include aspirin, blood thi n- ners, beta blockers, nitroglycerin , and clopidogrel (Plavix). For non - ST - segment elevations , antic o a- gulants are used in conjunction with the above medications. Risk stratific ation determines the next step, such as angiograms and other interve n- tions. Most individuals do not require open heart surgery at the time of an actual heart a t- tack. In fact, if necessary in some individuals, it is done at a later time , and a combination of med i- cations is used to bridge the gap. The m ost frequent interven tions pe r- formed include coronary angioplasty and use of stents — tubes that are inserted in the walls of the blo od vessels to keep them patent. The stents are passed vi a a blood vessel in the groin. This proc e- dure is simple and routinely performed. If you have had a heart attack, you will be leaving the hospital w ith a list of new medic a- tions. You w ill probably feel tired and wo r- ried. These feeling s are quite normal and will go away. Most individuals will start a cardiac reh a- bilitation program , whic h will provide you not only with the prop er reconditioning of your heart but also with advice on lifestyle changes as well as interaction s with other patients who have gone through the same experience. I hope this information will help prepare you for wha t happens in the hospital. This brief overview is by no means complete: t here are many individual vari a- tion s and complicated present a- tions. However, having a general understanding of the procedures and tests outlined above can make you a less anxious and a better informed patient.
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