Myocard infarction (heart attack)
definition: part of the myocard (heart muscle) is damaged by oxigen shortage.
Impaired bloodsupply through the coronary arterys causes ischaemia of the heartmuscle.
clenching pain in the middle of the breast, behind the breastbone, often radiating to the under jaw or the leftarm
pain starts often in rest and prolonges
Shock (visible if paleness, low blood pressure, fast weak pulse)
pain isn't always present
The anamnesis is very important
ECG: starting ischaemia a ST shift starting from the basal line. The damage in the heart muscle is still reversibel. If necrosis starts, a pathologic Q arrises. The heart damage is not reversible anymore.
Several serum enzymes are released during a heartattack:
myoglobuline, afterwards CK-MB, troponine T, ASAT, LDH. Troponine T is very specific for a myocardial infaction.
-step 1 not in hospital.
Heart massage and resuscitation, if possible directlyly apply an infusion
Emergency admission in a heart surveilance department
-step 2 in hospital.
Artificial ventilation 20x500 ml/min 100% O2
infusion (NaCl, preferably in the vena basilica or the vena jugularis)
In case of ventricle fibrillation or a pulseless ventricular tachycardia directly reanimation (200J asynchronic, 200J asynchronic, 360J asynchronic)
-In case of asystoly 1 mg adrenalin (through a central or peripheral infusion)
-In case of ventricle tachycardia anti arrythmics (lidocaine 1mg/kg)
-In case of extreme bradycardia anticholinergics (atropine 0,5 mg)
if the hart massage worked and there is a pulse and conciousness: amiodaron
In case of a pH less then 7,20: consider NAHCO3 (1 mmol/kg). The pCO2 has to be minimally 30 mmHg and the pO2 minimally 60 mmHg
-if no heart activity after step 3:
In case of asystole: adrenalin 1mg (can be repeated)
In case of ventricle fibrillation or pulslessnes ventricular tachycardia: anti arritmics, lidocaine, amiodaron
In case of ventricle tachycardia: 50-200 J synchronic
In case of extreme bradycardia a pacemaker
-if there is still no heart activity:
continue reanimation 60 minutes or in case of a very bad prognosis stop treatment and let the patient die
-if there is heartactivity after step 3:
In case of no pulse:
Dopamine and dobutamine. if there still is no pulse: an ultrasound of the heart
In case of a pulse:
Intensieve therapy and artificial ventilation
-these can also be used:
Intense pain allevement (morfine)
Fibrinolytics (streptokinasis) only in a hospital setting
Antithrombotics (acetylsalicylic acid)
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