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You’re at greater risk for heart attack if you have high blood
pressure. Normal blood pressure is below 120/80 mm Hg
(millimeters of mercury) depending on your age. As the numbers
increase, so does your risk of developing heart problems. Having
high blood pressure damages your arteries and accelerates the
buildup of plaque.
Having high levels of cholesterol in your blood puts you at risk for
acute myocardial infarction. You may be able to lower your
cholesterol by making changes to your diet or by taking certain
medications called statins.
HIGH TRIGLYCERIDE LEVELS
High triglyceride levels also increase your risk for having a heart attack.
Triglycerides are a type of fat that clog up your arteries. Triglycerides from
the food you eat travel through your blood until they’re stored in your
body, typically in your fat cells. However, some triglycerides may remain in
your arteries and contribute to the buildup of plaque.
• Diabetes
• high blood pressure
• high cholesterol levels
• high triglyceride levels
SMOKING
Smoking tobacco products increases your risk for heart attack. It
may also lead to other cardiovascular conditions and diseases.
AGE
The risk of having a heart attack increases with age. Men are at a higher risk of a
heart attack after age 45, and women are at a higher risk of a heart attack after age
55.
FAMILY HISTORY
You’re more likely to have a heart attack if you have a family history of early heart
disease. Your risk is especially high if you have male family members who developed
heart disease before age 55 or if you have female family members who developed
heart disease before age 65.
Other factors that can increase your risk for heart attack include:
• stress
• lack of exercise
• the use of certain illegal drugs, including cocaine and amphetamines
• a history of preeclampsia, or high blood pressure during pregnancy
To determine whether you’ve had a heart attack, your doctor will listen to
your heart to check for irregularities in your heartbeat. They may measure
your blood pressure as well. Your doctor will also run a number of different
tests if they suspect that you’ve had a heart attack. An electrocardiogram
(EKG) may be done to measure your heart’s electrical activity. Blood tests
can also be used to check for proteins that are associated with heart
damage, such as troponin.
• a stress test to see how your heart responds to certain situations, such as
exercise
• an angiogram with coronary catheterization to look for areas of
blockage in your arteries
• an echocardiogram to help identify areas of your heart that aren’t
working properly
Heart attacks require immediate treatment, so most treatments begin in
the emergency room. A minimally invasive procedure called angioplasty
may be used to unblock the arteries that supply blood to the heart. During
an angioplasty, your surgeon will insert a long, thin tube called a catheter
through your artery to reach the blockage. They will then inflate a small
balloon attached to the catheter in order to reopen the artery, allowing
blood flow to resume. Your surgeon may also place a small, mesh tube
called a stent at the site of the blockage. The stent can prevent the artery
from closing again.
Your doctor may also want to perform a coronary artery bypass graft
(CABG) in some cases. In this procedure, your surgeon will reroute your
veins and arteries so the blood can flow around the blockage. A CABG is
sometimes done immediately after a heart attack. In most cases,
however, it’s performed several days after the incident so your heart has
time to heal.
A number of different medications can also be used to treat a heart
attack:
Blood thinners, such as aspirin, are often used to break up blood clots
and improve blood flow through narrowed arteries.
Thrombolytics are often used to dissolve clots.
Antiplatelet drugs, such as clopidogrel, can be used to prevent new clots
from forming and existing clots from growing.
Nitroglycerin can be used to widen your blood vessels.
Beta-blockers lower your blood pressure and relax your heart muscle.
This can help limit the severity of damage to your heart.
ACE inhibitors can also be used to lower blood pressure and decrease
stress on the heart.
Pain relievers may be used to reduce any discomfort you may feel.
WHAT CAN BE EXPECTED AFTER
TREATMENT?
Your chances of recovering from a heart attack depend on how much
damage there is to your heart and how quickly you receive emergency care.
The sooner you receive treatment, the more likely you are to survive.
However, if there’s substantial damage to your heart muscle, your heart may
be unable to pump an adequate amount of blood throughout your body.
This can lead to heart failure.
Heart damage also increases your risk of developing abnormal heart rhythms,
or arrhythmias. Your risk of having another heart attack will be higher as
well.
Many people who’ve had heart attacks experience anxiety and
depression. It’s important to speak with your doctor about your
concerns during recovery. It may also be beneficial to join a support
group or to speak with a counselor about what you’re going through.
Most people are able to resume their normal activities after a heart
attack. However, you’ll need to ease back into any intense physical
activity. Your doctor will help you develop a specific plan for recovery.
You may be required to take medications or undergo a cardiac
rehabilitation program. This type of program can help you slowly
regain your strength, teach you about healthy lifestyle changes, and
guide you through treatment.
HOW CAN ACUTE MYOCARDIAL
INFARCTION BE PREVENTED?
There are many steps you can take to prevent a heart attack, even if you’ve had
one before. One way to lower your risk is to eat a heart-healthy diet. This diet
should largely consist of:
whole grains
vegetables
fruits
lean protein
You should also reduce the amount of the following in your diet:
sugar
saturated fat
trans fat
cholesterol
This is especially important for people with diabetes, high blood
pressure, and high cholesterol.
3 or 5 Lead monitoring
A patient may also go to the cath lab without having a STEMI, and they
may still find a clot. Most NON-STEMI’s are treated without
catheterization.
For STEMI
Bolus: 60 units/kg (max 4,000 units)
Continuous infusion: 12 units/kg/hr
-Adjust according to your organization's nomogram (Q6H- based on results
of aPPT or Anti-Xa)
For N-STEMI
Bolus: 60-70 units/kg (max 5,000 units)
Continuous Infusion: 12-15 units/kg/hr
-Adjust according to your organization's nomogram (Q6H- based on results
of aPPT or Anti-Xa)
Monitor Cardiac Enzymes: Troponin I Creatine Kinase-MB (CKMB)
Troponin I is an enzyme that helps the interaction of myosin and actin in the
cardiac muscle. When necrosis of the myocyte happens, the contents of the cell
eventually will be released into the bloodstream.
Troponin can become elevated 2-4 hours after in ischemic cardiac event and can
stay elevated for up to 14 days.
Creatine Kinase MB: This enzyme is found in the cardiac muscle cells and
catalyses the conversion of ATP into ADP giving your cells energy to contract.
When the cardiac muscle cells are damaged the enzyme is eventually released
into the bloodstream.
CKMB levels should be checked at admission, and then every 8 hours afterwards.
Desired Outcomes