Cardiac Infarction: its symptoms and treatment

The substance of rehabilitation

The role of prevention, health-giving quality of nature

Cardiac Infarction: its symptoms and treatment

About coronary diseases and Cardiac Infarction in general

In the human body, the heart is usually situated in the middle of the thorax a little on the left.
Its task is to pump collected de-oxygenated blood from all parts of the body towards the lungs and then it pumps out the perked up blood to the different parts of the body – supplying all the cells with indispensable substances for our lives. The myocardium is strong, it has rich own blood supply. Veins encompassing our heart and supplying it with blood are referred to as coronary arteries. In medical science the expression of cardiac infarction means tissue cytonecrosis, necrosis due to the ceasing of arterial blood supply. Athough infarction, thrombosis can happen in any organs, coronary occlusion is a major fact since it can be found in that organ which provides the blood supply our body. Infarction is mostly in connection with arterial sclerosis. Fat is gradually multipled in the arteries; this process is the so called nodular sclerosis. Ateromas are curved in the arteries while they are growing and they tighten their cavities, partially blocking the circulatory system. In the course of time in the ateromas there will be more and more lime. The plaque can crack or haemorrhage so the size of it can continue growing and the artery narrows down even more so. The cracking of the ateromas can cause thrombus, which fills and blocks the vascular bed and cause infarction at that region which supplied by the effluent artery section.

Consequences of ceasing perfusion

We talk about disturbance of perfusion - in case of the heart as well – when the myocardium loses the balance between the oxygen requirements and supply. The balance can be broken by many factors. On the one side in case of loading the oxygen requirements of the myocardium can increase five or sixfold more of the baseline score and without adequate blood supply it can cause anoxia. On the other side blood supply of artery behind the intracoronary narrowness (coronariasclerosis – one form of the arteriocapillary sclerosis which is a characteristic of coronary) cannot increase above a certain limit. For this reason the amount of oxygen „required” by the cells of the cardiac muscle is not available, their metabolism changes and if anoxia is permanent (as a consequence of prolonged disturbance of perfusion), the cells of the cardiac muscle are damaged or they can be destroyed as well. Disturbance of perfusion caused by anoxia is called ischaemia.

Consequences of short-run ischaemia

If the disturbance of perfusion develops suddenly, cardiac muscle cannot comply with the changed circumstances. Its metabolism changes quickly and under the pressure of necessity, the accrued harmful metabolic products are likely to apply stimulus to nocireceptors, that’s why the patient starts to feel that special precordialgia. This pain is the so called angina pectoris. If the blood supply is re-established within some minutes, then the pain will come to a close and the metabolism and function of the myocardium will be restored. In this case there is no myocardial damage or it can only be demonstrated by molecular methods.

Consequences of permanent ischaemia

The permanent, more than 20 minutes’ precordialgia, which cannot be eased by medicines (nitrate placing under the tongue) either, will cause myocardial infarction. It generally happens when the artery becomes fully blocked and not only when stenosis limits the appropriate blood bleeding in the coronary artery. The size of cardiac muscle necrosis depends on the location and the places of supply of the coronary occlusion. Occlusion near the place where the coronary artery is derived from can cause large myocardial necrosis or occasionally sudden death as a result. Occlusion farther the place where the coronary artery is derived from can cause minor infarction. The repeated opening of the blocked coronary reduces the size of myocardial necrosis. The opening – with the help of medicines, medical devices – is conceivable within 12 hours. Thenceforward with the opening of the artery it is impossible to find living muscular tissues. It is obvious that the less time the obstruction takes– exists even 1 or 2 hours -, the less damages the cardiac muscle will have. Despite the fact that the artery opens again in some hours after the obstruction and the given myocardial area gets blood again, its function is not restored immediately because it takes for weeks in many cases by the time its function gets better in comparison with the other parts of the myocardium. This phenomenon is the so called stunning, which can lasts for days or perhaps weeks. In the case when the obstruction is not a sudden event but a slow process (during months or years), heart muscle tries to substitute the missing blood supply from healthy veins. Therefore in heart muscle more and more smaller veins can be developed (collaterals – the name of the process is collateralisatio), which provide some blood supply by-passing the blocked part of the vein. However it is rarely enough for the heart muscle to function, most of the time it stops the contraction but keeps its basal metabolic rate. When the heart muscle gets the appropriate amount of blood again (with opening the original vein by catheter or surgical intervention) then after a while its function can be postponed. This type of heart muscle is the so called hibernated heart muscle.
When the heart muscle is destroyed, its function won’t recover and the overall performance of the heart will decline according to it.  Loosing about the 10% of the total weight of the heart muscle does not have particular symptoms. Between 10 and 20% lowers the efficiency, between 20 and 30% even the everyday life runs into difficulties, between 30 and 35% it is difficult to supply the circulation even at rest, till the sudden myocardial necrosis is above 40% can cause quick cardiovascular shock.

The symptoms of heart attack

The symptoms of heart attack mostly depend onthe patient’s age, his or her other diseases, the area of the infarction and the size of the involved heart muscle. At the very beginning the symptoms of heart attack are the same as the symptoms of angina pectoris. But while the the symptoms of angina pectoris take some minutes, in the case of heart attack these can exist for hours. The typical symptomps are the sudden pressing, gripping and blinding precordialgia which extend towards the shoulders, typically towards the left one or perhaps the left arm or the little finger of the left arm. It gets more intensive during physical loading but does not end while resting. Sicchasia, vomiting, decrease in blood pressure, cold sweating can appear. Because of the pain necrophobia is very frequent. Heart attack can sometimes happen without symptoms and only additional medical examination discovers the fact of heart attack („walking heart attack”).

The possibilities of treatment in case of infarction

heart muscle must be done with the least possible delay.
The possibilities are the following:

• Medicinal dissolving of the thrombus causing embolism.
• Mechanical opening of the embolism via catheter operation.
• Bypassing the fraction of the clogged vein via cardiac surgical procedure (bypass).
• Besides the above mentioned things the treatment of the symptoms and the complications of infarction (e.g. arhythmia) is very important.

Medicinal dissolving of the thrombus: It is the medicine which particularly teases with thrombus, breaks it down and sets the blood flow in action soon afterwards by dispersing the thrombus. Its advantage is that it is available in most hospitals. The disadvantage of it is that thrombolysis is not successful in 10-50% of the total cases and obstruction remains. The other disadvantage of it is that we can only reckon upon success within the first 3 hours from the first symptoms.        In addition it only dissolves the thrombus, but not the vascular lesion (arteriosclerosis plaque), which is responsible for the origins of the formation of thrombuses.

Cathetertreatment: It is the most modern operation nowadays whereby the coronary circulation can be recovered.  The main point is that via the femoral artery (or any other deep arteries) a special catheter is led into the flow of the coronary and then through this the blockade is opened with very fine medical devices. Thenceforward an „inner angioprosthesis”, the so called stent is placed in and in this way they enlarge the tight vein and stabilise the damage of the vein wall. The disadvantage of it is that it requires a special heart catheter laboratory and specially experience staff workers, which is not available everywhere.

Cardiac surgical procedure:  Among the treatments of acute heart muscle infarction it rarely comes into question. Mainly when the blockade cannot be treated via catheter operation.  Still, surgical service is the method to be chosen to prevent the complications (e.g. slitting of interventricular septum of heart, collapsing of cardiac valve).

 

The substance of rehabilitation

Rehabilitation of heart-patients

In Hungary approximately 25-30000 people suffer acute cardiac infarction. This tendency – unfortunately – keeps show increase. When somebody overtakes the acute section of infarction must know that his / her recovery process does not finish in hospital after the treatment, which is very time-consuming.
After the acute section of infarction the patient’s health status is usually restored in an internal treatment department then later in a health-resort.

The aim of the rehabilitation is that patients got over infarction can return to their original way of life and work as much as possible. After the treatment at the health-resort they need rest at home as well by all means. The physical and mental activities are gradually raisable but only until the limit prescribed by the doctor.

According to the World Health Organisation (WHO) cardiological rehabilitation is the complex of those activities, during which the patients got over cardio vascular diseases - with their own active co-operation – can get into the  best health, physical, mental and social conditions and they can keep or recover their proper social positions and active way of life.

Successful rehabilitation can be carried out in multidisciplinar group work. The most efficient is when started from the acute section and continuously go on till the end of the patient’ s life. It is a general principle that after an acute cardial disease (e.g. heart attack or heart operation) all of the patients should take part in the early cardiological rehabilitation. Chronic heart patients re-rehabilitative treatment can be repeated again depending on their conditions.

A Health-resort is a kind of inpatient hospital, which provide further inpatient supply for those patients who previously went to other intstitutions (e.g. in hospital) for medical check-up or medical treatment. The aim of the treatment in a health-resort is to restore the unsound functions as completely as possible or to prevent the further caducous in the case of those patients who cannot be rehabilitated as outdoor patients at their residences. During the treatment pharmacological and psycho-therapeutic methods or natural healing factors or together these previously mentioned ones are applied. The aims of the living-in and outpatient programmes are the same. The structure of the first one is more complex so that they could provide the more complex supply. The advantage of institutional rehabilitation is that in a short time after the acute cardial disease rehabilitation can be started, patients with complications and risks, the seriously disabled or elder people (they usually have other significant diseases as well). These programmes can help the smooth transition from the hospital treatment to the independent home life.

The programme of the cardiological rehabilitation

• Diagnostics, risk assessment
• Power of exercise
• Early mobilization
• Training programme
• Psychotherapeutics  
• Theme-orientated group discussion
• Autogenic therapy
• Teaching healthy attitude; establishing proper lifestyle and behaviour
• Establishing proper diet

 

The role of prevention, health-giving quality of nature

 

How can cardiovascular diseases be prevented?

One of the main causes of death here in Hungary is cardiovascular disease. Approximately 25-30 000 of our fellow countrymen get heart attack every year. Though with some basic but life-preserver changes of lifestyle in the long run 80 percent of heart attacks would be preventable, claim the experts.

According to the opinions of experts there are several pivotal points in prevention of cardiovascular diseases, just as well as  in the case of heart attack. One of them is healthy eating, while the other one is the proper way of living and as a part of this regular exercise is very important. It is very essential to be very particular about the amount and quality of food because sudden increase in weight can be followed by many damaging complications. First of all bread diet, vegetable and fruit-rich nourishment is suitable because of their high fibre, vitamin and mineral content. Instead of fatty pork and indigestible beef we should eat light poultries and a lot of fish! There are countries where it is recognized  that as long as it is given full support to healthy food, the risks of cardiovascular diseases can be reduced. In our counry this approach is not general.

Maybe this is the explanation of having so many overweight people in our country, and this can cause cardiovascular diseases, adult diabetes and hypertension.

In connection with the right and proper way of living we have to say some words about smoking and extreme consumption of alcohol as well because both of them are considerable risk factors. Smoking narrows the veins and alcohol rises blood pressure. Untreated hypertonia damages heart, vascular system and our kidneys.

Avoiding negative effects, such as stress is a part of the right and proper way of living. The best way to compensate stress is doing exercises and physical activities. It’s also good for your psychosomatic recreation as well. During exercise such hormones are released which have the beneficial influence on the state of mind, general condition and mood. In most people’s life there is a lack of exercise. Going for plentyful walks in the fresh air every day can help a lot to prevent cardiovascular diseases.


Health-giving quality of nature, the role of psychosomatic balance

Even the ancient Greek physician, Hippocrates stated out that our body and soul function as a psychosomatic unit and a patient becomes ill when the harmony of body and soul with the environment is broken. Physical diseases – such as heart diseases – can develop when people who cannot give voice to their feelings turn the passion inside and if they have constitutional sensitivity, their organs can be affected. The state of our immune system greatly depends on our nervous system, since then we know. It is not only an experience-based but an argumentative fact that depression shows favour towards the blockade of the immune system and the severe frustrations lead to affection – just because of the insufficiency of the immune system. In this case both the physical and the psychic disease must be healed.

In the latest decades reaching the balance has become the main point in the development of human society. We have to learn how to keep our family and occupational life in balance and equalise our external and internal world. This balance can lead us towards peace, tranquillity of mind and strength, which reduces stress and emotional press and relieves blockages of energy. The balance of body-soul-intellect affects as one unit and stops the causes of diseases and disorders. It helps us come to like ourselves again and enables to close the gap between our surroundings and us. It forms the original harmony again. It puts a check on negative emotions and thinking, helps us destroy anger and fear. It activates creativity and efficiency. It develops personality harmonically and helps human relations to be balanced.

You must have had that experience when you sink under burden and go on for a walk among trees with leafy crown in the fresh air and you cool down there as if a gentle touch would put your mind at ease.  It is not mere chance because trees have health-giving quality. We do much for our health when we are in nature and cool mountain air has good influence on the nervous system as well. At least one hour in nature and trees collect our negative thoughts and fill us with positive attitudes towards life. Trees have great strength, be broad-minded and you will realise how wonderful thing is to refresh ourselves in the open air.

Should you reduce the risk factors mentioned below, you will relieve the prevalence of cardiovascular and coronary diseases. Have a screening test at least once a year even if you do not have any complaints!

• Have your blood sugar values, cholesterol and bloodpressure checked!
• Go on a sugarfree, fat-restricted and low-calorie diet if it is needed!
• Quit smoking, do exercise or go on for a walk regularly!
• Laughing is a therapy for what you do not have to stand in the queue in a pharmacy. Realise the small the joys in life! Learn to laugh in the problem’s face!
• Go into nature! Stay there as much time as you can in order to refresh your body and mind! Try hard to keep the above mentioned advice as far as you can! Consequently, you can get much more chances for leading a calm, healthy and long way of life.