Heart attack

Cardiovascular disease

Cardiovascular diseases are the most common cause of death worldwide and in Switzerland. Every year, around 30,000 people in Switzerland suffer a heart attack. The faster the diagnosis is made and targeted heart attack treatment can be initiated, the higher the patient's chances of survival.

A heart attack is an emergency situation

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Patients with a heart attack are hospitalized in an emergency. Once the diagnosis has been made, immediate treatment is initiated at the hospital. The aim is to reopen the blocked coronary artery as quickly as possible, restore the function of the heart and prevent permanent damage to the heart. Following the acute treatment, the aim is to prevent a new heart attack through a healthy lifestyle and selected medication in the sense of secondary prevention.

Overview: What is a heart attack?

The main task of the heart is to maintain blood circulation and thus the supply of oxygen to the body. If this important function is prevented, there is a risk to life. The coronary vessels supply the heart muscle with blood. In a heart attack, a blood clot causes a coronary artery to become blocked. A sudden occlusion of such a vessel jeopardizes the blood flow and oxygen supply to the heart muscle, which can be permanently weakened as a result.

Heart attack: causes and risk factors

A heart attack is usually the result of a disease of the coronary arteries, known as coronary heart disease. The most common cause of a heart attack is a blockage of a coronary artery.

In most cases, an atherosclerotic plaque in the vessel wall favors the formation of a blood clot. The deposition of blood lipids, inflammatory cells and connective tissue in the vessel wall leads to the formation of an atherosclerotic plaque over the years, which narrows the vessel. This can lead to a reduction in blood flow. If such a plaque ruptures, i.e. if it becomes unstable and breaks open, the atherosclerotic material comes into contact with the blood and leads to the formation of a blood clot. A blood clot then causes a partial or complete blockage of the coronary artery. If a clot blocks a coronary artery, the blood flow to the heart muscle is severely disrupted and a heart attack occurs. Depending on the location of the vessel, it is referred to as an anterior wall, posterior wall or lateral wall infarction.

The development and progression of atherosclerosis is favored by risk factors over many years. In addition to increasing age and male gender, the risk factors include lack of exercise, obesity, smoking, high blood pressure, diabetes and lipometabolic disorders such as high cholesterol. It is therefore important to optimally control these risk factors through lifestyle changes and medication. This reduces the risk of the development or progression of atherosclerosis. Some people also have a certain predisposition, a family history, to developing atherosclerosis.

However, a heart attack can also occur without previous atherosclerotic changes in the coronary arteries. Such a clinical picture can be due to various causes, such as a tear in the vessel wall (coronary dissection), an embolism (coronary embolism) or a functional disorder of the small coronary vessels (microvascular dysfunction). Emergency diagnostics and targeted therapy are also important for these clinical pictures.

This can manifest itself in worry, tension, circling thoughts or sleep disturbances, among other things, and can complicate the course of treatment. If you or your relatives desire psychiatric-psychological counseling and support, our specialists at the USZ will be happy to assist you.

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Heart attack: symptoms

Many heart attacks come out of nowhere. Sudden severe chest pain, typically of a pressing nature, radiating into the arm or neck. However, a heart attack does not always manifest itself with these typical symptoms. Atypical symptoms such as nausea, tiredness or abdominal pain are frequently observed, particularly in women, diabetics or older patients. As a result, those affected usually underestimate the symptoms and it is more difficult to recognize a heart attack quickly.

It is also possible for a heart attack to occur completely without symptoms, in which case it is referred to as a “silent heart attack”.

The following symptoms indicate a heart attack:

  • Severe pain, tightness or burning in the chest
  • Pain radiating to the arms, neck or upper abdomen
  • Shortness of breath and fear of death
  • Cold sweats and weakness
  • Nausea and vomiting

Heart attack: Diagnosis with us

Even if symptoms can be unspecific and unclear, emergency diagnosis and treatment of heart attack patients is important. So don’t hesitate to call the emergency services or go to hospital if you experience sudden symptoms. The doctor can then initiate the necessary diagnostic and therapeutic steps.

We use various methods for diagnosis: an electrocardiogram (ECG) maps the heart’s current curve and enables signs of a circulatory disorder in the heart muscle or a heart attack to be identified immediately. A blood test makes it possible to measure specific proteins, so-called cardiac markers, which are released when heart muscle cells die. The diagnosis of a heart attack can be made quickly and reliably on the basis of these examinations.

Treatment of myocardial infarction

Heart attack: immediate treatment

Once a heart attack has been diagnosed, important medication is administered immediately to stop the formation of clots. Blood-thinning medications include aspirin and heparin. Pain medication such as morphine relieves the pain of a heart attack. Oxygen is also administered if necessary. If there are signs of a coronary artery blockage, an emergency cardiac catheterization, known as coronary angiography, is performed. During this examination, a catheter is inserted via the arm or groin vessel to the heart. By injecting contrast medium into the coronary arteries, a blockage in a coronary vessel can then be identified, localized and treated immediately afterwards.

To treat a vascular occlusion, the vessel is opened, dilated using a balloon catheter and then usually treated by inserting a fine metal tube, a so-called stent (coronary angioplasty). This can normalize the blood flow and keep the vessel open in the further course. Patients with a major heart attack sometimes require circulatory support in the form of medication or circulatory support systems, as well as treatment in the intensive care unit.

Heart attack: long-term treatment

After immediate treatment with blood-thinning medication and opening of the coronary artery in the cardiac catheterization laboratory, long-term secondary prevention is important. This includes lifestyle changes and drug therapies to control the risk factors. The use of aspirin is permanently recommended for patients who have suffered a heart attack. In the first year after implantation of a stent, another medication is also administered to inhibit the blood platelets. Taking a cholesterol-lowering agent is also central to the treatment of patients after a heart attack. A healthy lifestyle with regular physical activity, a balanced, healthy diet and stopping smoking is essential in heart attack aftercare. These measures not only have a positive effect on the blood vessels, but also on the development of numerous other diseases. Structured rehabilitation is therefore usually carried out after a heart attack in order to restore physical performance.

Heart attack: prognosis

The prognosis of a heart attack depends above all on how quickly the patient is admitted to hospital and whether the doctors succeed in stabilizing the heart function. Patients who survive the first few days after a heart attack often have a good prognosis, especially if typical risk factors such as tobacco consumption or obesity are reduced later on.

Prompt treatment is very important, as blood flow to the heart must be restored as quickly as possible. It is therefore crucial to call the emergency services in good time. If too much time passes between the infarction and treatment, this often leads to the damaged heart tissue becoming scarred and being unable to recover. The risk of dying from a heart attack is particularly high in younger women if it is not treated in time.

During a heart attack, a life-threatening cardiac arrhythmia or cardiac arrest can occur. Rare complications of a heart attack include dysfunction of a heart valve or – particularly in the case of long-lasting heart attacks – a tear in the heart muscle. Cardiac arrhythmias can lead to cardiac arrest and require immediate resuscitation measures. Immediate cardiac massage and defibrillation can save people in cardiac arrest.