Instructor's Note: This is a critical decision point for the cardiologist. There are several algorithms (flow chart protocols) for treating patients with an acute heart attack. They include the patient's symptoms and history; the interpretation of the 12-lead EKG; the results of cardiac enzyme markers and cardiac-specific proteins, the echocardiogram results and others. Based on available evidence, the cardiologist implemented the following treatments:

1. Intravenous beta blockers for decreasing oxygen demand to the heart, as well as other symptoms.

2. Intravenous streptokinase to dissolve clots and promote vascular healing.

3. Admission to the coronary care unit (CCU) for careful observation and additional testing.

4. Continued aspirin therapy (300 mg twice a day)

 

Treatment of heart attack patients depend on several factors: The cardiologist's assessment, results of diagnostic testing and the patient's overall response to initial therapy. More aggressive options may be needed.

 

37. Describe how beta blockers, streptokinase (thrombolytic therapy), and aspirin therapy are effective heart attack treatments.

Early on the second day, the patient was scheduled for an angiogram to help assess the patient's coronary blood flow.

38.  What is an angiogram?

39.  Why is this test done?

40.  What health care professional assisted the physician in performing the angiogram?

The angiogram showed several blocked arteries that could lead to subsequent heart attacks. The cardiologist now has several treatment options. Angioplasty is an option as is coronary bypass surgery.

41. What is an angioplasty?

42. Which artery is used to access the coronary arteries?

43. What is coronary artery bypass surgery?

44. Why is the body cooled in coronary artery bypass surgery?

An expanded blood chemistry work-up was ordered early on the second day to include a second measurement of cardiac enzymes. 

 

Cardiac Markers after 24 hours of admission   Additional Blood Tests Relating Risk Factors of Heart Disease

 

An angioplasty was scheduled. The cardiologist was pleased with the results of the procedure. After 2 full days in the CCU, Mr. Dixon continued to improve and was transferred to the regular medical floor of the hospital for continued observation of vital signs, monitoring of serum cardiac markers and other key parameters.  After 6 days, he was discharged from the hospital with specific orders for post-AMI recovery.  Mr. Dixon was lucky to have survived this heart attack, as they are the nation's number 1 killer of adult males with over 800,000 deaths/year.  The keys to his survival were the quick action by his wife by calling 911 and the EMTs, who administered life-saving, on-scene assessment and treatments that contributed greatly to his survival.  Prompt emergency room care by physicians and critical personnel, coupled with proper treatments and care gave this patient a second chance.  In the long run, and to help reduce further cardiac problems, Mr. Dixon will have to make several lifestyle changes: These will include controlling weight and making dietary changes, reducing work-related stress, stopping smoking and implementing a plan for moderate exercise.