Feature article

What Patients Should Expect After A Cardiac Event

If you’ve experienced a cardiac event, such as chest pain or a heart attack, you likely have a lot of questions about what to expect in terms of diagnostic tests and treatments. Below is an overview to help you understand and prepare for what your next steps might entail, along with reducing some anxiety about the unknown.

Symptoms and events

Cardiac arrest is not the same thing as a heart attack but can be caused by one, or occur on its own as a result of electrolyte disturbances, (low or high potassium, or low magnesium), congenital abnormalities, or poor pumping function that often results in heart failure.1

Chest pain may be symptomatic of cardiac disease, such as angina pectoris (chest pain), myocardial infarction (MI - heart attack), aortic stenosis (valve disfunction), or pericarditis (inflammation of the heart membrane), or of pulmonary disease, such as pleurisy, pneumonia, or pulmonary embolism (blood clot in the lung) or infarction (lung tissue death) and must be evaluated immediately.14

Heart attack is when blood flow to your heart is blocked and the muscle can’t get oxygen from red blood cells resulting in muscle damage and tissue death.3 Every 40 seconds, someone in the United States has a heart attack because an area of the heart muscle doesn’t get enough blood pumped to it.4

Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through to meet the body's needs for blood and oxygen, and the heart may enlarge, thicken, or speed up to try to meet the workload.10

Diagnosing symptoms and events

While the condition your cardiologist thinks you might have ultimately determines the specific diagnostic tests you’ll need, a physical exam (blood pressure, pulse, etc) along with a personal and family medical history including lifestyle (smoking, alcohol, stress) and hereditary factors will be taken first.6 Based on these initial evaluations, there are several other tests you could be prescribed.6

Blood tests can provide useful information about current cardiac events as well as clues to future events by measuring levels of various blood components that signify high levels of cholesterol, inflammation and plaque build-up, along with key factors that signal a heart attack.2,11

Heart enzymes such as the protein troponin, which is found in the heart muscle, are one type of important information blood tests provide.2,6 This is because heart enzyme levels rise when they are released into the bloodstream as a result of muscle cell damage caused by the lack of oxygen and nutrients blocked during heart attacks and heart failure.2,6,11 Because a rise in levels doesn’t always show up right away, you might be kept a while for follow up testing.2,6

Cardiac catheterization or coronary angiogram is an invasive exam procedure involving insertion of a thin tube into a vein or artery in your leg (groin) or arm that is aided by x-ray images on a monitor and guided through the artery until it reaches your heart.2,6,13 It measures the pressures in your heart chambers and can inject a dye visible on x-ray that helps your cardiologist check for abnormalities in blood flow.2,6,13

Cardiac computerized tomography (CT) scan is used to evaluate and diagnose the extent of damage from heart attacks, particularly if symptoms remain unclear.2,6 While lying on a table inside a doughnut-shaped machine, an x-ray tube inside the machine rotates around your body and collects images of your heart and chest.2,6

Cardiac magnetic resonance imaging (MRI) produces a magnetic field that creates images to help your cardiologist diagnose and evaluate the extent of damage from heart attacks.6 While lying on a table inside a long tube-like machine, the magnetic field aligns atomic particles in some of your cells so that when radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart.6

Chest x-rays are useful for assessing enlargement of the heart due to heart failure and any structural changes, such as the growth of a new blood vessel that may be attempting to circumvent a blocked artery thereby signaling the potential for a future heart attack.11,12 It is also used as a way to look for other causes of chest pain like pneumonia or lung tumors.5

Echocardiogram tests are noninvasive exams that take an ultrasound (using sound waves) of the heart and chest area to show detailed images of your heart's structure and function.6 It can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally or at peak capacity.6

Electrocardiograms (ECG/EKG) are simple painless tests that record electrical signals from your heart that help your doctor detect irregularities in your heart's rhythm and structure.6 You may have an ECG while you're at rest, in an ambulance, at the hospital, or while exercising during a stress test.6 An ECG can reveal if you're having a major heart attack because a blocked artery preventing part of your heart muscle from receiving the blood supply creates a distinct signature.

Holter monitoring is a type of ECG using a portable Holter monitor device that records continuous electrical signals for up to 72 hours and is used to detect heart rhythm irregularities not found during regular ECG exams.6

Stress tests involve raising your heart rate with exercise on a treadmill or stationary bike attached to an ECG to check how your heart and blood vessels respond to exertion.6 Variations include receiving a drug intravenously that stimulates your heart similar to exercise or a nuclear perfusion stress test that uses an injected dye and special imaging techniques to produce detailed images of your heart while you're exercising.6

Treatment pathways

Treatment for cardiac events vary by condition and severity and your cardiologist will make this determination after careful evaluation of your test results and symptom evaluation.6 They may include several of the following options:

Lifestyle habits affect your heart health and the right changes can both prevent and help you recover from a cardiac event.6 One of the most important things to do if you’re a smoker is to quit immediately.6 Controlling high blood pressure and cholesterol, getting regular medical check-ups, managing diabetes, reducing stress, eating a low-fat and low-sodium diet, getting at least 30 minutes of moderate exercise on most days of the week, and limiting alcohol intake are other ways to prevent and ensure a quick, full recovery.6

Medications may be used but vary based on the type of event.6 During a serious heart attack with blockage, clot busters (thrombolytics) are used intravenously to restore blood flow through an artery as quickly as possible.6 For blockages caused by spasms, nitrates and calcium channel blockers are used. Aspirin is often given to reduce clotting, as are blood thinners and antiplatelet agents.6

Medical procedures or surgery can be used in conjunction with medications depending on the type of cardiac event and extent of damage to your heart.6

Coronary angioplasty and stenting may be done immediately after a cardiac catheterization exam that located your blockage if you’ve just had a heart attack. This catheter procedure uses a special balloon that is briefly inflated to open the artery while a stent is put in place to keep it open long term.6

Coronary artery bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed vessel so blood flow to the heart bypasses the narrowed or blocked section.6 It may be performed as an emergency procedure at the time of a heart attack or after your heart has had time to recover from your heart attack, usually between three and seven days later.6

Once blood flow to your heart is restored and your condition is stable, you're likely to remain in the hospital for several days.6

Cardiac rehabilitation program enrollment after being discharged from the hospital can help you develop an exercise routine in a safe, monitored environment.15 They assistance with dietary changes and coaching on post-heart attack lifestyle changes combined with the support of other people who have been through similar experiences.15

If you or someone you care about has just experienced a cardiac event, remember it's never too early or too late to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against heart disease and its complications, as well as the best ways to ensure a swift and complete recovery.

References

  1. Types of Heart Attacks. The Society for Cardiovascular Angiography and Interventions. http://www.secondscount.org/heart-condition-centers/info-detail-2/types-of-heart-attacks#.Wtu3WojwbIV Accessed 4.18.2018
  2. Diagnosing a Heart Attack. The Society for Cardiovascular Angiography and Interventions. http://www.secondscount.org/heart-condition-centers/info-detail-2/diagnosing-heart-attack#.Wtu3s4jwbIU Accessed 4.18.2018.
  3. After a Heart Attack: What Happens Now? (Part One). American Heart Association. http://heartinsight.heart.org/Fall-2016/After-a-Heart-Attack-What-Happens-Now/ Accessed 4.18.2018.
  4. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408160/ Accessed 4.18.2018.
  5. When chest pain strikes: What to expect at the emergency room. Harvard Medical School. https://www.health.harvard.edu/pain/when-chest-pain-strikes-what-to-expect-at-the-emergency-room Accessed 4.18.2018
  6. Heart Attack Diagnosis & Treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-attack/diagnosis-treatment/drc-20373112 Accessed 4.18.2018
  7. Diagnosing a Heart Attack. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Diagnosing-a-Heart-Attack_UCM_002041_Article.jsp#.Wtvzd4jwbIU Accessed 4.18.2018
  8. Heart attack recovery FAQs. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeartAttack/Heart-Attack-Recovery-FAQs_UCM_303936_Article.jsp#.WtzmEYjwbIU Accessed 4.18.2018
  9. How heart attacks became less deadly. Harvard Medical School. https://www.health.harvard.edu/healthbeat/how-heart-attacks-became-less-deadly Accessed 4.18.2018
  10. What is heart failure? American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/What-is-Heart-Failure_UCM_002044_Article.jsp#.WtzydIjwbIV Accessed 4.18.2018
  11. Blood tests for heart disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease/art-20049357 Accessed 4.18.2018
  12. Chest x-ray for heart failure. Stanford University. https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/heart-failure/diagnosis/chest-xray.html Accessed 4.18.2018
  13. What is a coronary angiogram. American Heart Association. https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300436.pdf Accessed 4.18.2018
  14. Chest pain. Mosby's Medical Dictionary, 8th edition. https://medical-dictionary.thefreedictionary.com/chest+pain Accessed 4.18.2018
  15. 5 things you need to do after a heart attack. Harvard Medical School. https://www.health.harvard.edu/heart-health/5-things-you-need-to-do-after-a-heart-attack Accessed 4.18.2018