Every five years a person dies from the most common type of heart attack. The European Society of Cardiology (ESC) treatment guidelines for acute coronary syndrome without an increase in the ST segment are published online today on the European Heart Journal, 1 and on the ESC website. 2
Chest pain is the most common symptom, with pain radiating to one or both arms, neck, or jaw. Anyone with these symptoms should call an ambulance immediately. Complications include life-threatening heart rhythm disturbances (arrhythmia), which is another reason to seek immediate medical attention.
Treatment targets the underlying cause. The main cause is fatty deposits (atherosclerosis) that are surrounded by blood clots, narrowing the arteries that supply blood to the heart. In these cases, patients should be given anticoagulants and stents to restore blood flow. For the first time, the guidelines recommend imaging to identify other causes such as a tear in a blood vessel leading to the heart.
Regarding diagnosis, there is no specific change on the electrocardiogram (ECG), which may be normal. The main step is to measure a chemical in the blood called troponin. When the blood flow in the heart is reduced or blocked, the heart cells die and the level of troponin increases. If levels are normal, the measurement should be repeated after one hour to rule out the diagnosis. If it is high, hospitalization is recommended so that the severity of the disease can be assessed and the treatment strategy can be decided.
Since the main cause is related to atherosclerosis, there is a high risk of recurrence, which can also be fatal. Patients should be prescribed anticoagulants and lipid-lowering treatment. “Equally important is a healthy lifestyle that includes smoking, exercising, and eating a diet that emphasizes vegetables, fruits, and whole grains while limiting saturated fat and alcohol,” Professor Jean-Philippe Collette, Working Guidelines Group President and Professor of Cardiology, Sorbonne University, Paris, France.
Behavior change and medication adherence are best achieved when supported by a multi-disciplinary team consisting of patients and cardiologists, general practitioners, nurses, dieticians, physiotherapists, psychologists and pharmacists.
The likelihood of another heart attack during sexual activity is low for most patients, and regular exercise reduces this risk. Healthcare providers should ask patients about sexual activity and provide counseling and counseling to them.
Annual influenza vaccination is recommended – especially for patients over 65 years of age – to prevent heart attacks and increase longevity.
“Women should have equal access to care, early diagnosis and treatment with equal speed and intensity,” said Professor Holger Thiele, president of the group working on the guidelines. Medical Director, Department of Internal Medicine / Cardiology, Heart Center Leipzig, Germany.