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ELIPS®
Hôpitaux Universitaires de Genève
rue Gabrielle Perret-Gentil 4
(ex - 24 rue Micheli-du-Crest)
1211 Genève 14
e-mail : elips.heart@hcuge.ch

Management of a heart attack

Initial medical management

In order to resupply the heart muscle with oxygen, several treatments are started as soon as the emergency staff arrives:

During this period, you will be constantly looked after by the medical staff using technology that enables the monitoring of your electrocardiogram, your blood pressure and your oxygen levels.

The results of your electrocardiogram and the dosage of substances in your blood called cardiac enzymes (troponin and CK), will give rise to 2 possible situations:

Opening a coronary artery known as revascularization 

Coronary angiogram, coronary angioplasty and stents

A coronary angiogram is an exam that enables coronary arteries to be visualized. Under local anesthetic, a plastic catheter is inserted into an artery located in the groin or at the wrist and pushed up into the coronary arteries. The local anesthetic can create a burning sensation. An iodine based contrast product is then injected into the left and right coronary arteries to allow visualization of the arteries with X-rays. In this way, narrowing or complete obstructions that are responsible for heart attacks or unstable angina, can be seen.

This intervention can also be used to treat the narrow arteries, or unblock the blocked arteries. This is done with a procedure called coronary angioplasty. A balloon is placed within the narrowed area and then blown to unblock the artery and re-establish blood flow. In general, the success of the procedure can be increased, and a recurrence of the narrowing prevented, with the implantation within the sick arteries of cylindrical metallic lattices, called stents.

The main inconvenience of the procedure is that the patient must remain calm on an examination bed during the procedure, which lasts between 1 to 2 hours, as well as remain in bed afterwards for a few hours. This is to help with the healing of and prevent bleeding from the puncture point at the groin or at the wrist.

There are 2 types of stents: bare metal stents and stents encoated with medication known as drug eluting stents. These medications are aimed at preventing re-narrowing of the arteries. The use of drug eluting stents requires that, in addition to aspirin, another type of blood thinner be taken for at least 12 months (as opposed to 1 one with bare metal stents). This is because drug eluting stents slightly increase the risk of blood clots (thrombosis); the metal lattice is more slowly covered with body tissue. The choice of stent will depend on factors such as whether surgery is planned in the near future. In this case, a bare metal stent will be preferred as risk of bleeding is increased when 2 blood thinners (anti platelet aggregators) are used simultaneously.

Importantly, you must never stop taking the platelet anti aggregators without in prior speaking to your physician or cardiologist.

As with any procedure, coronary angiography and angioplasty carry some risk:

Other rare complications that may occur are:

Coronary artery bypass surgery

This is surgery that usually requires opening of the chest (thoracotomy) and the temporary arrest of the heart. The aim is to use segments of your own veins or arteries and to graft them to your coronary arteries so as to by-pass the areas that are narrow or blocked by atherosclerosis.

These days, cardiac revascularization surgery is less frequently proposed because coronary angioplasty has become effective and safe. However, there are situations when coronary artery bypass surgery remains appropriate:

Last modification on 24/09/2010