Around 300,000 people in Germany suffer a heart attack every year. 255,000 of them survive it – mostly thanks to quick medical measures. But what exactly is happening here? FOCUS online explains what is important in the time after that.

Heart attack – the word makes our pulse rise directly, some freeze the blood in their veins. Many emotions are attached to it, as it affects the power plant of our lives.

A heart attack often catches you unexpectedly. Many people are heart patients without even knowing it. According to the current heart report, almost 45,000 people in Germany died of heart attacks in 2020. But there is a positive trend: Mortality has been falling for years. For men it fell by 27.2 percent from 2011 to 2020 – for women it fell by 32.8 percent.

On the one hand, this is because the rescue chain has improved. On the other hand, doctors can diagnose and treat heart attacks better. But what exactly happens after someone survives a heart attack? What are the five most important measures?

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That sounds banal at first. But Heribert Brück, cardiologist and spokesman for the Federal Association of Resident Cardiologists, knows from experience that those affected often wait too long. “Women in particular often don’t do it straight away – they often want to do this or that. That’s dangerous,” warns Brück. Because every minute counts. Then patients can survive a heart attack without consequential damage.

The primary goal after a heart attack is to unblock the blood vessels as quickly as possible. As soon as the heart is not supplied with sufficient oxygen, heart muscles begin to die. Hence the principle “Time is Muscle”, in German “Time is Muscle”, according to which physicians act.

The so-called coronary arteries lead to the heart. If one of them closes with a blood clot/blood clot (thrombus), a heart attack (myocardial infarction) occurs. The result: parts of the heart muscle are no longer supplied with blood well or at all. The muscles no longer get oxygen. That usually hurts. As a result, sufferers experience prolonged chest pain, usually under the breastbone. But other symptoms can also occur – especially in women. If the organ is undersupplied for more than a few minutes, muscle cells die. Doctors therefore act according to the principle “Time is Muscle”.

“The pain is already an expression of undersupply,” says cardiologist Brück. “That doesn’t mean the muscle is already damaged. But when symptoms such as cold sweats, fear of death or the feeling of ‘squeezing your chest like an elephant’ come along, you have to react quickly.”

The heart attack patient is therefore already given medication that has a vasodilating effect in the ambulance. In addition, doctors give other drugs that prevent blood clots (such as heparin), protect the heart, and control pain.

“In the hospital, a heart catheter is made immediately,” explains Heribert Brück. “This is now the gold standard in heart attack treatment.” It has been shown that all patients benefit from it. The fact that fewer and fewer people are dying of a heart attack is also due to this.

“The lysis, on the other hand, is no longer popular today,” explains the cardiologist. It is occasionally used in regions where patients cannot be treated quickly enough with a catheter. As a rule, however, the emergency doctor will choose a hospital with the appropriate equipment.

Heribert Brück is a specialist in cardiology with his own practice in Erkelenz near Mönchengladbach. He has been spokesman for the Federal Association of Resident Cardiologists (BNK) since 2008. In addition, he gives lectures on the subject of heart health and organizes specialist cardiological training courses.

Once the acute phase is over, the intensive diagnostics begins. Doctors and patients want to know: how bad was the heart attack? How many heart muscles are damaged?

The emergency doctor usually writes the first electrocardiogram (ECG) during transport to the hospital. This can often even be sent digitally to the clinic, so that the doctors treating you know directly what to expect. In the further course, ECG examinations check the heart activity.

“But there are many heart attacks that do not show any ECG changes,” Heribert Brück points out. “So you shouldn’t rely on that alone. The laboratory values ​​are much more important.”

Crucial here: highly sensitive troponin (troponin T hs), an enzyme that is released in the heart muscle. It must be checked several times within a few hours. If the concentration in the blood goes up or down, doctors know for sure that it was a heart attack.

Another value that appears in the blood count is the so-called CK (from the enzyme creatine kinase found in the muscles), which used to be the focus of attention. After four to six hours, this shows how much muscle mass has been damaged. After the infarction, the value remains elevated for a longer period before falling again several days later.

Different types of creatine kinase move around in the body. CK-MB is important for heart muscle cells. If muscle cells die during an infarction, CK-MB is increasingly detectable in the blood.

Depending on how severely the heart muscle and the supplying vessels are affected, the doctors decide to place one or more stents. If that is not sufficient, they secure the blood supply to the heart via a bypass, sometimes several bypasses.

“Nowadays, patients no longer stay in the clinic for long, but are mobilized quickly,” explains Heribert Brück. Patients are discharged the very next day or two after the infarction “when the heart enzymes are back in the right range”.

Everyone is entitled to follow-up treatment or rehabilitation. Who pays these and what the exact process is depends on whether someone is still working or not.

It is crucial for life after the heart attack that the patient recognizes: I am a heart patient. “We can’t cure those because the cause remains coronary artery disease,” says the cardiologist. And with it a 25 percent risk of having another heart attack. One in ten dies within a year of the heart attack.

But those affected can do a lot for their heart health. The keyword is: lifestyle change. According to the expert, this is the most important measure after acute therapy.

A heart-healthy lifestyle involves three things:

Doctors prescribe medication for those who survive a heart attack. On the one hand, they reduce the risk of having another seizure. On the other hand, they relieve the heart and “support the remodeling process in the heart that happens after a heart attack,” explains Brück. That is why people who do not have high blood pressure are also given antihypertensive drugs.

Heart attack patients always take two medications for the rest of their lives:

“Consistent medication intake is extremely important after a heart attack,” emphasizes Heribert Brück. Even if your heart has suffered little or no damage, you still remain a “heart patient”.

For at least a year, cardiac patients also take:

“After a year, heart attack patients should then validate the medication with their cardiologist and check whether and what dose is still necessary,” explains Brück.

If the heart function is in order, ACE inhibitors, sartans and beta blockers could possibly be saved. The lifestyle change may have contributed enough to heart health.

Read more about life after a heart attack and the 8-week program for a healthy heart here!