Coronary heart disease
A myocardial infarction, or heart attack, is a life-threatening cardiac event. It occurs when blood flow to and from the heart is impeded due to narrowed or blocked coronary arteries.
Unless the blocked coronary artery can be reopened within a few hours, the part of the heart muscle supplied by the artery will die (infarct).
Causes / Risk factors
Atherosclerosis is the main cause of narrowed coronary arteries. Even younger adults will show some evidence of atherosclerosis. Atherosclerosis is not limited to the coronary arteries but can affect all the body's blood vessels.
The main risk factors associated with atherosclerosis include:
- Increasing age
- High blood pressure
- Increased blood cholesterol levels
- Being overweight
- Family history, i.e. cardiovascular disease in members of the family
- Lack of exercise
Typical symptoms of a heart attack include a sudden, severe, crushing or burning pain in the centre or left side of the chest, often radiating to the left arm. However, symptoms may also include upper abdominal pain, back pain or jaw pain.
Pain may be accompanied by feelings of anxiety, or a sense of impending doom, severe shortness of breath or dizziness.
Research suggests that symptoms of a heart attack can be very different in men and women. Women commonly experience fewer of the "typical" symptoms associated with a heart attack:
- Only approximately 30% of women experience chest pain
- 39% experience pain in the stomach rather than in the area around the heart
- 42% experience shortness of breath
- 48% experience disturbed sleep
- 70% experience fatigue
15-20% of all heart attacks are "silent heart attacks", i.e. are not associated with any pain. Silent heart attacks are particularly common among people with diabetes.
For a healthy heart the normal heart rate at rest is between 60 and 80 beats per minute (cardiac frequency = beats per minute). A healthy heart beats regularly, i.e. the intervals between beats are more or less the same. During exercise, cardiac frequency can reach 180 beats per minute, while it can drop to 40 beats per minute during periods of deep sleep. Even a healthy heart will produce the occasional extra beat, thus producing brief spells marked by a more irregular pulse. These are harmless and, in most cases, will go completely unnoticed.
The term "cardiac arrhythmia" is used to describe a heart which consistently beats either too fast or too slowly given the affected person's actual level of physical activity, or a heart that beats irregularly over long periods of time. Cardiac arrhythmias may or may not produce symptoms. Typical symptoms may include a skipping sensation in the chest, uncomfortable palpitations or a pounding heart, shortness of breath, reduced physical performance, dizziness and even sudden loss of consciousness.
Although symptoms can be very unpleasant, most arrhythmias are harmless. Most arrhythmias will only require treatment if they produce symptoms.
A small number of arrhythmias, however, can be life-threatening and will require urgent treatment. In many cases, cardiac arrhythmias characterised by a fast or irregular heartbeat can be treated with medications (antiarrhythmic drugs). Catheter ablation is also often an option. Fast arrhythmias can be terminated by delivering an electric shock (cardioversion), while a pacemaker is usually a good option for treating a heart that beats too slowly.
Where patients with much rarer and life-threatening fast arrhythmias are concerned, and patients with heart disease that places them at a high risk of suffering a life-threatening arrhythmic event in the future, treatment may have to include the implantation of a defibrillator (ICD).
You can take your own pulse by placing your left index finger on the inside of your right forearm, approximately 2-3 centimetres below the base of your thumb. You can also take your pulse in your neck. To do so, place your index finger directly next to your larynx just below the lower jaw.
Chest Pain Unit
Ludwigshafen Hospital has a certified Chest Pain Unit (CPU). The Unit forms part of the Medical Clinic B and is dedicated to the prompt investigation of unexplained chest pain.
The CPU is a major link in the treatment pathway available for patients with acute chest pain. The Unit will be able to quickly establish whether the patient has suffered a heart attack, whether they suffer from unstable angina pectoris or aortic disease, whether they have a pulmonary embolism, or whether they have myocarditis. Our Unit, which is equipped to the latest standards in diagnostic technology and follows treatment procedures in line with the relevant specialist guidelines, can provide a much improved assessment of the patient's condition. This is particularly important when a patient presents with a life-threatening condition whose symptoms are similar to that of a heart attack. Our close working relationship with the Central Institute for Diagnostic and Interventional Radiology is of particular significance. The Institute offers Cardiac CT- scanning, which, in certain cases, may help avoid catheter-based investigations.
Prompt diagnosis is provided via ECG, echocardiography, X-ray, cardiac catheterisation or cardiac stress testing, leading to a quick decision as to whether emergency treatment will be required. Similarly, where the condition is less serious, a prompt decision as to whether the condition might be treatable on an outpatient basis means that the patient will be discharged quickly and will be able to return home. If ECG changes are clearly indicative of a heart attack, patients will have immediate access to one of our two catheterisation laboratories.
The Chest Pain Unit achieved certification by the German Cardiac Society in late 2009, making Ludwigshafen Hospital's CPU one of approximately 40 such certified units.
We are open 24 hours a day for emergencies:
Tel: 0621 503 4006 or 4007
If an ST segment elevation myocardial infarction (STEMI) is suspected:
Cardiac Catheter Unit
Tel: 0621 503 3737
Artikel und Abstracts zur klinischen Forschung der Medizinischen Klinik B finden Sie auf der Website der KliLu Forschung GmbH.