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How diagnosed heart attack?

The diagnosis of myocardial infarction is in most cases easy to adjust, but sometimes it can be difficult. The medical requirements for diagnosis certain is that there is a typical increase of troponin in the blood, and that in addition, either symptoms suggestive of infarction, typical changes on ECG or proven blockage of blood vessels by X-ray (PCI) .

The first investigations
A heart attack usually begins acutely, but the process continues over hours. For every minute that passes before the initiation of treatment, the more damage is applied to the heart. Therefore, you must seek help as soon as possible if you suspect that you have a heart attack - that is, symptoms of heart attack.

In some cases the diagnosis is reasonably clear already before transported to the hospital. Medical history, your findings as a GP and / or paramedics do, and the results of the ECG taken place, in many cases almost certainly give the diagnosis.

At the hospital, they will quickly make an initial assessment of your condition. If you are able to respond to you, they will ask you whether symptoms. They will examine you, and great emphasis is placed on examining the pulse, blood pressure, circulation, heart and lungs.

Upon arrival at the hospital will be taken ECG to check for early signs of developing heart attack. A quick diagnosis is essential to start treatment as early as possible. If doctors think you're about to have a heart attack, you upon arrival at the hospital and the following days shall be thoroughly examined by tests with high certainty say if you have had a heart attack.

Blood tests

Routine blood tests include counting the number of blood cells (such as white blood cells) and to analyze chemical substances in the blood.

Infarct markers. When the heart muscle is damaged, releases certain muscle proteins into the bloodstream, and they can be measured. Elevated levels of some of these proteins is tantamount to the existence of an acute myocardial infarction. Repeated measurements of these markers useful, especially if recording an ECG does not show a certain heart attack.

Troponin rise in a patient with chest pain is tantamount to a heart attack. The level rises 6-8 hours after heart attack begins, and they can remain elevated as long as a week. To a certain extent the level of troponin used to predict the risk of complications. The level can also be useful when deciding what treatment you should receive. Measured in addition also an enzyme called CK-MB. This enzyme rises first few hours after cell damage and normalize within 24 hours after the heart attack occurred.

This test records the heart's electrical activity, which is displayed in a distinctive graphic pattern. Each heartbeat has a certain pattern. Deviations from this pattern can provide information about the heart's condition. The survey is safe and without discomfort, and it only takes a few minutes. Electrodes attached to the arms, legs and chest. The electrodes pick up electrical impulses from your heart and depicts them graphically. ECG changes typical of myocardial infarction can sometimes be seen early in the course, but the ECG can be normal at first and examination must be repeated. Sometimes old ECG changes make it difficult to interpret the ECG.

This is an ultrasound examination of the heart . The survey uses sound waves to create an image of the heart, an image is transferred to a TV screen. This is a safe and useful test that is without discomfort. The echo can show changes in cardiac structure, such as changes in hjerteveggens movements.

A heart attack is a damaged heart wall. Echo may show abnormal enlargement (hypertrophy) or ballooning of the heart wall (aneurysm). Echo can also highlight the complications of a heart attack that flap problems, cracking of the heart muscle or the accumulation of fluid in the pericardium (pericardial fluid). The most important information that echo can give is to determine the so-called "ejection fraction". This is a measure of cardiac muscle strength. This information can be used to predict the prognosis of myocardial infarction and to determine further treatment.

Coronary angiography
This is the best test to detect blockages in the coronary arteries. The investigation is often performed in people with persistent pain and have not had a blood thinning medication to reopen the blocked artery. At some hospitals take the patient directly to the catheterization after they have undergone the first medical examination.

A long, thin plastic tube (catheter) is inserted into the bloodstream via an insert in the groin artery or an artery in the arm. The catheter is then passed up to the heart. Under the fluoroscope doctor looking forward to the opening of the coronary arteries. Dye is injected into the arteries so that blood vessels are visible on radiographs (see video ).

The investigation is ongoing into the coronary arteries angiography. Survey could lead to serious problems, but the experienced physician, can be carried out by small complications.

An angiogram is the best examination to determine what treatment is most appropriate: Medical, blocking the artery (angioplasty), insertion of armor in the clogged artery (stenting) or bypass surgery.

Load Tests
A load test performed a few times before leaving the hospital. The investigation carried out after you have been stable and have recovered from myocardial infarction and / or treatment. A physical stress testing is that it takes a while ECG heart charged (eg. going on a treadmill). Certain changes in the ECG may indicate possible blockage of a coronary artery. Such an exercise test is 60-70% accurate when it comes to predicting the risk of future heart attack. If the load test shows serious blockages may be required (new) coronary angiography to confirm the diagnosis and determine the need for further treatment.

Scintigraphic stress testing is another form of stress testing. It uses a special camera that examines blood stream after a minimal dose of radioactive material (an isotope) is injected into the coronary arteries. The test measures the amount of blood flow that reaches the various parts of the heart muscle through the coronary arteries. Just as the physical load test pictures taken while the heart is placed under "stress". If a particular coronary artery is completely or partially blocked, the portion of the heart which causes blood supply from the artery appear as a "cold spot" of images, because no radioactive isotopes when this area. This test is quite accurate for detecting blockage of a coronary artery. The tiny amount of radioactivity used is

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