Heart Attack - Diagnosis

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Please describe the events that led to a diagnosis of a heart attack. What tests and exams did you have?

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How is a heart attack diagnosed?

When there is severe chest pain, suspicion that a heart attack is occurring usually is high, and tests can be performed quickly that will confirm the heart attack. A problem arises, however, when the symptoms of a heart attack do not include chest pain. A heart attack may not be suspected, and the appropriate tests may not be performed. Therefore, the initial step in diagnosing a heart attack is to be suspicious that one has occurred so that the appropriate tests can be done.

Electrocardiogram. An electrocardiogram (ECG) is a recording of the electrical activity of the heart. Abnormalities in the electrical activity usually occur with heart attacks and can identify the areas of heart muscle that are deprived of oxygen and/or areas of muscle that have died. In a patient with typical symptoms of heart attack (such as crushing chest pain) and characteristic changes of heart attack on the ECG, a secure diagnosis of heart attack can be made quickly in the emergency room and treatment can be started immediately. If a patient's symptoms are vague or atypical and if there are pre-existing ECG abnormalities, for example, from old heart attacks or abnormal electrical patterns that make interpretation of the ECG difficult, the diagnosis of a heart attack may be less secure. In these patients, the diagnosis can be made only hours later through blood tests.

Blood tests. Cardiac enzymes are proteins that are released into the blood by dying heart muscles. These cardiac enzymes are creatine phosphokinase (CPK), special sub-fractions of CPK (specifically, the MB fraction of CPK), and troponin, and their levels can be measured in blood. These cardiac enzymes typically are elevated in the blood several hours after the onset of a heart attack. Currently, troponin levels are considered the preferred lab tests to use to help diagnose a heart attack, as they are indicators of cardiac muscle injury or death. A series of blood tests for the enzymes performed over a 24-hour period are useful not only in confirming the diagnosis of heart attack, but the changes in their levels over time also correlates with the amount of heart muscle that has died.

The most important factor in diagnosing and treating a heart attack is prompt medical attention. Rapid evaluation allows early treatment of potentially life-threatening abnormal rhythms such as ventricular fibrillation and allows early reperfusion (return of blood flow to the heart muscle) by procedures that unclog the blocked coronary arteries. The more rapidly blood flow is reestablished, the more heart muscle that is saved. At this time, mechanical reperfusion with angioplasty and/or stenting to increase the flow of blood to the heart is the preferred way to preserve heart muscle if it can be performed within 90 minutes of arrival to the hospital; if there will be a delay, thrombolytic agents (clot busters) are preferred.

Large and active medical centers often have a "chest pain unit" where patients suspected of having heart attacks are rapidly evaluated. If a heart attack is diagnosed, prompt therapy is initiated. If the diagnosis of heart attack is initially unclear, the patient is placed under continuous monitoring until the results of further testing are available.

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See what others are saying

Comment from: teri, 45-54 Female (Patient) Published: March 13

I had chest pains, burning and clammy sweating, the pain was severe in the middle of my chest. I went to the emergency room. My ECG was negative but my blood enzymes were elevated so they said I had heart attack and did heart catheterization which showed I had 85% blockage in my widow maker. I had 2 open heart surgeries in 3 days' time. During my first surgery my pin came out and my heart filled with blood. I had blood clots and had to have transfusion from blood lost. I had machine on me to keep my body temperature warm and was on life support. I died twice, now I'm recovering. I had COPD and was on oxygen before all this happened and I still can't get disability.

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Comment from: knucklehead, 55-64 Male (Patient) Published: December 13

I felt a little pressure in the center of my chest and elevated breathing for about 20 seconds while walking through an airport early one morning. It went away quickly. Two days later, I was riding my bicycle and the pressure and elevated breathing happened again, this time stronger. But after I stopped and rested, it went away. I assumed it was acid reflux since it was in the center of my chest and not on the left side. Over several days, I realized that whenever I walked 50 yards or more, the pressure and shortness of breath would occur, but would go away when I stopped and rested. I finally told my wife, we went to the emergency room, they ran blood tests, etc. and everything looked fine. I was told to return in 2 days for a stress test. I failed the stress test, they performed an angioplasty, found I had 99% stenosis (blockage) in my right coronary artery. They immediately put a stent in.

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