Heart attack

and Martina Feichter, medical editor and biologist

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

A heart attack (myocardial infarction) occurs when a blood vessel in the heart muscle (coronary artery) closes. The muscle is then cut off from the oxygen supply and can no longer do its work. A heart attack can be life threatening! That is why it is important to identify the symptoms of a heart attack as early as possible. Here you can read everything you need to know about warning signals, causes and treatment options and first aid in the event of a heart attack.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. I22I21I23

Heart attack: quick reference

Typical symptoms: severe pain in the left chest area / behind the sternum, shortness of breath, feeling of oppression / fear; Warning, the symptoms in women may be different (dizziness, vomiting) than in men!
First aid: Call an ambulance, calm the sick, raise the upper body, loosen tight clothing (tie, collar, etc.), in the event of unconsciousness and lack of breathing, immediate resuscitation!
Risk factors: high blood pressure, high cholesterol, obesity, little exercise, diabetes, smoking
Cause: usually a blood clot blocking a coronary artery
Examinations: EKG, heart ultrasound, blood tests, cardiac catheter examination
Treatment options: widening of the narrowed heart vessel (balloon dilatation) and installation of a vascular support (stent) as part of a PTCA, drug dissolution of the blood clot (lysis therapy), other drugs, bypass surgery
Prevention: healthy lifestyle, regular exercise, healthy body weight

Heart attack: symptoms

There is no time to lose when you have a heart attack. The earlier it is recognized and treated, the greater the chances of survival. That is why you should dial the emergency number (Tel. 112) at the slightest suspicion and the first symptoms of a myocardial infarction - even at night or on the weekend!

In order to be able to react quickly, however, one must know the heart attack symptoms in men and women. But be careful: the typical signs do not always appear. Also, a woman's heart attack symptoms are often different from a man's.

Heart attack

Three questions for

Prof. Dr. med. Eberhard Windler,
Specialist in internal medicine and endocrinology
1
Can I do physical exertion after a heart attack?

Prof. Dr. med. Eberhard Windler
Physical exercise also makes you healthy after a heart attack! But: shortly after a heart attack, the heart muscle is not yet fully efficient and sensitive. Since performance depends on many factors - such as the size of the infarct - there is no rule for everyone. It is best to talk to your doctor and do not play sports alone at the beginning, but in coronary sports groups under medical supervision.
2
I am afraid of another heart attack - what do you advise me to do?

Prof. Dr. med. Eberhard Windler
In fact, there is a high risk of having another after having a heart attack. Therefore, you would do well to minimize all known risk factors. Mind your blood pressure, watch your blood sugar levels. The lowering of cholesterol is very effective, regardless of whether the level is increased or in the reference range. And: lose weight if you need to.
3
What is the influence of diet?

Prof. Dr. med. Eberhard Windler
Those affected are often not aware of how important their lifestyle is! A healthy diet is highly effective: a predominantly vegetarian diet not only influences the known risk factors, but also has its own beneficial effect on the blood vessels. Those who then exercise daily, quit smoking and avoid the underestimated factor stress are doing a lot for themselves and their hearts.
Prof. Dr. med. Eberhard Windler,
Specialist in internal medicine and endocrinology
As co-director of the Medical Prevention Center Hamburg (MPCH), Prof. Windler gives advice on the prevention of hardening of the arteries (arteriosclerosis) and the subsequent diseases.

This is how you can tell if you have a heart attack

A classic sign of a heart attack ("heart attack") is sudden, severe pain in the chest, in the front left chest area or behind the sternum. The pain can be pressing, stabbing, or burning. According to the German Heart Foundation, they last for at least five minutes. Sometimes they also radiate to other regions of the body. Pain in the arm (especially on the left), in the upper abdomen, in the back, in the shoulder or in the jaw can be a warning signal for a heart attack.

Other typical heart attack symptoms are:

Feeling of anxiety or tightness: Those affected often describe this strong feeling of constriction as “as if an elephant was standing on my chest”.
Feeling anxious to the point of fear of death: The strong fear is often accompanied by cold sweat, a sallow complexion and cold skin.
Sudden severe shortness of breath, loss of consciousness or severe dizziness: These unspecific symptoms can have many causes, including a heart attack. They occur more often in women.
Nausea and vomiting: These symptoms, which occur in many diseases, are also possible signs of a heart attack, especially in women. This is especially true if those affected have not previously experienced such complaints to this extent.

The signs of a heart attack also depend on which coronary artery is affected. For example, blockages of the right coronary artery often lead to what is known as a posterior wall infarction. They are more likely to cause discomfort in the upper abdomen. If, on the other hand, the left coronary artery is blocked, an anterior wall infarction results. Here the pain is more localized in the chest area.

Typical signs of a heart attack

The symptoms shown indicate a heart attack. Particularly sudden, severe chest pain is a typical sign of a heart attack. But be careful: not all people who suffer a heart attack have the typical symptoms!

In some cases, a heart attack is pain-free. Such a "silent infarction" occurs particularly often in patients with diabetes mellitus and in older people.

Deviating heart attack symptoms in women

The symptoms described above do not always appear in a heart attack. Women often have different symptoms. While the majority of affected men feel the classic chest pain, this occurs in only about a third of women. In addition, patients more often report a feeling of pressure or tightness in the chest instead of severe chest pain.

In addition, unspecific complaints are much more often a sign of heart attack in women. These include shortness of breath, nausea and vomiting, as well as discomfort in the upper abdomen.

Such complaints are often not immediately identified as heart attack symptoms and are not taken seriously. This is why women with a heart attack come to the clinic on average one hour later than affected men (counted from the onset of the first signs of heart attack). However, rapid medical care is vital.

Heart attack: harbingers

Many heart attacks occur “out of the blue”. There was previously no evidence that a coronary artery was threatened with occlusion.

In the other cases, signs herald the heart attack. Many patients suffered (unnoticed) from coronary heart disease (CHD) decades before. The coronary vessels become increasingly narrower due to "calcification" (arteriosclerosis). This increasingly affects the blood flow to the heart muscle. This can be recognized, for example, by the fact that chest pain and / or shortness of breath occur during physical exertion or emotional excitement. After the end of the exercise, the symptoms disappear again within minutes.

Doctors speak of "chest tightness" (angina pectoris). A heart attack can develop from it at any time. This is especially true when the duration and intensity of the angina attacks increase. Particular caution is also required if the chest pain and / or shortness of breath occur even with the slightest stress or even at rest. These are then serious harbingers of an impending heart attack. In such cases, call the emergency doctor immediately!

Heart attack: causes and risk factors

A heart attack usually results from a blood clot blocking a coronary artery. The cardiac cranial vessels are the vessels that supply the heart muscle with blood and oxygen. Most of the time, the artery in question has already been narrowed by deposits (plaques) on the inner wall. These consist of fats and lime. Such hardening of the arteries (arteriosclerosis) in the area of the coronary arteries is called coronary heart disease (CHD).

The plaques can crack and break open. Then blood platelets (thrombocytes) immediately accumulate to close the cracks. This releases messenger substances that attract more blood platelets - a blood clot (thrombus) forms. If this clot completely blocks the vessel in question, a heart attack occurs: The heart muscle, which is primarily supplied by this coronary vessel, no longer receives enough oxygen. It can then die within a few hours. In the worst case, the patient dies of the heart attack (acute cardiac death).

That happens with a heart attack

During a heart attack, narrowed coronary arteries clog due to deposits on the vessel wall. Often they are also blocked by a blood clot. The affected coronary artery can no longer supply the heart muscle with sufficient blood and oxygen. Intervention must be taken as quickly as possible so that the heart muscle does not die.

Coronary artery disease is considered to be the main cause of myocardial infarction. Other causes of myocardial infarction are very rare, for example cramps (spasms) of the coronary arteries.

Risk factors for heart attack

Certain factors are not a direct cause of myocardial infarction, but increase the risk of a heart attack. These include above all those risk factors that favor the above-described deposits on the inner wall of the coronary arteries (arteriosclerosis).

Some of these risk factors cannot be influenced. These include, for example, older age and male gender. However, something can be done about other risk factors: for example, obesity and a high-fat diet. In general, the following applies: The more of the risk factors mentioned below a person has, the higher their risk of heart attack.

Male sex: The sex hormones apparently have an influence on the risk of heart attack. Because women before menopause have a lower risk of heart attacks than men; they are then better protected by the female sex hormones such as estrogens.

Genetic predisposition: Cardiovascular diseases are more common in some families - genes seem to play a role in the development of a heart attack. So the risk of a heart attack is to some extent hereditary.

Older age: The degree of hardening of the arteries increases with age. This also increases the risk of a heart attack.

Diet: High-fat and high-energy foods lead to obesity and high cholesterol levels. Both of these promote hardening of the arteries and thus coronary artery disease - the most common cause of heart attacks.

Obesity: It is generally unhealthy to put too many pounds on the scales. This is even more true if the excess weight is concentrated on the stomach (instead of the hips or thighs): Belly fat produces hormones and messenger substances that increase the risk of cardiovascular diseases such as coronary artery disease and heart attacks, among other things.

Lack of exercise: Adequate exercise has many positive effects on health. One of them: Regular physical activity prevents hardening of the arteries and coronary heart disease by lowering blood pressure and improving cholesterol levels. These protective effects do not apply to those who don't like exercise.

Smoking: Substances from tobacco smoke promote the formation of unstable plaques that can break open easily. In addition, when you smoke every cigarette, the blood vessels, including the coronary arteries, constrict. Most people who have a heart attack before the age of 55 are smokers.

High blood pressure: Constantly high blood pressure values directly damage the inner walls of the blood vessels. This promotes deposits on the walls (arteriosclerosis) and thus coronary heart disease.

Elevated cholesterol: high LDL levels and low HDL levels also encourage plaque build-up.

Diabetes mellitus: In diabetes, the blood sugar level is abnormally high. In the long run, this damages the blood vessels - a risk factor for arteriosclerosis and coronary heart disease.

It is controversial whether an increased value of the protein building block (amino acid) homocysteine also represents a heart attack risk factor.

Heart attack: treatment

Heart attack: first aid

Here's how you should provide first aid if you have a heart attack:

Call the emergency doctor (Tel. 112) at the slightest suspicion of a heart attack!
Position the patient with the upper body elevated, for example by leaning them against a wall.
Open tight clothing such as a collar and tie.
Calm the patient down and ask them to breathe calmly and deeply.
Don't leave the patient alone!

If the patient becomes unconscious, no breathing is recognizable or no pulse can be felt, then there is a cardiovascular arrest. Then you have to act quickly and revive (reanimate) the patient: Do the cardiac pressure massage or - if you are used to it - alternate cardiac pressure massage and mouth-to-mouth resuscitation (alternately press 30 times and ventilate twice). Continue the resuscitation measures until the emergency services arrive or the patient is breathing independently again.

Heart attack: what does the emergency doctor do?

The emergency doctor or paramedic will immediately check the most important parameters of the patient such as level of consciousness, pulse and breathing. He also connects the patient to an EKG or a monitor to monitor heart rate, heart rhythm, oxygen saturation and blood pressure. The EKG is very important for an accurate diagnosis of a heart attack. It can be used to determine whether it is a so-called heart attack with ST segment elevation (ST elevation infarction, STEMI) or a heart attack without ST elevation (non-ST elevation myocardial infarction, NSTEMI). This distinction is important for the choice of immediate therapy (see below).

The patient is supplied with oxygen via a nasogastric tube if the oxygen saturation is too low, or if there is shortness of breath or acute cardiac insufficiency.

Access is also provided through a vein so that the patient can quickly administer the medication that is needed. These can be, for example, diazepam against severe anxiety and morphine against pain. Also important are active ingredients (such as acetylsalicylic acid) that prevent the blood clot in the coronary artery from getting bigger or further clots from forming.

The emergency doctor also gives the patient nitrates, usually in the form of an oral spray. These widen the blood vessels, lower the heart's need for oxygen, and reduce pain. However, nitrates do not improve the prognosis for myocardial infarction.

If a cardiac arrest occurs during the transport to the hospital, the emergency doctor or paramedic immediately start the resuscitation with a defibrillator.

More heart attack therapy

Further treatment for a heart attack depends largely on whether it is a heart attack with an ST segment elevation (STEMI) or a heart attack without an ST segment elevation (NSTEMI) (see below: "Heart attack: examinations and diagnosis"):

STEMI: The therapy of first choice for these patients is acute PTCA. This means that the constricted heart vessel is widened by a balloon (balloon dilatation) and kept open by inserting a stent. If necessary, a lysis therapy is carried out at STEMI (administration of drugs that dissolve the blood clot in the heart vessel). Under certain circumstances, a bypass operation may be necessary in the further course.
NSTEMI: The benefit of immediate balloon dilatation (acute PTCA) has not been proven here. Lysis therapy is also not indicated. Instead, those affected receive medication immediately after the diagnosis, for example against (further) clot formation (such as acetylsalicylic acid). In addition, a cardiac catheter examination can be useful to determine the extent of damage to the heart muscle. It should be performed within two to 72 hours, depending on the patient's risk profile. Further therapeutic measures depend on the result of the examination (e.g. further drug treatment, balloon dilatation and stent installation, bypass surgery).

The various therapy options for heart attacks are described in more detail below.

Heart attack therapy: acute PTCA

In the case of a heart attack with ST segment elevation (STEMI), the therapy of first choice is a so-called acute PTCA (percutaneous transluminal coronary angioplasty). A cardiac catheter is immediately inserted to expand the blocked vessel with the help of a balloon. This is called balloon dilatation. Afterwards, a stent is often implanted in the event of a heart attack: This is a small metal stent that is supposed to keep the blood vessel open. Stents that are coated with an anticoagulant drug are often used. It prevents a blood clot from forming again at this point.

In most cases, acute PTCA can reopen the blocked blood vessel after a heart attack. To do this, it should be performed within 60 to 90 minutes of the onset of pain.

However, such an operation is not available promptly for all STEMI patients, because not every clinic has cardiac catheter slots. If a heart attack patient cannot be brought to a hospital where acute PTCA is possible within 120 minutes, they should instead receive lysis therapy (see below) within 30 minutes. He should then be transferred to a cardiology center for an acute PTCA within the next three to 24 hours.

Heart attack therapy: lysis therapy

Lysis therapy (thrombolysis therapy) is an option for patients with ST segment elevation myocardial infarction (STEMI). The blood clot that triggered the heart attack is dissolved with medication (lysis). To do this, the doctor injects the patient into a vein that either breaks down the thrombus directly or activates the body's own breakdown enzymes (plasminogen), which in turn dissolve the blood clot.

The chance that the coronary artery will open again is greatest shortly after the heart attack. Sometimes the emergency doctor starts the lysis therapy even before the patient arrives at the hospital.

The lysis can be carried out up to a maximum of twelve hours after a heart attack. After that, the blood clot will no longer dissolve properly and the side effects of treatment will predominate.

Side effects: The lysis drugs administered after a heart attack strongly inhibit the body's own blood clotting - not just in the heart, but in the entire body. Serious bleeding can therefore occur as a complication. Hitherto undetected sources of bleeding such as stomach ulcers or vascular malformations (aneurysms) can be activated and start to bleed. One of the most serious side effects is a cerebral haemorrhage.

Heart attack therapy: medication

In the case of a heart attack, the doctor usually prescribes medication for the patient. Some of these have to be taken permanently. Which active substances are prescribed for the patient and how long he has to take them depends on the individual risk profile. Common medications for heart attack patients are:

Acetylsalicylic acid (ASA): The active ingredient ASA is a so-called platelet aggregation inhibitor. That is, it prevents platelets from sticking together. In the event of an acute heart attack, this prevents the blood clot in the affected coronary artery from enlarging (or new clots from forming). Even the emergency doctor injects ASA into the patient because early treatment improves the prognosis.
Other antiplatelet drugs: Some heart attack patients also receive clopidogrel, prasugrel, or other antiplatelet drugs.
Beta blockers: They lower blood pressure, slow the heartbeat and relieve the heart. If they are given early, you can reduce the size of the heart attack and prevent life-threatening arrhythmias (ventricular fibrillation). Even the emergency doctor can administer beta blockers to the patient.
ACE inhibitors: These drugs widen blood vessels, lower blood pressure, and relieve the heart. They lower the risk of death in heart attack patients.
Cholesterol lowering drugs: So-called statins lower high levels of the "bad" LDL cholesterol. This can reduce the risk of another heart attack.

For heart attack without ST segment elevation (NSTEMI), drug treatment is generally started immediately after diagnosis. Patients receive antiplatelet drugs (such as acetylsalicylic acid, prasugrel), anticoagulants (such as fondaparinux) and drugs to prevent blood flow (beta blockers). Sometimes drug therapy is sufficient for NSTEMI. However, further therapeutic measures may also be necessary (such as balloon dilatation or bypass surgery).

Heart attack therapy: bypass surgery

In some heart attack patients, the coronary arteries are so severely altered that bypass surgery is necessary: Under general anesthesia, the surgeon first removes an artery from the patient's chest wall or a superficial leg vein. He then uses this to bridge the constriction of the coronary artery.

Heart attack: examinations and diagnosis

The urgent suspicion of a heart attack arises from the patient's complaints. But the signs are not always clear. Therefore, various examinations are necessary. They help to confirm the diagnosis of myocardial infarction and to rule out other diseases that can trigger similar symptoms (chest pain, etc.). This includes, for example, an inflammation of the pericardium (pericarditis), a tear in the large body artery (aortic dissection) or a pulmonary embolism.

EKG

Electrocardiography (EKG) is the most important examination method for suspected heart attack. Electrodes are placed on the patient's chest. These record the electrical excitation in the heart muscle. Characteristic changes in this electrical cardiac activity indicate the size and location of the infarct. When planning therapy, it is important to differentiate between a heart attack with and without an ST segment elevation:

Heart attack with ST segment elevation (STEMI): In this form of heart attack, a certain section of the ECG curve (the ST segment) is raised in an arc. The infarct affects the entire heart wall (transmural myocardial infarction).
Heart attack without ST segment elevation (NSTEMI or Non-STEMI): In this internal wall infarction (non-transmural infarction), the ST segment is not raised in the ECG. Sometimes the EKG is even completely normal despite the typical symptoms of a heart attack. The diagnosis of myocardial infarction can only be made here if certain "heart enzymes" can be detected in the blood (see below: "Blood test").

In addition, heart attacks that do not cause symptoms (silent or silent heart attack) can also be detected by means of an EKG. Cardiac arrhythmias can also be seen in the ECG. These are by far the most common complication of a recent heart attack.

In addition, the ECG helps to differentiate an acute myocardial infarction from a heart attack that has been in the past.

Some heart attacks do not show up on the EKG immediately after they occur, but only become visible a few hours later. Therefore, if a myocardial infarction is suspected, several ECG examinations are carried out a few hours apart.

Cardiac ultrasound (echocardiography)

If the ECG does not show any typical changes, although the symptoms suggest a heart attack, a heart ultrasound through the chest may help. The technical term for this examination is "transthoracic echocardiography". The doctor can detect disorders of the wall movement of the heart muscle here. Because if the blood flow is interrupted by the infarct, the heart section in question no longer moves normally.

Blood test

The heart muscle cells that die in a heart attack release certain enzymes. In the event of a heart attack, their concentration in the blood is increased. These proteins, also known as biomarkers, include troponin T, troponin I, myoglobin and creatine kinase (CK-MB). However, with the classic tests used for this, the concentration of the enzymes in the blood does not increase measurably until about three hours after the heart attack at the earliest. Newer, highly refined procedures can accelerate the diagnosis.

Cardiac catheter

A cardiac catheter examination reveals which coronary artery is closed and whether other vessels are narrowed. The function of the heart muscle and heart valves can also be assessed with the aid of this examination.

As part of the cardiac catheter examination, the doctor inserts a narrow, flexible plastic tube into the leg artery (femoral artery) and pushes it against the bloodstream to the heart. A coronary angiography is usually carried out as part of the examination, i.e. a contrast agent is injected through the catheter so that the coronary vessels can be shown in the X-ray image.

During the cardiac catheter examination, the closed coronary artery can also be reopened immediately: the doctor inserts a small balloon over the catheter. It is filled with fluid at the location of the vascular occlusion, thereby expanding the constriction (balloon dilatation or PTCA: see above). After that, the doctor usually inserts a small metal framework into the vessel as a vascular support (stent) to keep it open.

Stent surgery for a heart attack

In a stent operation, a catheter is used to insert a balloon into the narrowed coronary artery and inflate it at the narrowed point in order to widen the vessel. When inflated, the stent unfolds, which then supports the vessel and thus ensures normal blood flow.

Exercise after a heart attack

A heart attack reduces the patient's cardiac output and thus also his strength and endurance. Everyday tasks quickly become physical stress: the heart muscle tissue that died in a heart attack is scarred. Therefore, the rest of the tissue has to perform by its own pump function. Slow, continuous training strengthens the sick heart again. Sport is therefore an important component of therapy after a heart attack.

However, physical activity also has a positive effect on other body functions. she

improves the oxygen supply to the body
lowers blood pressure
regulates blood sugar and blood lipid levels
counteracts inflammatory processes
promotes healthy body weight
reduces unnecessary fat deposits
breaks down stress hormones

Note: Training after a heart attack should only take place with prior consultation with the attending physician. Participation in a cardiac sports group is recommended.

Studies have shown that exercise not only helps prevent a heart attack in the run-up to a heart attack. Training also has a positive effect after a heart attack. Anyone who becomes or remains active after a heart attack significantly increases their chances of survival. This is the result of a Swedish study with more than 22,000 heart attack patients.

Starting training after a heart attack

After a heart attack (STEMI and NSTEMI), scientific studies recommend starting training early - as early as seven days after the heart attack. This early mobilization supports the healing process and helps the patient to find his way back to everyday life more quickly.

After an operation to widen the coronary arteries (percutaneous transluminal coronary angioplasty, PTCA), the patient can start an individual sports program on the fourth day after the operation. However, this only applies to operations without complications. However, the training should only take place under medical or therapeutic supervision.

After a bypass operation, the affected person can begin early mobilization as early as 24 to 48 hours later. However, restrictions are to be expected in the first few weeks after the bypass. The training should start with gentle exercises. Support, tensile and pressure loads are to be avoided for at least six weeks. Pressure on the chest is also not advisable in the first few weeks after the procedure. There should be no jerky movements. If the procedure was carried out in a minimally invasive manner, this period of time can be shorter.

How often do you train?

Patients should exercise at least twice a week shortly after the heart attack - regardless of the severity of the heart attack. It is important that the patient begins training carefully at first. Gradually increase the intensity and duration of the training.

Four to five times a week, 30 minutes each of moderate endurance training is recommended for cardiac patients.

Suitable exercise after a heart attack

In order to train the cardiovascular system and to optimally support recovery after a heart attack, endurance sports are particularly suitable. But strength training and exercises for mobilization and flexibility are also building blocks of cardiac sports.

Moderate endurance training

Suitable sports after a heart attack are so-called endurance sports. They are the focus of cardiac sports, as they improve cardiopulmonary function and help to achieve higher levels of stress without discomfort.

According to the recommendation of the German Society for Prevention and Rehabilitation of Cardiovascular Diseases, cardiac patients should do at least 30 minutes of moderate endurance training four to five times a week.

After a heart attack, walking quickly for ten minutes at about 5 km / h is enough to improve your health. Alternatively, if the pace is too fast, those affected can walk slowly for 15 to 20 minutes.

Suitable endurance training after a heart attack is for example:

(quick) walking
Walking on a soft mat / in the sand
Walking
Nordic walking
Cross-country skiing
(Step) aerobics
Cycling or exercise bikes
rowing
Climbing stairs (e.g. on the stepper)

It is important that cardiac patients choose short exercise phases of five to a maximum of ten minutes at the beginning. The duration of the exercise is then slowly increased over time

Jogging after a heart attack

Walking, running, walking and jogging are the easiest ways to train your circulation after a heart attack. However, it is important to keep an eye on the training intensity. The attending physician determines the performance and load capacity of the heart in advance with an exercise ECG. On this basis, he recommends the individual training effort to the patient.

Note: The targeted training zone for cardiac patients is 40 to 85% VO2max. VO2max describes the maximum amount of oxygen that can be absorbed by the body during maximum exercise. The heart rate should be 60 to 90 percent during endurance training.

Heart attack patients should initially avoid competitions. Participation in competitive or competitive sports should only be done in consultation with the attending physician.

Cycling after a heart attack

Cycling after a heart attack or ergometer training is particularly suitable for overweight patients or for people with orthopedic complaints. The person concerned does not have to bear the body weight himself. This is easy on the joints. The ergometer has the further advantage that the patient can measure his pulse during exercise. This allows him to optimally control the training intensity.

Weight training for cardiac patients

Strengthening exercises promote muscle building and strength. Muscle mass consumes more energy than fat at rest and helps in the fight against extra pounds. When carried out conscientiously under professional guidance, strength exercises do not pose an above-average risk for cardiac patients.

In order to avoid blood pressure peaks, it is important to avoid pressured breathing during exertion. In addition, the athlete should make sure to relax the muscles as completely as possible between repetitions.

Gentle exercises for heart patients to build muscle in the upper body are, for example:

Strengthening the chest muscles: Sit upright on a chair and press your hands together in front of your chest. Hold the tension for a few seconds. Then let go and relax. Repeat several times.
Strengthening of the shoulders: Sit upright in a chair and hold your hands in front of your chest. The left hand pulls to the left, the right hand to the right. Hold the train for a few seconds, then relax completely.
Strengthening the arms: Stand an arm's length in front of a wall and place your hands on the wall at about shoulder height. Bend your arms and do “push-ups” while standing. Ten to 15 repetitions.The intensity increases the further you move away from the wall.

Exercise your legs particularly gently with these exercises:

Strengthening the abductors (extensor muscles): Sit upright on a chair with your hands on the outside of your thighs, as close as possible to the knee. Now press the outside of your legs with your hands, your legs press against your hands. Hold the pressure for a few seconds and then relax.
Strengthening the adductors (flexor muscles): Sit upright on a chair with your hands between your knees. Now push outwards with your hands, legs working against your hands. Hold the tension for a few seconds and then relax completely.

When doing any strengthening exercise, make sure you breathe relaxedly.

Cardiac sports groups

Participation in a cardiac exercise group is recommended after a heart attack. The patients train together with other affected persons under professional supervision. All exercises are adapted to the needs of the heart patient.

In cardiac sports groups, light circuit training is often carried out. The participants complete eight different stations, for example. Depending on the exercises chosen, this promotes endurance, strength, flexibility and coordination at the same time. One minute of exercise is followed by a 45-second break. Then the athletes rotate to the next station. There are one or two rounds depending on individual fitness.

Various playful approaches are also carried out in cardiac sports groups. For example badminton, exercises with the Theraband or ball sport exercises are integrated into the training.

Heart attack: disease course and prognosis

Two possible complications are particularly decisive for the acute prognosis after an acute myocardial infarction - cardiac arrhythmias (especially ventricular fibrillation) and failure of the myocardium to pump (cardiogenic shock). Patients can die from such complications.

The long-term prognosis after an acute heart attack depends, among other things, on the answers to the following questions:

Does the patient develop heart failure (see below: Consequences)?
Can the risk factors for another heart attack (high blood pressure, high cholesterol levels, etc.) be reduced or eliminated entirely?
How consistently does the patient adhere to a healthy lifestyle? These include, for example, regular exercise, a healthy heart diet, smoking cessation, reducing excess weight and avoiding stress and tension.
Does the disease of the coronary arteries (vascular calcification) progress?

Statistically, five to ten percent of heart attack patients die of sudden cardiac death within the next two years after they are discharged from the hospital. Patients over 75 years of age are particularly at risk.

Heart attack: follow-up treatment

Follow-up treatment is very important for the prognosis of a heart attack. As early as the first few days after the myocardial infarction, patients begin physiotherapy and breathing exercises. Physical activity gets the circulation going again and prevents further vascular occlusion.

A few weeks after a heart attack, patients can begin cardiovascular exercise. But this is far from competitive sport! Recommended sports include hiking, light jogging, cycling and swimming. Those affected should discuss an individual training program with their doctor. You can also join a cardiac sports group: Training together with other cardiac patients can be a lot of fun and also motivating.

Most heart attack patients spend some time in a rehab facility after they are discharged from the hospital. There they learn to rearrange their lives in such a way that the risk of another heart attack is reduced.

As mentioned above, risk factors for a (renewed) heart attack such as high blood pressure, high cholesterol, obesity or diabetes mellitus should be reduced as much as possible. This includes that the patients adhere to the therapy prescribed by the doctor, for example conscientiously take the antihypertensive medication. Regular check-ups with a doctor are also important. In this way, you can identify any problems early on and take countermeasures in good time.

Heart attack: consequences

For many people affected, a heart attack has consequences that can change their lives. On the one hand, this includes short-term consequences such as cardiac arrhythmias. They can take the form of atrial fibrillation or life-threatening ventricular fibrillation.

Long-term consequences are also possible after a heart attack. For example, some patients get depression. Chronic heart failure (heart failure) can also develop: the heart muscle tissue that has died from the infarction is replaced by scar tissue, which impairs heart function.

Rehabilitation treatment and a healthy lifestyle help prevent such complications and consequences of a heart attack. You can read more about this in the article Heart Attack - Consequences.

Heart attack: prevention

You can prevent a heart attack by reducing the risk factors for hardening of the blood vessels (arteriosclerosis) as much as possible. That means:

Do not smoke: Those who refrain from cigarettes and the like can significantly reduce their risk of heart attacks. At the same time, the risk of other secondary diseases such as stroke is also reduced.
Healthy diet: A heart-healthy diet is the Mediterranean diet. It consists of lots of fresh fruit and vegetables and little fat. Instead of animal fats (butter, cream, etc.), vegetable fats and oils are preferred (olive, rapeseed, linseed oil, etc.).
Lose excess weight: Just a few pounds less have a positive effect on your health. With a healthy body weight, heart attacks and other diseases (stroke, etc.) can be prevented.
Lots of exercise: Be physically active on a regular basis. This is not about high-performance sport: even a half-hour walk every day is better than no sport at all and reduces the risk of heart attacks. Exercise in everyday life (such as climbing stairs, shopping by bike, etc.) also contributes to this.
Treat high-risk diseases: Basic diseases such as diabetes, high blood pressure or high cholesterol levels should be treated optimally. This not only includes the regular use of the prescribed medication. With a healthy lifestyle (exercise, healthy diet, etc.), each patient can also contribute a lot to the success of the therapy.
Avoiding Stress: Try to avoid prolonged stress in your work and personal life as much as possible. This has been shown to reduce the risk of a heart attack.

Additional information:

Book recommendations:

New start: A heart attack can be the end - or the beginning (Oliver Gaw, 2016, adeo)
Trauma heart attack: the psychological coping with a cardiovascular disease (Mag Alexander Urtz, Dr. Sebastian Globits, 2017)

Guidelines:

Pocket guideline "Therapy of acute myocardial infarction in patients with ST-segment elevation (STEMI)" (Version 2017) of the German Society for Cardiology - Heart and Circulatory Research e.V.
Pocket guideline "Acute coronary syndrome without ST elevation (NSTE-ACS)" (Version 2015) of the German Society for Cardiology - Heart and Circulatory Research e.V.