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HEART ATTACK: LIFE-SAVING INTENSIVE CARE

When the patient arrives at the hospital, the physician on duty must first of all either confirm or eliminate the diagnosis of heart attack by listening to the symptoms, what measures have already been taken, and the circumstances surrounding the attack. The spouse of the patient should not forget the list of drugs which have been taken. The EKG is taken immediately and sometimes indicates certain changes, but may not indicate anything unusual in the early stage. In these cases, the changes become evident in the EKG only a few hours or even a few days later.

Blood tests may yield more infonnation in most cases. It is possible to measure the amount of certain enzymes which the damaged heart muscle releases into the blood stream. Since these enzymes indicate the time and course of the response to the heart attack, they must be checked daily.

If a heart attack can be ruled out as a possibility, by a normal EKG and enzyme level, then the patient is transferred to a general ward. A few days of observation should reveal the cause of the symptoms which resulted in the emergency. In some cases an impending heart attack is discovered, which would have occurred sooner or later if the necessary steps are not taken. In other cases, the cause of the pain has little to do with the heart, but instead originates in the spinal column or in an emotional or nervous disorder.

If a heart attack is indicated or suspected, the patient is transferred as soon as possible to the intensive care unit. It is understandable that relatives and the patient himself often view this admission with mixed feelings.

Heinz P., a sixty-year-old railroad official remembers: "I sustained a heart attack while I was in Munich visiting my children. The fire department rushed me to the nearest hospital where the physician on duty took an EKG. The immediate diagnosis was that I had sustained a minor heart attack and that it would be best if I were admitted to the intensive care unit where I could be observed and treated more effectively. My wife was relieved, but I began to worry. Although the nurses and physicians took good care of me, I simply could not grow accustomed to the strict order to stay in bed, the constant coming and goings of the staff, the restless woman in the bed next to mine, or to the urinary catheter."

Is the discomfort experienced by this patient in the intensive care unit absolutely necessary? As a matter of fact it is necessary and his wife was right to be relieved when he was admitted to the unit. It is only natural that he did not like to lie in a horizontal position for three days. Regulation of the bowel movement and urination may prevent disturbances of the heart rhythm. Unfortunately the restlessness of the other patients does distract the patient and a death in the hospital might depress him even further.

However, all these disadvantages are far out-weighed by excellent treatment offered at such intensive care units, which is not found in general medical wards. Since the first days following the heart attack are the most crucial ones, the therapy and observation of the patient must be constant. The patient is usually monitored by an instrument which detects any irregularities in the cardiac rhythm.

At the same time a device is inserted into the vein of the arm or of the collar bone region, by means of which necessary drugs to relieve pain or to calm the patient can be infused over a period of several days. Moreover, the inner pressure of the major vein leading to the heart can be measured.

The recovery from an acute heart attack may be severely impaired by irregularities in the cardiac rhythm and by circulatory complications. Irregularities of the cardiac rhythm which cause the heart rate to either increase or decrease must be treated immediately by infusions of necessary medication, because a decrease in the pumping activity of the heart would result in an insufficient oxygen supply to the brain. This dangerous situation

can only be prevented by the use of a pacemaker in certain circumstances.

Various technical means are available to make the use of a pacemaker possible. The pacemaker relies on the principle that an electrical impulse can stimulate the heart to beat regularly. This impulse is generated by a battery and reaches the heart through a wire passed into a vein. In most cases, the pacemaker can be removed after a few days when the regulatory system of the heart regains its normal functioning .

Any weakness of the heart or other circulatory problems must also be monitored constantly. It is possible to increase the pumping action, strengthen the heart, and improve kidney function and fluid output, raise or lower the blood pressure by means of drug therapy. It is hoped that the consequences of a heart attack can be controlled in this manner, in addition to a supply of oxygen through the nose.

During the crucial stage after the heart attack, the intensive care unit offers a maximum of security with the best technical equipment and highly skilled personnel; although certain discomforts and great financial burden to the family are unavoidable. Visiting hours are arranged as conveniently as possible, but children and flowers cannot be allowed. Moreover, there is very little space for the personal belongings of the patient. Since nurses and physicians are in attendance around the clock, they are available for consultation at any time. The relatives and the patient should take advantage of this situation in order to gain information which may help the patient overcome the fears of the first few days after the heart attack. This psychological consideration is important for the patient and the relatives.

Young patients in particular experience emotional distress when they become conscious of having just escaped death. The patient's previous feeling of well-being and security is undermined. Although the advantage of the intensive care unit is its sophisticated equipment, it is the sight of all that machinery which often causes fear and insecurity in the patient. Yet such fear could be allayed in a sympathetic and honest discussion with the physician. Such conversations can play an important role during the early phase of recovery.

The spouse and the patient will often avoid talking with the physician about the condition, because they may think the physician too busy or be afraid they will not understand his explanation. Since they are also afraid of depressing or frightening news, some of the much-needed discussion with physicians may never take place.

It is still more problematic, however, when the spouse and the patient avoid any serious conversation and engage in meaningless chatter about the weather or the food. Although each does not want to upset the other, each may actually feel lonelier by avoiding important topics. Even though it is natural to avoid serious conversation in the first few days when the patient is gravely ill and under sedation, it is not acceptable if serious talk is avoided for several weeks. The patient may repress fears, making it more difficult to overcome them. Later, the patient may minimize or overcompensate for the early stage of recovery, instead of trying immediately to start for a new life together with loved ones. If the spouse tries to protect the patient from the truth by making light conversation, avoiding topics such as the children's education, the financial situation or the business, this may deprive the patient of the opportunity to participate and make decisions as was true earlier. Instead, husband and wife should cooperate in resolving the problems which arise. Only by offering advice while the patient is ill, can one help him or her to regain confidence. Whether you are a patient or are visiting a patient, you should engage in open and frank, intimate conversation rather than idle chatter. By sharing your feelings and empathizing with the other person, both of you will gain from the experience.

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Cardio & Blood

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