Myocardial Infarction - Diagnosis & Treatment

How is myocardial infarction diagnosed?

A heart attack can be diagnosed using a variety of tests which can be non-invasive or invasive. Sometimes, a combination of tests may be needed.

Non-invasive tests to diagnose a heart attack include:

• Electrocardiogram. An electrocardiogram (ECG) records the heart’s electrical activity to help determine if a heart attack has already occurred.
• Chest X-ray. A chest X-ray helps to capture images of the heart, lungs and chest structure to reveal if the heart is enlarged or if the heart is accumulating fluid as a result of a heart attack.
• Echocardiogram. An echocardiogram uses high frequency soundwaves or ultrasound to produce images of the heart’s size, structure and movement to identify abnormal rhythms or arrhythmia.

Invasive tests to diagnose a heart attack include:

• Blood tests. Blood tests check for cardiac enzymes, C-reactive protein (CRP) and other indicators to confirm if a heart attack has occurred, the extent of damage and determine the future risk for coronary artery disease.
• Cardiac catheterisation and angiogram. In this procedure, a catheter is inserted and guided to the heart in order to inject a dye that makes the blood vessels visible on X-ray. This gives doctors a clearer view of narrowed or blocked coronary arteries. Cardiac catheterisation can also be used to perform a percutaneous coronary intervention (PCI) to open blocked segments of the coronary artery.

If you are diagnosed to be at risk of heart disease, your cardiologist will assess the severity of your condition and may prescribe medication or lifestyle changes. In life-threatening cases, surgical intervention may be required. Talk to your cardiologist to find out more.

How is myocardial infarction treated?

The aim of myocardial infarction treatment is to unblock the affected artery quickly to minimise the amount of damage to the heart muscle.

Your doctor will evaluate the severity of your condition and perform the most effective way of unblocking the artery. This may include a combination of surgery, medication and rehabilitation.

Surgery to treat a heart attack

Surgical options, depending on the extent of the blockage and the patient’s health, include:

• Coronary angioplasty, where a small balloon or a stent (small mesh tube) is inserted into the blocked artery to help re-open it and restore blood flow.
• Coronary artery bypass, in which a healthy blood vessel taken from the leg, arm or chest is used to go around a blocked artery. This provides an alternate route for blood to flow to the heart muscles.

Medication to treat a heart attack

Medication is prescribed to help relieve symptoms such as chest pain and to reduce the risk of another heart attack. Medication may also be necessary to help manage chronic conditions such as diabetes, high blood pressure and high cholesterol, which increase the risk for another heart attack.

Some medication your doctor might prescribe include:

• Antiplatelet agents to prevent the formation of blood clots.
• Angiotensin II receptor blocker to help control blood pressure.
• Beta blockers to lower blood pressure by making the heart beat more slowly and with less force.
• Calcium channel blocker to relax blood vessels.
• Diuretics to eliminate excess fluids and relieve strain on the heart.
• Statins to reduce blood cholesterol levels, or alternative cholesterol-lowering medication if statins are ineffective or not tolerated.
• Vasodilators to relax blood vessels and increase supply of blood and oxygen to the heart.

Cardiac rehabilitation

Cardiac rehabilitation is a programme specifically created to improve your cardiovascular health after a heart attack. A comprehensive rehabilitation programme will encompass three aspects:

• Exercise to help reduce weight and manage modifiable risk factors such as diabetes, high cholesterol and high blood pressure.
• Education on improving your diet and managing your medications.
• Counselling to quit smoking and manage stress, anxiety and depression.