In the hospital the Emergency Room physician will assess the patient right away and do appropriate tests like an ECG, blood work for cardiac enzymes, start IV lines and give intravenous fluid. A cardiac monitor is applied to the skin right away as well which tells the physician whether there are any dangerous irregular heartbeats developing.
Within a short period of time the cardiac enzymes will be reported back to the ER physician and indicate whether or not damage to the heart muscle has occurred. The isoenzyme of creatine kinase, called CK-MB, is found abundantly in heart muscle and is released following a heart attack as early as 3 hours of the onset of a heart attack. It peaks at 24 hours and normalizes at 2 to 3 days. The cardiac specific troponins (Troponin I and T, or abbreviated as TnI and TnT ) are other markers for heart attacks and show up in the blood 3 hours after a heart attack and are lasting until 5 to 7 days. Another marker for heart attacks is myoglobin, which is released into the blood 1 to 2 hours following a heart attack, reaches a peak at 5 to 6 hours and returns to normal within 24 hours. Between these three blood tests (CK-MB, TnI or TnT and myoglobin) virtually all heart attacks can be detected in an acute situation.
A 12 lead ECG tracing is used to identify those patients who benefit from fibrinolytic therapy (see under “treatment” below).
When in doubt, the cardiologist may want to do a stress test of the heart. This is an exercise test combined with ECG’s before, during and after the test to see whether the oxygen supply to the heart muscle remains constant during exercise or whether it drops off. Here is a link showing an image of a patient doing an exercise stress test.
If this test is not clearly positive, meaning that there are narrowed coronary arteries proven, this test can be more refined by doing a thallium stress test or the MIBI scan. The scan on the left of this link was taken from a patient who had chest pain and was found to have severe perfusion defects at the bottom of the heart. After bypass surgery the right MIBI scan showed that his heart perfusion was normalized. Chest X rays can detect congestive heart failure and gives an overall impression of the heart size. Two-dimensional echocardiography shows whether there are any motion abnormalities of the heart chamber. Contractility problems can be depicted, which would tell the cardiologist to look at this patient more carefully, perhaps with a MIBI scan or by doing a heart catheterization.
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