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Heart attack – from fate to controllable diseaseHeart attack – from fate to controllable disease

Rapid progress in diagnostis and treatment options has played a key role in significantly reducing the mortality rate following a heart attack over the past 30 years. Through rapid response and the right medication, many of those affected can now benefit from the medical breakthroughs of the past and significantly reduce the consequences of heart attacks.

Few treatment options until the 1970s

Johann Wolfgang von Goethe unquestionably died of heart disease in 1832: cold sweat, drop in blood pressure with cold limbs, cardiac arrhythmia and finally heart failure and shortness of breath – the classic symptoms. Goethe’s personal physician didn’t understand the cause of this ailment nor had any means of treating it.1 Intensive medical research has completely changed this situation.

Great progress has been made in the diagnosis and treatment of heart attacks, especially over the last few decades. In the 1970s, hardly any effective treatments were available to doctors. In some cases, heparin was already being administered back then, which can prevent further vascular occlusions owing to its blood-thinning effect. After a heart attack, those affected were also prescribed bed rest, often for weeks.1 This is now handled completely differently: Following an uncomplicated heart attack, patients are sometimes allowed to get up on the first or second day and are discharged from the hospital after one to two weeks. This was made possible primarily due to the wide range of medications that are now available for use following a heart attack.2

Major breakthroughs that have become standard

Since the early 1980s acetylsalicylic acid and beta blockers have been administered to patients after a heart attack. The acetylsalicylic acid prevents blood platelets from clumping together and thus the formation of new blood clots. Heparin can also still be used for this purpose. Beta blockers lower blood pressure, slow the heartbeat and relieve strain on the heart. Analgesics and sedatives are often used as well.2

Meanwhile, acute procedures with balloon catheters and stents are also part of the treatment regimen after a heart attack. The era of so-called “percutaneous coronary interventions” began in 1977, when a balloon catheter was used for the first time. The first stents then followed in the late 1980s. The objective of these procedures is to reopen the occluded vessel. The stent serves as a support for the vessel at the narrowed point. Although the introduction of stents was another major advance, in the years following their introduction it became apparent that platelets could easily adhere to their surface, leading to blood clots. For this reason, various medications have been prescribed after stent procedures since the 1990s, usually acetylsalicylic acid mentioned above and clopidogrel (medication to prevent blood platelet aggregation). Today, there are also drug-eluting stents (DES).2

Over the past two decades, thrombolysis has also become an integral part of acute heart attack treatment – in particular when intervention with balloon catheters and stents is not possible.3 Thrombolysis involves an attempt to dissolve the blood clot using administered intravenously drugs with the aim to restore blood flow through the affected vessel.

Rehabilitation after an acute heart attack and handling risk factors

After successful acute treatment, patients are monitored in the intensive care unit for a few more days. If the course is uncomplicated, patients now only stay in the hospital for a few days. Follow-up treatment is carried out in a rehabilitation clinic or in an outpatient setting to facilitate reintegration into everyday life and work. Despite cutting-edge treatment, cardiovascular events may still occur after a heart attack. Drug treatment and close monitoring are therefore of great importance.3 Many of the medications prescribed after a heart attack must be taken permanently. These include beta blockers, acetylsalicylic acid and cholesterol-lowering drugs (statins). ACE inhibitors, which dilate blood vessels and lower blood pressure, are also standard medicines.3

In addition to milestones in the treatment of acute heart attacks, the improved diagnosis of diseases such as high blood pressure or elevated cholesterol levels and the corresponding medication options have also led to progress in combating heart attacks. For example, beta blockers have been used to treat high blood pressure since the mid-1960s and statins have been used to lower cholesterol levels since the late 1980s. Ideally, this treatment would prevent a heart attack from occurring in the first place.4

The advances in treatment are underpinned by impressive figures. A recently published study shows a large decrease of the mortality rate in Switzerland for all cardiovascular diseases from 2010 to 2019: over 30 percent for women and over 40 percent for men.4 The greatest advances were made in the treatment of heart attacks. Figures from Germany also underscore this development.

Decrease in mortality from cardiovascular diseases (Source: Meinertz T. et al. (2018). Public Health Forum 26(3): 216-219)

In addition to improved drug treatments, the development of stents and generally improved techniques (e.g. during surgery) have ensured that a heart attack is no longer necessarily a death sentence. Researchers are still working intensively on innovations – both in the prevention and in the treatment of heart attacks and other cardiovascular diseases. Hope remains that treatments such as the recently announced “heart attack injection” will soon become a reality.5

1 Lüscher, T.F. et al (2004): Der Herzinfarkt. Geschichte der kardiovaskulären Medizin. Kardiovaskuläre Medizin 7: 386–391.
2 Deximed (2022): Perkutane Koronarintervention, PCI. https://deximed.de/home/klinische-themen/herz-gefaesse-kreislauf/patienteninformationen/behandlungen/perkutane-koronarintervention
3 Internisten im Netz (2022): Herzinfarkt: Therapie. https://www.internisten-im-netz.de/krankheiten/herzinfarkt/therapie.html
4 SRF (2022): Weniger Tote wegen Herzinfarkt & Co. https://www.srf.ch/wissen/gesundheit/erfreuliche-entwicklung-weniger-tote-wegen-herzinfarkt-co
5 Deutsche Herzstiftung: „Spritze gegen Herzinfarkt“: Wie sieht Kardiologe neuen Cholesterinsenker? – Pressemeldung. https://www.herzstiftung.de/service-und-aktuelles/presse/pressemitteilungen/spritze-herzinfarkt

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