Latest news with #myocardialinfarction
Medscape
8 hours ago
- Health
- Medscape
CMR in MINOCA Linked to Improved Diagnosis and Management
TOPLINE: In a prospective study of over 300 patients with myocardial infarction with nonobstructive coronary arteries (MINOCA), cardiovascular magnetic resonance (CMR) was associated with meaningful changes in clinical diagnosis and/or management in 63% of patients and a similar increase in diagnostic certainty. METHODOLOGY: Previous CMR studies in MINOCA have focused on radiologic yield — a limited metric that does not reflect real‐world clinical utility. Prospective data on patient care are lacking. This prospective study conducted in Australia and the UK assessed the impact of CMR on diagnosis and management in 320 patients with MINOCA (mean age, 55.6 years; 52% men) recruited between January 2019 and July 2023. Patients were included if they had a hospital admission with acute features consistent with the Fourth Universal Definition of Myocardial Infarction, no obstructive coronary artery disease on angiography, and a clinician assessment indicating acute myocardial infarction as the most likely presentation. The treating cardiologists completed a questionnaire before and after CMR to record their working diagnosis, rate diagnostic certainty on a 1-10 scale (10 = most certain), and specify intended management, including medications and follow-up testing. The primary endpoint was a composite of change in clinical diagnosis or management after CMR. TAKEAWAY: CMR was associated with a change in diagnosis or management in 63% of patients (P < .001), with diagnosis revised in 38% and management changed in 50%. Diagnostic certainty increased significantly from a median score of 6-8 after CMR (P < .001), and diagnostic confidence numerically increased in 63% of patients. The absence of coronary atheroma, a pre-CMR diagnostic certainty score ≤ 5, and early CMR (performed within 14 days of hospital presentation) independently predicted a change in diagnosis or management, with 80% of patients with all three predictors vs 40% of those with none meeting the primary outcome. Of 172 patients initially prescribed dual antiplatelet therapy, 66 (38%) had it deprescribed following CMR, yielding a number needed to test of 3. IN PRACTICE: 'Integration of CMR into diagnostic imaging pathways may be reasonable to augment clinical diagnosis and management; however, further cost-effectiveness analyses are now warranted,' the study authors wrote. SOURCE: This study was led by Adil Rajwani, PhD, of the Royal Perth Hospital, Perth, Australia. It was published online on June 13, 2025, in Heart. LIMITATIONS: The study was limited by the impracticality of conducting a bias-free randomized trial of CMR vs no CMR. It was also limited by the assessment of CMR's impact only immediately after imaging, potentially missing later clinical insights. Medication protocols were not standardized, and the limited use of additional diagnostics such as optical coherence tomography may have influenced the findings. DISCLOSURES: This study was funded by a grant from the Royal Perth Hospital Medical Research Foundation in Australia. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
16-06-2025
- Health
- Medscape
Missed Target Treatment Times May Increase MI Mortality
When it comes to delivering timely treatment for patients experiencing myocardial infarction (MI), many hospitals are continuing to fall short of national guidelines, new research showed. Benchmarks for percutaneous coronary intervention, the standard of care for acute ST-elevation MI (STEMI), aren't being met in some cases. Delays in care in the key metric of the time from first contact with medical care to angioplasty with stenting resulted in worse patient outcomes and were associated with increased in-hospital mortality risk in some cases, according to the findings, published on June 11 in JAMA Cardiology . 'There are two categories of patient delays: Those that are patient-centered and those that are system-centered,' said Neal S. Kleiman, MD, Houston Methodist DeBakey Heart and Vascular Center, Houston, the senior author of the new study. 'We don't have control over patient-related factors, but there is a lot we can do in terms of hospital systems.' For the retrospective cross-sectional study, Kleiman and his colleagues analyzed data on 73,826 patients with STEMI or STEMI equivalent from 503 sites across the United States. The goal was to determine site-level variability in patterns of treatment times and clinical outcomes from 2020 to 2022 based on an analysis of data from the American Heart Association's Get With the Guidelines — Coronary Artery Disease registry — a quality improvement program for patients with coronary artery disease, acute MI and chest pain. The authors said the study is the first large-scale analysis of treatment goals and outcomes in STEMI based on hospital performance. The researchers found an association between failure to reach the target time from first medical contact with care to angioplasty with stenting — 90 minutes or less — and increased risk for in-hospital mortality for primary presentations and transfers (adjusted odds ratio, 2.21; 95% CI, 2.02-2.42, and 2.44; 95% CI, 1.90-3.12, respectively). Low-performing hospitals were associated with increased risk for mortality and longer stays in the hospital than were high-performing hospitals. However, hospital location and case volume were not associated with worse outcomes. The guidelines recommend a target time from first contact with care to angioplasty with stenting of 90 minutes or less for patients presenting directly to hospitals offering angioplasty with stenting and 120 minutes or less for patients requiring transfer to a facility offering the procedure. The study findings revealed significant variability between hospital sites in meeting the key metric of the recommendations — adherence in at least 75% of patients with STEMI. At hospitals with the capability to perform angioplasty with stenting, the target was met in 72.2% of patients at high-performing sites, 60.8% at intermediate-performing sites, and 46.0% at low-performing sites. When patients required transfers to other facilities with the capability to perform angioplasty, a target first medical contact-to-device treatment time of 120 minutes or less was achieved in 72.3% of patients at high-performing sites, 48.8% at intermediate performing sites, and 21.9% at low-performing sites, according to the researchers. In these hospitals, treatment delays were caused primarily by longer stays in the emergency department and time from arrival in the catheterization laboratory to stenting. Limitations of the study included the fact registry responses were provided on a voluntary basis and may not reflect the totality of STEMI care in all geographical areas, according to the researchers. The analysis also lacked data on follow-up after discharge, making it difficult to extrapolate the findings over the long term, they said. Yasser M. Sammour, MD, MSc, cardiology fellow at Houston Methodist DeBakey Heart and Vascular Center, who led the work, said several decades of research have highlighted the importance of treating patients with STEMI efficiently. A previous registry study found fewer treatment delays were linked to reduced mortality. 'The current study tried to take that research one step further, assessing how factors such as hospital performance and location affect patient outcomes,' Sammour said. The result, he said: 'We're still underperforming. We need to have coordinated strategies with local intervention at the hospital level to examine where significant delays in percutaneous coronary intervention time are occurring.' The absence of uniformity in established performance measures such as time to initiate treatment in STEMI has led to calls for greater adherence to current recommendations. In an editorial accompanying the journal article, Roxana Mehran, MD, Mount Sinai Fuster Heart Hospital in New York City, wrote: 'After two decades of data collection, national initiatives, and public accountability, the next step must involve tailored solutions addressing barriers within each institution. Bridging the gap now requires renewed efforts and commitments to prioritize timely, coordinated STEMI care. Until then, the clock will continue to tick — against our patients.'
Health Line
19-05-2025
- Health
- Health Line
Heart Attack Symptoms, Causes, and Treatment
A heart attack is a stoppage of blood flow to the heart. While chest pain is the most common symptom, recognizing other symptoms can help ensure you receive prompt treatment and limit damage to your heart. Heart attacks are very common in the United States. About 805,000 heart attacks occur each year, or roughly one every 40 seconds. Chest pain is the most common warning sign of a heart attack. But other symptoms can also occur, like lightheadedness, nausea, and shortness of breath. Symptoms can be severe or mild and often vary from one person to the next. Some people may not even notice any warning signs of a heart attack. This article will take a closer look what causes a heart attack, how to recognize it, what steps to take, and what to expect for treatment. What is a heart attack? A heart attack, also known as a myocardial infarction, occurs when blood flow to the heart is blocked or cut off. If there's not enough oxygen-rich blood flowing to the heart, it can damage the affected area. As a result, the heart muscle begins to die. When your heart isn't getting the blood and oxygen it needs to function properly, it can put you at a higher risk of heart failure and other serious complications. A heart attack is a life threatening medical emergency If you, or someone around you, experiences the symptoms of a heart attack, call 911 or your local emergency services immediately. The sooner you can get medical treatment that restores normal blood flow to your heart, the better your chance of a successful outcome. What are the symptoms of a heart attack? General symptoms for a heart attack can include: chest pain or discomfort shortness of breath pain in your arm, shoulder, or neck nausea sweating lightheadedness or dizziness fatigue upper body pain trouble breathing Anyone experiencing any of the above heart attack symptoms should contact emergency services immediately. How heart attack symptoms vary between men and women Many people experience a mix of heart attack symptoms regardless of sex or gender. However, there are sex-specific differences in the presentation, biology, and outcomes of heart attacks. A 2019 study found that chest pain was the most common symptom regardless of sex. According to the American Heart Association (AHA), females are somewhat more likely than men to experience the following heart attack symptoms: shortness of breath nausea or vomiting pain in the upper back or jaw dizziness or lightheadedness extreme fatigue How heart attack symptoms may differ for people with diabetes People with diabetes are more likely to have silent heart attacks compared to people who don't have diabetes. A silent heart attack means you don't experience symptoms, but there's still damage to your heart. This may be due to cardiac autonomic neuropathy, a type of nerve damage that's a common complication of diabetes. It may interfere with the ability to feel chest pain caused by a heart attack. Angina vs. heart attack Angina is chest pain caused by reduced blood flow to the heart. It's the pain you feel during a heart attack, but it's also a symptom of heart disease due to blockages in the arteries that supply blood to your heart. Some people experience frequent and predictable bouts of angina with triggers like exertion. Known as chronic stable angina, this usually eases with rest within about 5 minutes. However, angina that's new or changed may be due to a heart attack. If your chest pain doesn't subside with rest or lasts longer than usual, you may be having a heart attack. What causes a heart attack? The leading cause of heart attacks is coronary heart disease. That's when plaque builds up in the arteries that supply blood to the heart. The general buildup of plaque in the arteries is also known as atherosclerosis. Doctors can classify heart attacks according to the cause: Type 1: The heart attack occurs when a sudden disruption of blood flow occurs due to plaque rupture or a blood clot. Type 2: The lack of oxygen supply to the heart is not due to an event but a systemic issue, like low blood pressure or a fast heart rate. Other causes of heart attacks include: torn blood vessels blood vessel spasms drug misuse hypoxia (lack of oxygen to tissue) or hypoxemia (lack of blood oxygen) What are the risk factors for a heart attack? Several factors can put you at greater risk of a heart attack. You can't change some factors, such as age and family history. However, you can make changes related to the following modifiable risk factors: smoking high cholesterol obesity lack of exercise high levels of stress diabetes or prediabetes eating a diet high in trans fats and saturated fats excessive alcohol consumption sleep apnea Heart disease is the leading cause of death among most ethnic and racial groups in the United States and the most common cause of heart attacks. People of any age or sex can have a heart attack. However, your risk of a heart attack increases with age. Older adults are most likely to have heart attacks. Males are more likely to have heart attacks earlier in life. Heart disease risk increases in females after menopause. You may be at higher risk of a heart attack if you have a family history of any of the following: heart disease high blood pressure high cholesterol obesity diabetes How do doctors diagnose a heart attack? Doctors typically diagnose a heart attack after they perform a physical exam and review your medical history. A doctor will likely conduct an electrocardiogram (ECG) to check your heart's electrical activity. Your healthcare team will likely also take a blood sample or perform other tests to check for evidence of heart muscle damage. One common test checks for levels of troponin T, a protein found in the heart muscle. Elevated troponin T levels may suggest a heart attack. Diagnostic imaging can help doctors see how blood is flowing through the heart and detect if any parts have been damaged. Cardiac catheterization is a test that allows a doctor to visualize blood flow and treat blockages. A doctor may also perform other imaging tests to evaluate the heart, including: What is the treatment for a heart attack? If you've had a heart attack, a doctor may recommend a surgical or nonsurgical procedure. These procedures can relieve pain and help prevent another heart attack from occurring. Common procedures include: Angioplasty: An angioplasty opens the blocked artery by using a balloon or removing the plaque buildup. Healthcare professionals rarely use angioplasty alone anymore. Stent: A stent is a wire mesh tube surgeons insert into the artery to keep it open after angioplasty. Heart bypass surgery: In bypass surgery, a doctor reroutes the blood around the blockage. Heart transplant: Surgeons may recommend a heart transplant in cases of serious and irreversible heart failure. A doctor may also prescribe medications to treat your heart attack, including: aspirin other drugs to break up clots antiplatelet and anticoagulants, also known as blood thinners pain relievers nitroglycerin blood pressure medication beta-blockers cholesterol-lowering medication like statins Timing is crucial Timely treatment of a heart attack is crucial. The sooner you get treatment after having a heart attack, the more quickly blood flow can be restored to the affected part of your heart, and the more successful the outcome is likely to be. Doctors who treat heart attacks Since heart attacks are often unexpected, an emergency room doctor is usually the first healthcare professional to diagnose a heart attack. They may also provide initial medications to break up the blood clot. The emergency doctor will transfer you to a cardiologist, a doctor who specializes in treating heart conditions. Cardiologists perform procedures to treat heart attacks and oversee their management and recovery. How to help someone having a heart attack If you are with someone who's experiencing symptoms of a heart attack, call emergency services immediately and follow the instructions they give you regarding what to do. If the person isn't responsive and doesn't have a pulse, doing cardiopulmonary resuscitation (CPR) or using an automated external defibrillator (AED) can be lifesaving. Most businesses and many public places have AEDs, but if one isn't present, continue to perform CPR until help arrives. Giving CPR can help pump oxygenated blood through a person's body until emergency services arrive. The sooner a person can get emergency medical attention, the less damage their heart muscle will likely sustain. What should you do if you have a heart attack? If you suspect you're having a heart attack, the AHA advises calling 911 or your local emergency services immediately, rather than attempting to drive yourself to the hospital. Paramedics can begin treating you when they arrive and monitor you on the way to the emergency department. Follow the instructions of the emergency personnel on whether to take an aspirin and let them know if you have any medication allergies or bleeding. The antiplatelet qualities of aspirin may help break up the clot that might be blocking blood flow to your heart. If possible, ask a family member, friend, or neighbor to be with you while you wait for the ambulance or are undergoing treatment at the hospital. Timely treatment for women who have heart attacks Because females are more likely to experience atypical heart attack symptoms, they tend to wait longer to contact emergency services, according to a 2019 Swiss study. Researchers also found that women tend to experience greater delays in receiving treatment in emergency settings. Recognizing the symptoms of heart attacks in females can make a big difference in getting timely treatment. What are the possible complications of a heart attack? Heart attacks can result in various complications. When a heart attack occurs, it can disrupt your heart's normal rhythm, potentially stopping it altogether. These abnormal rhythms are known as arrhythmias and can cause sudden cardiac death. When your heart stops getting a supply of blood during a heart attack, some of the heart tissue can die. This can weaken your heart and cause serious complications such as heart failure. Heart attacks can also affect your heart valves and cause leaks. The long-term effects on your heart will depend on how long it takes to receive medical treatment and how much damage your heart sustains. What to expect during recovery after a heart attack A heart attack can damage your heart muscles and affect their function. This can include changing your heart's rhythm and reducing its ability to pump blood effectively to all the organs and tissues in your body. Following a heart attack, it's essential to work with your healthcare team to design a recovery plan. This plan may include the following lifestyle changes: participating in light or moderate exercise, according to what your doctor approves eating a nutrient-dense, balanced diet low in saturated and trans fats losing weight if you're carrying extra weight quitting smoking if you smoke monitoring your blood sugar levels closely if you have diabetes taking steps to keep your blood pressure and cholesterol within a healthy range avoiding strenuous activities, especially shortly after the heart attack undergoing cardiac rehabilitation How to prevent a heart attack While some risk factors are beyond your control, you can take some basic steps to help keep your heart healthy. Examples include: Eat a healthy, balanced diet: Try to incorporate heart-healthy foods, like lean proteins, whole grains, fruits, vegetables, and low fat dairy, as often as possible. Limit fatty, fried foods and foods that contain simple sugars like sodas, baked goods, and white bread. Exercise regularly: Aim for at least 150 minutes of physical activity a week for optimum heart health. Quit smoking: If you smoke, consider talking with a doctor about starting a smoking cessation program. Limit your alcohol intake: Moderation is key when it comes to alcohol and heart health. If you do drink, limit yourself to one drink per day for women or two drinks per day for men. Get your cholesterol levels checked: If your LDL cholesterol or triglycerides are higher than they should be, talk with a doctor about what you need to do to lower them. Manage diabetes: If you have diabetes, take your medications as prescribed and check your blood glucose levels regularly. Work with a doctor: If you have a heart condition, work closely with a doctor and follow your treatment plan, which includes taking your medications. The bottom line Most people who have a heart attack survive. Still, it's important to know how to reduce your risk and how to respond if you experience symptoms of a heart attack. While chest pain is the most common symptom, it's only one of several common signs of a heart attack. If you think you may be having a heart attack, call for emergency medical help immediately. The sooner you get treatment for a heart attack, the better the outcome will likely be. Doctors can use various tests to diagnose a heart attack and guide treatment. Effective treatment plans help restore blood flow and minimize complications.
