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Exclusion of heart attack

Recognizing a heart attack – typical symptoms

There are numerous symptoms for a heart attack. However, heart attack symptoms can also be associated with other diseases. These can also require emergency treatment. Quick and thorough differential diagnosis is therefore important to quickly confirm or exclude a heart attack.

Symptoms of a heart attack

  • chest or shoulder pain
  • nausea
  • paleness
  • anxiety
  • cold sweat
  • shortness of breath
  • low pulse (bradycardia) / increased pulse (tachycardia)
  • raised blood pressure

These are some of the symptoms that can indicate a heart attack. A severe infarction can also cause life-threatening ventricular fibrillation.

Heart Attack Diagnostics

Physical examination in case of a suspected heart attack

A complete physical examination, including a stethoscopic examination, can provide initial indications of cardiac complications.

Electrocardiography / electrocardiogram (ECG) for suspected infarction

An ECG is the first and most important diagnostic procedure when a heart attack is suspected. During and after an acute phase, it provides clear information about the extent and region of the infarction. Electrocardiography is used to measure the heart current curve and is displayed in the electrocardiogram. The ECG provides important details such as regarding an infarction. It can also be used to determine the location, time and type of acute heart attack.
A distinction is made between a transmural heart attack (ST elevation myocardial infarction) and a NSTEMI (non-ST elevation myocardial infarction).
It is important to distinguish between these two types of infarction: In the case of NSTEMI, the diagnosis can only be made with certainty if laboratory blood tests confirm the presence of an infarction beyond doubt. In an acute heart attack, certain blood enzyme levels are significantly elevated. The creatinine kinase and the CK-MB proportion are examined here.

Laboratory test / laboratory diagnostics

If a heart attack is suspected, laboratory diagnostics are, in addition to clarifying the clinical symptoms and the ECG values, an essential part of the examination.

Troponins are proteins that are released into the blood when the heart muscle is damaged (e.g. during a heart attack). They are an important indicator if a heart attack is suspected. Troponins in the blood can be used to detect even the smallest degree of damage to the heart muscle (micronecrosis).
Within three to eight hours after a heart attack, the damaged heart muscle cells release increased amounts of troponin. This increase can last up to 24 hours and longer.
We use the Troponin T testing, which is appropriate for acute diagnostics.

  • GOT (glutamate oxaloacetate transaminase)
  • LDH (lactate dehydrogenase)

Clinical summary: The diagnosis of myocardial infarction requires laboratory tests in connection with an ECG and a clinical examinination.

Patients with these findings are immediately reffered to hospital

  • ECG changes
  • positive Troponin testing
  • further significant features that indicate a heart attack from a medical point of view, e.g. a drop in heart rate (low pulse) or blood pressure (hypotension)

Follow-up examinations and treatment of myocardial infarction in hospital

Additional diagnostic and therapeutic procedures that are applied following an initial diagnosis in a hospital may include:

  • Coronary angiography 
  • Coronary interventions, e.g. placement of a stent
  • There are diseases that generate similar symptoms to those of a heart attack. These can only be excluded on the basis of a carefully conducted differential diagnosis. 

Differential diagnosis myocardial infarction: diseases with similar symptoms to myocardial infarction

  • Pulmonary embolism
  • Pneumonia
  • Aortic dissection (tear in the large aorta)
  • Pericarditis (inflammation of the pericardium)
  • Pneumothorax (air accumulation between inner and outer lung membranes)
  • Biliary colic
  • Pancreatitis
  • Heart murmurs indicative of a heart valve problem (e.g. aortic valve stenosis or
    mitral valve insufficiency) may indicate
  • Extrasystoles – these are heartbeats that start too early and do not match the basic rhythm of the heart
  • Pericarditis – inflammation of the pericardium: This can be indicated by a scratching sound that can be localized with the stethoscope near the breastbone (pericardial rubbing)
  • Left heart failure with fluid in the lung tissue (pulmonary edema)
  • Blockage in the thoracic spine – Intercostal neuralgia

Most of these diseases with symptoms similar to those of heart attack are also medical emergencies.

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