Skip to main content
SpringerLink
Log in

Acute prevention of a heart attack

Early identification of prodromal symptoms as the Rosetta Stone in decoding the heart attack problem

Akutprävention des Herzinfarkts

Früherkennung von Prodromalsymptomen als der Stein von Rosette in der Entschlüsselung der Frage nach Vorliegen eines Herzinfarkts

  • Main topic
  • Published:
Herz Aims and scope Submit manuscript

Abstract

Chest discomfort before severe chest pain represents a marker of clinical ischemia and indicates live myocardium in jeopardy and often precedes cardiac arrest or acute myocardial infarction (MI). The intermittent or “stuttering” symptoms that precede MI are referred to as “prodromal symptoms.” These symptoms have been shown to correlate with cyclic ST changes and repeated episodes of spontaneous reperfusion and occlusion, occurring during a period of hours or days before the acute ischemia proceeds to death or heart damage. These symptoms of premonitory angina have been associated with improved outcomes due to ischemic pre-conditioning or opening of collateral vascular channels around the area of ischemia. Acute prevention of an MI through recognition of prodromal symptoms represents an opportunity to significantly reduce heart attack deaths. The Early Heart Attack Care (EHAC) program puts emphasis on prodromal symptom recognition and allows for a shift in time backward to prevent the ischemic process from proceeding to MI. This strategy has been shown to detect the 15% of patients with ischemia in the low-probability group and to reduce inappropriate admissions to hospital as well as to reduce the number of patients with missed MI being sent home from the emergency department.

Zusammenfassung

Thorakales Unwohlsein noch vor dem Auftreten starker Brustschmerzen stellt einen klinischen Ischämiemarker dar, der dem Myokardinfarkt oder plötzlichen Herztod vorausgehen kann. Intermittierend auftretende Symptome, die einem Myokardinfarkt vorausgehen, werden als „Prodromalsymptome“ bezeichnet. Es wurde nachgewiesen, dass diese Symptome mit zyklischen ST-Veränderungen sowie wiederholten Episoden spontaner Reperfusion und Okklusion korrelieren, die innerhalb eines Zeitraums von Stunden oder Tagen auftreten, bevor die akute vital bedrohliche Ischämie einsetzt. Als Pathomechanismus können sie mit einer ischämischen Vorkonditionierung oder partiellen Kollateralisierung in Korrelation gebracht werden. Die akute Prävention eines Herzinfarkts durch die Erkennung prodromaler Symptome bietet die Möglichkeit, die Zahl der schweren Infarkte und infarktbedingten Todesfälle zu senken. Das sog. Early-Heart-Attack-Care-Programm (EHAC) legt den Schwerpunkt auf die Erkennung prodromaler Symptome und ermöglicht eine zeitliche Verschiebung nach vorn, um zu verhindern, dass der präischämische Prozess in einen Myokardinfarkt übergeht. Dies trägt einerseits zur zeitgerechten Krankenhausaufnahme der 15% von Patienten mit Ischämie in der Gruppe mit niedriger Wahrscheinlichkeit bei und reduziert andererseits auch die Anzahl nicht notwendiger Krankenhauseinweisungen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bhatt DL, Lopes RD, Harrington RA (2022) Diagnosis and treatment of acute coronary syndromes: a review. JAMA 327(7):662–675

    Article  PubMed  Google Scholar 

  2. Denktas AE, Anderson HV, McCarthy J, Smalling RW (2011) Total ischemic time: the correct focus of attention for optimal ST-segment elevation myocardial infarction care. JACC Cardiovasc Interv 4(6):599–604

    Article  PubMed  Google Scholar 

  3. Lee Th, Goldman L (1998) The coronary care unit turns 25: historical trends and future directions. Ann Intern Med 105:887–894

    Google Scholar 

  4. Braunwald E (1997) Shattuck lecture—cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med 337(19):1360–1369

    Article  CAS  PubMed  Google Scholar 

  5. Walker DM, West NE, Ray SG, British Cardiovascular Society Working Group on Acute Cardiac Care (2012) From coronary care unit to acute cardiac care unit: the evolving role of specialist cardiac care. Heart 98(5):350–352

    Article  PubMed  Google Scholar 

  6. (1994) Emergency department: rapid identification and treatment of patients with acute myocardial infarction. National Heart Attack Alert Program Coordinating Committee, 60 Minutes to Treatment Working Group. Ann Emerg Med 23(2):311–329

  7. Thiele H, Eitel I, Meinberg C, Desch S, Leuschner A, Pfeiffer D, Hartmann A, Lotze U, Strauss W, Schuler G, LIPSIA-STEMI Trial Group. (2011) Randomized comparison of pre-hospital-initiated facilitated percutaneous coronary intervention versus primary percutaneous coronary intervention in acute myocardial infarction very early after symptom onset: the LIPSIA-STEMI trial (leipzig immediate prehospital facilitated angioplasty in ST-segment myocardial infarction). JACC Cardiovasc Interv 4(6):605–614

    Article  PubMed  Google Scholar 

  8. Weaver WD, Cerqueira M, Hallstrom AP, Litwin PE, Martin JS, Kudenchuk PJ, Eisenberg M (1993) Prehospital-initiated vs hospital-initiated thrombolytic therapy. The myocardial infarction triage and intervention trial. JAMA 270(10):1211–1216

    Article  CAS  PubMed  Google Scholar 

  9. Bahr RD (2001) Good, better, best “infarctus interruptus” view from a public health cardiologist’s perspective. Md Med (Suppl):80–82 (Spring)

  10. Andreotti F, Pasceri V, Hackett DR, Davies GJ, Haider AW, Maseri A (1996) Preinfarction angina as a predictor of more rapid coronary thrombolysis in patients with acute myocardial infarction. N Engl J Med 334(1):7–12

    Article  CAS  PubMed  Google Scholar 

  11. Bahr RD (2002) Prodromal symptom recognition of a heart attack. An overlooked phenomenon for recognizing a window of opportunity for early heart attack care. Crit Pathw Cardiol 1(3):194–206

    PubMed  Google Scholar 

  12. Bahr RD (1979) The chest pain emergency room-heart attack-how one baltimore hospital st.agnes is handling the problem. Md State Med J 28(9):82

    CAS  PubMed  Google Scholar 

  13. Bahr RD (1991) Chest pain emergency rooms: an ldea whose time has come. Cardiovasc Mamt 2(5):32–38

    Google Scholar 

  14. Bahr RD (2005) The chest pain center strategy for delivering community heart attack care by shifting the paradigm of heart attack care to earlier detection and treatment. Prev Cardiol 5(11):16–22

    Google Scholar 

  15. Bahr RD (1995) Growth in chest pain emergency departments throughout the United States: a cardiologist’s spin on solving the heart attack problem. Coron Artery Dis 6(10):827–838

    Article  CAS  PubMed  Google Scholar 

  16. Bahr RD (1998) The concept and the development of chest pain emergency departments as a strategy in the war against heart attack. Crit Care Nurs Clin North Am 10(1):41–51

    Article  CAS  PubMed  Google Scholar 

  17. Bahr RD (1995) The EHAC (early heart attack care) strategy: citizens chart the course for healthy people in the year 2000. J Cardiovasc Manag 6(3):19–23

    CAS  PubMed  Google Scholar 

  18. Bahr RD (2003) Value of the history in evaluating patients for early myocardial ischemia in observation chest pain centers. Crit Pathw Cardiol 2(2):104–112

    Article  PubMed  Google Scholar 

  19. Joseph AJ, Cohen AG, Bahr RD (2003) A formal, standardized and evidence-based approach to chest pain center development and process improvement: the society of chest pain centers and providers accreditation process. J Cardiovasc Manag 14(6):11–14

    PubMed  Google Scholar 

  20. Breuckmann F, Burt DR, Melching K, Erbel R, Heusch G, Senges J, Garvey JL (2015) Chest pain centers: a comparison of accreditation programs in Germany and the United States. Crit Pathw Cardiol 14(2):67–73

    Article  PubMed  Google Scholar 

  21. Dracup K, Moser DK, Eisenberg M, Meischke H, Alonzo AA, Braslow A (1995) Causes of delay in seeking treatment for heart attack symptoms. Soc Sci Med 40(3):379–392

    Article  CAS  PubMed  Google Scholar 

  22. Bahr RD (2014) Creating a virtual coronary care unit in the community in 2014 Dr. raymond D. bahr founder, society of cardiovascular patient care and early heart attack care. Crit Pathw Cardiol 13(4):159–162

    Article  PubMed  Google Scholar 

  23. Breuckmann F, Rassaf T (2020) Early heart attack care as a prehospital programme designed to supplement the established chest pain unit concept in Germany. Eur Heart J Acute Cardiovasc Care 9(1_suppl):93–94

    Article  PubMed  Google Scholar 

  24. https://deputyheartattack.acc.org

Download references

Acknowledgements

This article needed to be published for a long time in that it covers the 40 years of the chest pain center’s role in heart attack care in the United States. lts emphasis on early care for the treatment of heart attacks led to the discovery that “heart attacks had beginnings” and that these beginning symptoms might be a way to intervene early and prevent the heart attack from occurring. Acute heart attack prevention has now become a major strategy in reducing heart attack deaths in the United States. Much of the credit for this article must be given to Prof. Frank Breuckmann in Germany, who was the stimulus in seeing the need to have this story published for its contribution to meaningful heart attack care. It would not have been published without his guiding direction.

Author information

Authors and Affiliations

  1. ACC Accreditation Services, Early Heart Attack Care Subcommittee, Baltimore, MD, USA

    Raymond D. Bahr MD FACC

  2. 2901 Boston St, Apt. 609, 21224, Baltimore, MD, USA

    Raymond D. Bahr MD FACC

Authors
  1. Raymond D. Bahr MD FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raymond D. Bahr MD FACC.

Ethics declarations

Conflict of interest

R.D. Bahr declares that he has no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bahr, R.D. Acute prevention of a heart attack. Herz (2024). https://doi.org/10.1007/s00059-024-05239-0

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00059-024-05239-0

Keywords

Schlüsselwörter

Search

Navigation