Advice and questions - Interventional cardiology

Find out the most important advice given by our consultant and the most adequate medical responses for each particular case.

Emergency treatment of AMI (acute myocardial infarction)

The treatment of acute myocardial infarction is an emergency treatment that must be performed as soon as possible after the commencement of the infarction, in order to reduce the myocardial necrosis area and to prevent complications. The amount of muscle dying due to the lack of blood can be reduced by dissolving the clots in the coronary arteries and re-establishing blood flow.

When the pain begins, you can take a NITROGLYCERIN tablet under your tongue, if this medicine is already part of your treatment. If the pain does not go away, you can take 2 more tablets at an interval of 5 minutes.

If the symptoms do not disappear after 15 minutes, call an ambulance immediately! Attention! Do not take Nitroglycerin if it was not prescribed to you by your physician (because there are certain conditions that can be aggravated by taking this medicine!).

In the Emergency Room of the hospital the diagnosis is determined through clinical examination and electrocardiogram; then, the patient is transported to special units, called Infarction Centres, where the physicians perform a coronary monitoring and they start the treatment for acute myocardial infarction.

The treatment includes:

  • Installing a venous line;
  • Constant monitoring of the patient (arterial pressure, electrocardiogram, general condition);
  • Collecting emergency samples for tests;
  • Oxygen therapy;
  • underlingual nitroglycerin and intravenous perfusion;
  • Analgesics (Algocalmin, Mialgin);
  • Aspirin (and possibly Clopidogrel), heparin;
  • Thrombolytic treatment (if the patient arrives at the hospital less than 12 hours after the commencement of the AMI) with streptokinase or other thrombocytes; the role of this medicine is to dissolve the blood clots and re-establish a normal blood flow through the coronary arteries. The size of the area affected by the AMI can be reduced if blood flow is re-established quickly. But time is of major importance! If there are any delays, the benefits of this method diminish.

Another method of treatment for re-opening the coronary artery affected by AMI is coronary angioplasty of the artery (in the centres have a laboratory for catheterisation).

The physicians will continue to administer heparin, beta blockers (e.g. Metoprolol), Aspirin and possibly Clopidogrel, as well as other medicines that improve the heart function, depending on the patient's status. Anxiety treatment (frequent in patients with AMI in the first 24-48 hours) involves administering medication such as: Diazepam, Alprazolam and Hydroxyzine.

What you need to bear in mind is that treatment is not identical for all patients with AMI. It varies depending on the patient's clinical status, the location of the AMI and the occurrence or non-occurrence of complications.

Usually, the patient with AMI remains in the Infarction Centre for 24-48 hours (in cases that do not involve complications) and then s/he is transferred to the 2nd ward – the ward for post-infarction monitoring.

Healing of the heart

Nowadays, physicians know much more about the healing process of the heart and therefore patients receive a much better early care for myocardial infarction. Moreover, the recovery period has shortened.

In normal cases, when there is a blood flow in the coronary arteries, the healing process is faster. The area of the heart muscle that has suffered a permanent lesion is replaced by a scar.

The myocardial infarction can leave certain sequelae that are variable and depend on:

  • The size of the infarction;
  • Whether this is the first infarction or a second AMI;
  • The general state of the coronary arteries.

The sequelae can be minimal in the following cases: many patients agree to give up smoking, to do physical exercises, to lose weight and after a few months they recover well.

There is also the possibility of some sequelae:

  • Cardiac insufficiency that causes difficult breathing;
  • The persistence of an angina pectoris;
  • The occurrence of some cardiac rhythm irregularities.

Such problems need to be discovered as soon as possible – their occurrence after a myocardial infarction should lead you to a visit to your cardiologist! Depending on the results, the cardiologist will adapt your treatment.

Convalescence and rehabilitation

Each person that is in convalescence after an acute myocardial infarction has two main purposes:

  • Developing a plan to recover his/her capacities in order to live his/her life as normally as possible;
  • Controlling the risk factors in order to reduce the possibility of recidivism.

If there are no complications, patients do not have to remain in bed for more than 12 hours. Daily activities should be resumed progressively and in a personalised manner, depending on the patient's general state, age and physical capacity.

Stage 1 (days 1-2)

On the first day, the patient will remain in bed and will be able to feed himself/herself with the help of a support table. The patient will receive complete assistance for personal hygiene. With help, the patient will be able to make passive movements with his/her arms and legs.

On the second day, the patient can sit on the side of the bed or on an armchair for 1-2 hours/day. S/he will be able to actively move his/her arms/feet for 5-10 minutes/day.

Stage 2 (days 3-4)

The patient can do his/her personal hygiene and can dress himself/herself, but only in sitting position. The patient will be able to sit on a chair or in an armchair for as long as s/he wants and s/he can stroll across the ward.

On the fourth day, the patient can take a shower while standing or sitting (using a chair reduces the anxiety and fear of falling). The patient can stroll 50-100m under supervision, several times a day.

Stage 3 (days 5-7)

The patient can stroll for about 100 m, 3 times a day. S/he can shave or wash their hair (activities that consist of raising the arms above the head). S/he can climb up and down the stairs under supervision.

Usually, the best results are obtained when there are several people involved in the recovery program. The family should be understanding and should actively participate in the patient's program. However, an over-protective family or a family with high expectations can slow down the process. The physician is the person who recommends the progressive increase of activity, exercises and treatment.


The discharge date depends on the patient's status and on the type of treatment. Before getting discharged, patients will receive clear recommendations regarding the treatment, nutrition and the physical activities allowed. Some of the activities that used to be possible might be limited after the infarction. Nevertheless, the majority of patients can adapt and thus they can resume their active life in a satisfactory manner, including going back to work, if the case.

Recommendations upon discharge

At first, we recommend you to avoid significant physical effort and lifting heavy objects. Resting several times a day is important at this stage. In time, you will be able to do more activities, depending on how your body sustains them.

You should avoid any activity that causes you anginous chest pain!

It is very important to have Nitroglycerin with you at all times to use in case of need.

A long-term plan will include methods of reducing the risk factors that might cause recidivism of the AMI.

It is essential that you give up smoking permanently! In patients who have given up smoking, the risk of heart disease has diminished significantly in the following years.

Correct nutrition is also of major importance. It involves reducing the level of fat and cholesterol. In the first place, you have to reduce the ingestion of fat from meat and dairy products. It is beneficial to introduce fresh fruit and vegetables in your diet. In some cases, in order to reduce the cholesterol level in the blood you might need to take certain medication. Hypertensive patients also have to reduce the quantity of ingested salt.

Physical exercise and physical activity in general represent a major factor in the process of recovery after an AMI. It is very important to ask you physician about the amount of physical exercise that you are allowed to make. You will be put in contact with a consultant in cardiology recovery who will offer guidance. Under the supervision of said consultant, your physical activity will be monitored and guided for a good physical recovery. You should discuss all of this with your physician, without any inhibitions.

Sexual activity can only be resumed after undergoing an effort test at the hospital. The patient can usually resume sexual activity after s/he is able to climb two flights of stairs without any problems.

Other measures that need to be taken to reduce the cardiovascular risk in the future: control of the arterial hypertension, of diabetes mellitus and of dyslipidaemia (if present), weight control and avoiding stress. After an AMI or angina pectoris, medication is not enough. Medication can be insufficient if you are not fighting the risk factors as well: obesity, smoking, diabetes mellitus, arterial hypertension, dyslipidaemia, sedentary lifestyle.

The medication treatment prescribed upon discharge should be continued on the long term. It will include several categories of essential medicines that should not be interrupted without the consultant's approval.

Any adjustment of dosage or of the therapeutic scheme must be made with the physician's approval.

Medical exams after suffering an infarction

After suffering an acute myocardial infarction or even after the onset of angina pectoris, patients should undergo periodical cardiological exams.

These exams are essential for:

  • Monitoring the evolution of the coronary disease (chest pain, fatigue, suffocation etc.);
  • Monitoring the risk factors (weight, arterial pressure, diabetes, cholesterol, physical activity);
  • Possible effort test in order to determine the response of the myocardium to physical exercises.

It is very important to discuss with your cardiologist about the scheduling of medical exams that you will undergo in the hospital or at the polyclinic that you belong to.

Overweight or obese people have a higher risk of developing cardiovascular diseases, even when there are no other risk factors involved. The excess weight caused by fat forces the heart to work more and unbalances the cholesterol and glucose levels in the blood.

How can you find out whether you are obese or overweight?

In order to answer this question, specialists use two indicators: BMI (body mass index) and AC (abdominal circumference).

BMI (body mass index) is an official index used to measure the ideal body mass for a certain height. BMI helps determine a person's weight category, the degree of obesity and it also helps measure the number of kilograms that a person should lose or gain in order to reach the ideal weight. This method can be used for both men and women aged between 18 and 65 years. In order to find out your BMI, use the following tool: the body mass index calculator created by the BMI-Club.

Interpreting the body mass index:

The formula used to determine the body mass index is: weight (kg) / [height (m)]2

  • BMI under 18.5 – underweight
  • BMI 18.51 - 24.99 – normal weight
  • BMI between 25 - 29.99 – overweight
  • BMI between 30 - 34.99 – class 1 obesity
  • BMI between 35 - 39.99 – class 2 obesity
  • BMI over 40 – class 3 obesity

AC (abdominal circumference) – excess fat can deposit in various parts of the body. The most harmful type of fat is the one deposited in the abdominal area. This type of fat is quantified with the help of this parameter. It is very easy to measure your abdominal circumference by using a tailor meter that you put around your abdomen.

Depending on the value, you can find out whether you are at risk or not. The people at risk have the following values:

  • Men with AC larger than 95 cm
  • Women with AC larger than 80 cm

Control your blood pressure!

Arterial hypertension usually progresses in a silent manner, without any signs or symptoms that would alert the patients about the presence of the disease. This is why it is important to measure the arterial blood pressure at regular intervals. Arterial blood pressure is characterised by 2 values: the first is higher and it is called systolic pressure, the second is lower and it is called diastolic pressure. The difference between these two values should be of approximately 40 – 50 mmHg.

The hospitalisation period depends on the patient's condition:

Normal under 120 mmHg or under 80 mmHg
Prehypertension 120-139 mmHg or 80 -89 mmHg
Stage 1 hypertension 140-159 mmHg or 90 - 99 mmHg
Stage 2 hypertension over 160 mmHg or over 100 mmHg
Hypertensive crisis. Measure again in 5 minutes or call an ambulance over 180 mmHg or over 110 mmHg

Your future

Your future depends on the risk of new coronary and myocardial lesions and on the sequelae of the previous ones.

In the people's view, the heart conditions is often considered to be characteristic of active people with a stressful life, full of responsibilities or of people who have had a life full of excesses.

No, this is not true. The heart condition is not specific of stressed people with many responsibilities and it is not necessarily a dramatic and crippling disease.

It is rather a disease that you can act on, but only if you adopt a healthy lifestyle and if you comply with your physician's recommendations. Your main aim could be having a more harmonious and healthier life than before the acute myocardial infarction and this aim is certainly achievable.