Last Chance for Prevention (Acute Prevention): Identification of Prodromal Symptoms and Early Heart Attack Care

Abstract

Atherosclerotic cardiovascular disease is the leading cause of mortality and morbidity in the USA. Millions of dollars are spent each year for research efforts to find the best therapy for reperfusion of acutely closed coronary arteries, which would otherwise lead to acute myocardial infarction (MI). As with other disease states, heart attacks have beginnings. Chest discomfort before severe chest pain represents a clinical ischemia marker, and indicates live myocardium in jeopardy that often precedes cardiac arrest or acute MI. The intermittent or stuttering symptoms that precede MI are referred to as “prodromal symptoms.” These symptoms correlate with cyclic ST changes and repeated episodes of spontaneous reperfusion and occlusion, occurring during a period of hours or days before the ischemia proceeds to damage. Premonitory, or preinfarct angina, has been associated with improved outcomes in patients with acute MI by providing ischemic preconditioning or opening collateral vessels. Acute MI prevention through prodromal symptoms recognition represents an opportunity for reducing heart attack fatality. In conjunction with the Screening for Heart Attack Prevention and Eradication (SHAPE) initiative, the Early Heart Attack Care program emphasizes prodromal symptom recognition in at-risk populations, facilitating early detection and prevention of fatal heart attacks. Similarly, the strategy behind the chest pain centre movement in the USA is to prepare the hospitals for proper screening of patients suspected of acute coronary syndromes and to detect patients with prodromal symptoms in the community. In the era of the remarkably facilitated communication of Google, iPhone, Facebook, and Twitter, new developments are urgently needed to incorporate information technology into the early detection of prodromal symptoms. An example of such a development is proposed under “http://www.checkmyheart.com” in this chapter.Key wordsProdromal symptomsPreinfarct anginaChest pain centersEarly heart attack care