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

  • Raymond D. Bahr
  • Yasmin S. Hamirani
  • Morteza Naghavi
Chapter
First Online:
Part of the Contemporary Cardiology book series (CONCARD)

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 words

Prodromal symptoms Preinfarct angina Chest pain centers Early heart attack care 

Abbreviations

ACS

Acute coronary syndrome

CCU

Coronary care unit

CDU

Clinical decision unit

CHD

Coronary heart disease

CHEPER

Chest pain evaluation registry

CMS

Centers for medicare and medicaid services

CPC

Chest pain centers

CRUSADE

Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the American College of Cardiology/American Heart Association Guidelines – National Quality Improvement Initiative registry

ECG

Electrocardiogram

ED

Emergency department

EHAC

Early heart attack care

ER

Emergency room

GUSTO

Global utilization of strategies to open occluded coronary vessels

HCFA

Health care financing administration

MI

Myocardial infarction

MITI

Myocardial infarction triage and intervention

NEJM

New England journal of medicine

NHAEP

National heart attack alert program

NSTEMI

Non ST elevation myocardial infarction

OU

Observation unit

pPCI

Primary percutaneous coronary intervention

SCPC

Society of chest pain centers

SHAPE

Screening for heart attack prevention and education

SHAPE

Society for heart attack prevention and eradication

STEMI

ST elevation myocardial infarction

TIMI

Thrombolysis in acute myocardial infarction

tPA

Tissue plasminogen activator

USPHS

United States public health service

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Raymond D. Bahr
    • 1
  • Yasmin S. Hamirani
    • 1
  • Morteza Naghavi
    • 2
  1. 1.St. Agnes HealthcareBaltimoreUSA
  2. 2.Society for Heart Attack Prevention and Eradication (SHAPE)HoustonUSA

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