How can a heart attack be diagnosed and treated?

Question

Hello doctor,

My grandfather has been experiencing chest pain and high blood pressure for the last two days. We admitted him to the hospital, and according to the doctor, he had a mild heart attack. We would like to get a second opinion on his condition and further treatment. I will attach the reports.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

The heart attack in your grandfather’s case was diagnosed based on the CKMB (creatine kinase-MB) and qualitative troponin T tests (attachment removed to protect patient identity). CKMB is not a specific test for diagnosing a heart attack and may be elevated in many other conditions. The same applies to the 'qualitative' troponin T test. However, if there is no kidney problem, no severe infection in the body, and the patient has chest discomfort, then we can consider it a heart attack. An ECG (electrocardiogram) can also help in making the diagnosis. His echocardiography is overall normal. The best tests for diagnosing a heart attack are an ECG and a 'quantitative' troponin I test.

If your grandfather still has chest pain, I would advise proceeding directly with angiography and, if indicated, angioplasty. If he is not experiencing chest pain, then tests like stress echocardiography or myocardial perfusion imaging should be done. If these tests show changes consistent with a heart attack, angioplasty should be considered.

Please note, that in some cases, angioplasty is preferred, while in others, bypass surgery is more suitable. This decision is based on several factors, including the angiography report, the patient’s overall condition, and the patient’s preferences. In cases of very frail elderly individuals, only medical treatment may be recommended, with no attempt at angioplasty or bypass. This also depends on the patient's overall condition and the angiography results. In any case, whether angioplasty, bypass, or just medical treatment, medications will continue for life, taking into account contraindications and potential side effects.

Please provide more details about your grandfather’s overall health, such as any other conditions he might have, like kidney disease, lung problems, or walking difficulties. Also, share his ECG and any other reports that have already been done. With a clearer picture of his condition, I can guide you more effectively on the next steps for management.

Thanks and regards.