Hospital: When to go and What to Expect(About Heart)

When should you take your self to the hospital if you think you are having a heart attack?

Timing is every thing 1. If you think you are having a heart attack, call 911 ASAP. Do not drive yourself to the hospital or have someone else drive you. Call 911 which is different than calling an ambulance. 

What can they do in the hospital to tell if you are having a heart attack?

An electrocardiogram (ECG or EKG) is a is a painless non-invasive test that measures the electrical activity of the heart. Finding out how long a wave takes to travel from one part of the heart to the next shows if the electrical activity is normal or slow, fast or irregular. It can be used to detect if damage has been done to the heart muscle and in what general area of the heart the damage may have occurred. It also detects the rate and rythym of the heart.

Blood tests are done to detect cardiac enzymes. The blood test most commonly used to confirm the existence of heart muscle damage is the creation  kinase (CK). A small fraction of the CK enzyme, CK-MB, is often measured as well. CK-MB shows an increase above normal in a person's blood test about six hours after the start of a heart attack. It reaches its peak level in about 18 hours and returns to normal in 24 to 36 hours.

Tests can measure the amount of other cardiac muscle proteins called troponins, specifically troponin T (cTnT) and troponin I (cTnI). These proteins control the mechanism which contracts or squeezes the heart muscle. Troponins specific to heart muscle can detect minor heart muscle injury ("microinfarction") not detected by CK-MB. Normally the level of these special heart enzymes in the blood is very low because these enzymes normally exist and stay inside the heart muscle cells. When the heart muscle is damaged, these enzymes are released into the blood stream. It increases significantly within several hours (on average four to six hours) of heart muscle damage. It peaks at 10 to 24 hours and can be detected for up to 10 to 14 days. Levels of these cardiac enzymes compared to normal help doctors determine if you have a heart attack underway and its severity.

Echo cardiogram is a painless non-invasive imaging study which allows real-time imaging of the heart. It can assess how well the heart is or is not pumping. It uses high-frequency sound waves (ultrasound) to create an image of the heart . The sound waves measure the speed and direction of blood flow as well as wall motion and thickness of the heart chambers. It is commonly used for the evaluation of cardiac anatomy and physiology. It is similar to an ultrasound that is performed on pregnant women.

Cardiac catheterization is an invasive procedure used to detect the blocked arteries. See the page on operations for details.

CT coronary angiogram is a newer imaging study which may be done in some centers as a screening test for chest pains that are more atypical.

Coronary CT angiography (CCTA) has a relatively low technical burden for both the operator and patient and is quick to perform. The scanning time to acquire a three-dimensional dataset of the entire heart can take as little as 15 seconds. There are two types of CT scanners used for CCTA: electron beam computed tomography (EBCT), and multi-detector row or multislice CT scanners (MDCT or MSCT). MDCT scanners are much more widely available than EBCT scanners; as a result, most CCTA procedures are currently performed with MDCT scanners. To facilitate scanning and optimize image quality, most patients undergoing CCTA with current MDCT equipment receive oral or intravenous beta blockers to slow the heart rate to less than 60 to 70 beats/min. Sublingual nitroglycerin is sometimes given immediately before the scan to achieve maximal vasodilation.

Radiation exposure DCT scanners typically have higher spatial but lower temporal resolution than EBCT, and they impart a higher effective radiation dose to the patient when used for CCTA. In comparison, the effective radiation dose is 0.04 to 0.06 mSv from a routine chest x-ray, 2.0 to 5.0 mSv from an average diagnostic x-ray coronary angiogram, and the average annual background radiation in the United States is approximately 3.6 mSv.

Limitations The following patient-related factors can interfere with the diagnostic quality of CCTA images: 
Heart rate greater than 60 or 70 beats/min.
Irregular heart rhythm (atrial fibrillation; frequent atrial or ventricular extra-systoles). 
Inability to sustain a breath hold for at least 15 to 20 seconds.
Severe coronary calcification or the presence of coronary artery stunts, since image reconstruction artifacts related to radio-dense material such as calcium or metal can obscure the coronary artery lumen. 
Small vessel caliber (eg, distal segments of the left circumflex, marginal branches, and left anterior descending); segments with a diameter less then 1.5 mm can usually not be assessed for steno-sis 


These technical and image quality problems may be overcome with improvements in future generations of CT scanners.

Injection of iodinated contrast medium is required for both EBCT and MDCT coronary angiography. Thus, CCTA is contraindicated in patients with a history of allergy to iodinated contrast medium and relatively contraindicated in patients at high risk for contrast nephropathy (eg, diabetics with a serum creatinine concentration above 2.0 mg/dL.

How long does a heart attack patient need to stay in the hospital?

It varies depending on how complicated the case may be. In general 3 days is the average stay for an uncomplicated heart attack.

Heart Artery Disease FAQ

Q. Can you define heart disease?

A. The definition of heart disease as a term may describe many maladies including arteriosclerosis or atherosclerosis (artery disease or hardening of the arteries), congestive heart failure, valve problems. Other heart diseases or heart issues may result from other diseases such as heart trouble related to rheumatic fever. In this particular FAQ we will concentrate on heart artery disease sometimes called hardening of the arteries and medically referred to as atherosclerosis. So while you should remember how the dictionary may define heart disease, as used below in this FAQ we will used the limited definition specifically referring to heart disease from blockage in arteries leading to the heart.

Q. What happens in the body with heart artery disease?

A. Plaque builds up in the blood vessels that supply blood to the heart, then build up of the plaque causes a narrowing of the arteries restricting blood flow. If the restriction becomes significant enough it can affect a person’s ability to exert themselves and might lead to a heart attack.

Q. Is heart disease contagious?

A. No.

Q. Is heart artery disease inherited?


A. It can be, those with a family history of heart disease may have a predisposition to heart disease as well.

Q. If you have heart disease under age 60 who should you alert?

A. All first degree family members, like brothers, sisters and children so they can be screened for cholesterol, blood pressure and to make sure their doctors are aware and can pay more attention to potential heart disease symptoms.

Q. If you live with heart disease yourself who should you tell?

A. First you should make sure that those who live with you and your primary caretakers know. Next you should let other treating physicians know, including your dentist.

Q. Is there anything the people around me should know to do?

A. Those close to people living with heart disease should know where the patient’s nitro is and how to administer it (in cases where a doctor prescribed nitro for the person with the heart disease). All people living with heart disease patients should know how to call 911, including children. For kids this may just involve knowing how to dial 911 if the person has a heart attack, for adults they also need to understand what do in the event a heart disease patient displays any signs of chest pain. Read more on that in our hospitalization FAQ. Everyone, especially those living with a heart disease patient should learn CPR.

Q. How can you detect heart artery disease?


A. There are many tests read more in our Operations and Tests FAQ.

Q. Who should get tests for heart disease?

A. Any person displaying chest pain, anyone with family history of heart disease, anyone over 65. for more read the Symptoms FAQ and if you fear you see signs of a heart attack get checked. Even if your alleged heart disease symptoms turn out to be nothing, carving out part of your busy day to check them out will not take too much time or effort. Doctors want you to follow up on potential heart attack symptoms and will not resent the fact that you may have used their time on something that had nothing to do with heart disease. On the other hand, if you ignore heart disease signs because you figure there is no way you could have a heart attack or because you can't be bothered and you do have heart disease, a catastrophic heart attack could result. Think of it this way: If you think you may have a heart problem and you see a doctor who says you were wrong, you made a small mistake, if you ignore a real heart problem you made a HUGE mistake.

Q. Can anything reverse plaque buildup associated with heart artery disease?

A. Lowering cholesterol has been show to reverse plaque accumulation.

Q. Is heart artery disease always fatal?

A. No, it is not always fatal; you can live with a certain level of blockage without it affecting your life at all. On the other hand, if you ignore heart artery disease, especially a serious case, the blockage may eventually build to the point where tragedy might occur. People with any heart disease must never forget sometimes with even a low level of the disease a major event can occur because sometimes the plaque becomes unstable, ruptures and causes complete heart artery blockage.

Q. Can you live a normal life with some level of plaque buildup?

A. Yes, it depends on your level of activity; many people live with low levels of plaque lining their arteries and never become aware they have any heart disease at all. Generally blockage levels reaching as much as 10%-20% might not be noticed by a normal person.

Q. What kind of symptoms might someone feel as heart artery disease started to affect them?
A. You may never feel anything. That defines part of the problem with this type of heart disease; you may not experience symptoms until the disease has progressed quite far along. Unfortunately death sometimes marks the first symptom. Early signs, if they do present themselves, may include fatigue, specifically increased fatigue with exertion, shortness of breath, especially with physical effort, and sometimes chest pain which may be mistaken for heartburn. For more serious symptom as the disease progresses see the heart attack symptoms FAQ.

Q. They call this hardening of the arteries; do the heart arteries really get hard like rock?
A. Eventually, yes the plaque within the heart arteries gets fairly hard but more like coral than rock.

Q. Does plaque build up in other places besides heart arteries?

A. Yes anywhere you have blood vessels. Plaque buildup in arteries providing blood flow to the brain may lead to a stroke. In the arteries to the lower extremities you may develop peripheral vascular disease more specifically called claudication which causes leg pain predominantly in the calf. Buildup in arteries supplying blood to the kidneys can cause kidney disease, and the similar problems may occur with plaque inhibiting blood flow to any of the major organs.

Q. At what age does heart artery disease start?

A. Much earlier than most people think, depending on diet and family history it may start as early as age 10.