Acute myocardial infarct (AMI) causes the patient to suffer from an angina-like pain which is usually more intense and prolonged, accompanied by cold sweats, nausea or vomiting and symptoms such as palpitations, weakness, dizziness or a feeling of imminent death.
Emergency treatment consists of controlling the pain, reducing the size of the infarct and preventing or treating the ventricular arrhythmia and medical complications.
Whenever possible, treatment begins with the administration of thrombolytic and anticoagulant treatments.
After the acute stage, AMI is an illness with a very variable prognosis, which depends on the extension of the ventricular dysfunction, the patient’s age, arterial hypertension, diabetes, etc.
- Ventricular arrhythmia can appear days or weeks after an AMI, and is always indicative of a heart pumping failure.
- Accelerated idioventricular rhythm is frequent and benign, but in some cases causes hypertension that will require treatment.
- Congestive heart failure.
- Supraventricular arrhythmia, which can be secondary to congestive heart failure.
- Bradyarrhythmia and A-V blockage, caused by intense ischemia or of the AV node. A temporary pace maker could be indicated.
Therefore, these are patients who require correct evaluation of their left ventricular function, residual myocardial ischemia and electrical stability.
The results will show whether or not the prognosis for the disease is favourable, and if it can be controlled using medical treatment or will require catheterisation, angioplasty or surgery.
- Ventricular aneurysm is saccular protrusion in the left ventricle caused by a myocardial infarct.Genuine aneurisms are formed by scar tissue and do not rupture, but they can become complicated by congestive heart failure, ventricular arrhythmia and the formation of thrombi.If there is a thrombus in the aneurysm or the aneurysmatic sac is large, the patient should be anticoagulated for a period of months and his evolution should be monitored
- Cardiac pseudoaneurysm is a type of contained cardiac rupture through the pericardium and an organized thrombus, which usually requires surgery to prevent cardiac rupture.
The patient must not drive.
After surgery the specialist will decide whether driving is possible and if so, when, depending on cardiac function and the risk of added complications.
- Recurring angina indicates a high incidence of reinfarct.This often requires special studies to be carried out, which in many cases lead to the patient undergoing an angioplasty or coronary surgery
- Dressler’s syndrome is characterized by fever, thoracic pain and pericardial effusion that can appear between two and six weeks after an AMI.This requires anti-inflammatories, sometimes corticoids and follow up of the patient’s evolution.
Advice on acute myocardial infarct
- Patients who have suffered an AMI must not drive until the specialist, after waiting a sufficient time, which should be in excess of six months, can form an opinion about the patient’s prognosis, and issue advice regarding which daily activities are suitable for the patient, including driving.
- While complications or their underlying risk factors remain, the patient will not be allowed to drive.
- Patients taking anti-coagulants must be told they will be at greater risk if involved in a collision, as they are more likely to haemorrhage.
- If a patient has observed with the safety period while the illness evolves and has subsequently been given permission to drive, he should be warned that in the case of any sign that could make him suspect he may relapse, he should stop driving and consult his doctor.
- Patients who have suffered an AMI may suffer from mood disorders caused by fear. This anxiety could adversely affect the degree of safety of the person’s driving.
- Stress triggered by driving in big cities is harmful to patients who have suffered a fairly recent AMI, so such patients should be warned against driving during rush hour and on complicated roads.
- Patients who have undergone a coronary revascularlisation should be symptom free and have adequate cardiac function. The authorization of the specialist will indicate at what point in time the patient may drive again.
- Whenever the patient has a check up, possible changes in these driving recommendations will be made, according to the evolution of the patient.
Advice on Ventricular aneurysm
- Patients suffering from cardiac aneurysm with risks of complications must not drive.
- When the aneurysm has been stabilised and no longer interferes with heart function and there is only a minimum possibility of embolisation, driving can be permitted so long as it is continues to be authorized and reported by an expert during subsequent check ups.
- Patients on anti-coagulants should know they are more vulnerable if involved in a collision, because they are more likely to suffer from a haemorrhage, possibly a cerebral haemorrhage.
Advice on Cardiac pseudoaneurysm and Recurring angina
The patient may not drive until the clinical manifestations have resolved, he is asymptomatic and cardiac function is adequate.
A specialist report will be necessary for driving to be permitted.
Advice on Dressler’s syndrome
- The patient may not drive until the clinical manifestations have completely remitted and then with the express permission of the specialist.