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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, today’s tip is a question that we get quite frequently and many of our readers actually want to know, “Is it normal to be ventilated after a heart attack?” And the answer is, it really depends. So, if someone is having a heart attack, not all patients end up in ICU or in intensive care or in critical care, and that’s the good news. But if it is a severe heart attack and the heart muscles are damaged, it can happen very quickly that after a heart attack, cardiac arrest happens next. And if a cardiac arrest happens, that means the heart stops beating and then usually CPR or Cardiopulmonary Resuscitation needs to be commenced. And that’s when a patient usually ends up on the ventilator with the breathing tube to save their life.

Now, if a patient after a heart attack without a cardiac arrest goes on a ventilator, usually the following happens again. The heart muscle is damaged and therefore, the heart can’t pump enough blood around and therefore a patient can develop, for example, pulmonary edema. So, that means fluids are being pushed into the lungs, which makes it difficult for a patient to breathe after a heart attack. And that’s when they end up on a ventilator with a breathing tube. Sometimes they might just end up on BIPAP (bilevel positive airway pressure) or on CPAP (continuous positive airway pressure), which is non-invasive ventilation with a mask without a breathing tube, and without an induced coma. So, it really depends.

Next, when I say the contractility of the heart, which means the pump function of the heart. In medical terms, that’s also often described as EF or Ejection Fraction. So, an ultrasound of the heart can determine the ejection fraction of the heart. And if it’s less than roughly 35%, the risk of pulmonary edema to happen is much higher. And again, that’s a high risk for patients to go into pulmonary edema and then end up on a ventilator with the breathing tube and go into an induced coma.

Now, other things that happen after a heart attack, patients often go into the catheter lab or cath lab. They often have an angiogram to see where the blockage of the heart occurs, which vessels are blocked, which arteries around the heart are blocked. Then, sometimes they can have a cardiac stent. And when that happens, I have also seen that patients then end up on a ventilator because again, they decompensate during the procedure and they can’t breathe, or they go into pulmonary edema because they’re also lying flat during the procedure. That often doesn’t help either. And then they end up being ventilated as well and go into an induced coma.

What can also happen is when patients have a heart attack, they sometimes get rushed to cardiac surgery as well. Again, they might have open heart surgery such as bypass grafts, and then again, they end up being intubated after surgery and they might be intubated for a day or two. It really depends on the severity of the heart attack. It depends on how long cardiac surgery took. It depends whether there’s any bleeding. It depends whether they’re hemodynamically stable. That is another reason why patients sometimes end up being intubated and on a ventilator. If they’re hemodynamically unstable after a heart attack, again, they might end up on multiple inotropes or vasopressors to maintain a blood pressure that’s compatible with life.

And if that happens, patients often also automatically go on a ventilator because again, they’re decompensating when they’re on multiple inotropes. Also, some patients after a heart attack also end up on intra-aortic balloon pump, also known as IABP. Again, there are many patients that might go on the balloon pump and that are awake. They end up not even in ICU. They sometimes end up on a cardiac ward but there are also patients in ICU after heart attack on the intra-aortic balloon pump that are ventilated and are in an induced coma or sometimes patients are in ICU on an intra-aortic balloon pump after heart attack, and they’re waiting for cardiac surgery to have open heart surgery bypass grafts. Then they come back on the intra-aortic balloon pump, and then they are ventilated as well.

So, as you can see, there are a number of scenarios why patients end up on a ventilator after heart attack in ICU. I hope that’s given you a good overview.

If you have any other questions in relation to that, just send us an email or if you have a loved one in intensive care, contact us at intensivecarehotline.com and call us on one of the numbers on the top of our website, or simply send us an email to [email protected].

Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There, you have access to me and my team, 24 hours a day, in a membership area and via email.

Also have a look and contact us if you need a medical record review. We review medical records for patients in ICU in real time. And we also review medical records after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence. But we highly recommend that help you review medical records in real time so that you can get that crucial second opinion in real time.

So that’s my quick tip for today.

Like the video, subscribe to my YouTube channel for regular updates for families in intensive care, share the video with your friends and families, click the notification bell, and comment below if you have any questions or insights or what you want to see next.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care.