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If you want to know how your critically ill loved one in intensive care can be diagnosed for a heart attack, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecarehotline.com and I have another quick tip for families in intensive care.

There’s some context we are currently working with a client who has their 80-year-old mother in intensive care with Stage 4 breast cancer. She’s doing okay given that she went into ICU with a pneumonia. She needed some antibiotic therapy, but she never had to be intubated or needed BIPAP (bilevel positive airway pressure) or CPAP (continuous positive airway pressure), which is really good, so she got out of ICU within 5 or 6 days.

However, as she was going along in her ICU course, we found while we were reviewing the medical records that she had a high troponin in her blood results. Now, the troponin levels in the blood results indicate that someone has an acute heart attack or an acute MI (Myocardial Infarction).

I said to our client, “Has the ICU team spoken to you about your mom having a heart attack?” He said, “They have not mentioned it with one single word.” So, then the client obviously asked, how is a heart attack being diagnosed in intensive care? That’s pretty much what I’m answering today.

So, first off, it is diagnosed by checking a troponin level in the blood, and if troponin is high, then there’s a high chance your loved one would have a heart attack.

Now, but even leading up to a heart attack, how is a heart attack? What are the symptoms? Due to shortness of breath, tachycardia, arrhythmias, but also, chest pain, this patient wasn’t ventilated at that particular point in time. She didn’t complain about any chest pain, but that doesn’t mean it wasn’t a heart attack, it might have been a silent heart attack. In any case.

So, how do you diagnose a heart attack in intensive care? It really comes down to a combination of clinical assessments, ECG (electrocardiogram), cardiac biomarkers, i.e., troponin, imaging, and hemodynamic monitoring.

Here’s a more structured approach. 

Number 1, clinical assessment symptoms. Patients in ICU may or may not always be able to communicate chest pain. So, look for atypical signs such as sudden hypotension or shock. Hypotension means low blood pressure. New or worsening shortness of breath. Unexplained agitation, delirium, or confusion, arrhythmias or hemodynamic instability.

Risk factors are pre-existing conditions like coronary artery disease, diabetes, sepsis, or recent major surgery. None of that is the case with our client here.

Next, ECG, also known as an electrocardiogram. Obtain a 12-lead ECG immediately and look for ST segment elevation – ST elevation in at least 2 contiguous leads. It’s known as a STEMI (ST-elevation myocardial infarction), which means an ST segment elevation. It’s a very specific medical term. Doctors and nurses in ICU would know what it means, but I’m just breaking it down here for you. Non-ST elevation MI is a non-STEMI or NSTEMI – ST depression, T-wave inversion, or dynamic changes, at least now you know what you need to look for. Also, in the 12-lead ECG might show a new left bundle branch block (LBBB) may indicate myocardial infarct in critically ill patients.

Next, continuous ECG monitoring detects arrhythmias (abnormal heartbeat), ischemic changes, and ST segment trends.

Number 3, cardiac biomarkers. Like I said, high sensitivity troponin, elevated levels with a rising or falling pattern indicate myocardial injury. CKMB (creatine kinase-MB) can be used, but it’s less specific and reliable than troponin levels. Serial measurements, repeat troponins every 3 to 6 hours to confirm trends. Echocardiogram, besides ultrasound, point of care echocardiogram identifies regional wall motion abnormalities which suggests acute ischemia. So, you will see in an ultrasound some parts of the heart muscles are no longer moving because there’s ischemia. There’s dead heart muscle tissue from the heart attack.

Next, rule out other causes of hemodynamic instability such as pulmonary embolism, tamponade, or severe valvular disease.

Next, hemodynamic monitoring, invasive monitoring, patients with a myocardial infarct may develop cardiogenic shock requiring arterial blood pressure monitoring, pulmonary artery catheters, if indicated to assess cardiac output and filling pressures. Another term for pulmonary artery catheter is a Swan-Ganz catheter.

Next, additional tests. Chest X-ray rules out other causes like pneumonia, pulmonary edema, or aortic dissection. Next, coronary angiography for high-risk patients or those with ongoing ischemia despite medical therapy. 

Check for a differential diagnosis, which need to be considered. Sepsis-related myocardial dysfunction, Takotsubo cardiomyopathy, pulmonary embolism, aortic dissection, electrolyte imbalances causing ECG changes such as hypo or hyperkalemia, and low magnesium and high magnesium.

Immediate management if a heart attack is suspected. 

For STEMI, for an ST elevated myocardial infarct, emergency reperfusion therapy, PCI (percutaneous coronary intervention) or thrombolysis, if PCI is unavailable. Non-STEMI dual antiplatelet therapy, anticoagulation, betablockers, if stable and risk stratification for early invasive strategy. For the STEMI, if you wonder what PCI is, it’s basically an angiogram or an angioplasty.

So, I hope that helps.

I have worked in critical care nursing for 25 years in 3 different countries, where I worked as a nurse manager for over 5 years in critical care nursing and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can confidently, very confidently say that we have saved many lives for our clients in intensive care. I can also confidently say that our advice is absolutely life changing. 

You can verify all of that, Number 1, that we have saved many lives for our clients in intensive care. Number 2, that our advice is absolutely life changing. You can verify that in our testimonial section at intensivecarehotline.com and you can verify it in our intensivecarehotline.com podcast where we have done some client interviews. You can watch for yourself what our clients have said.

Now, you can join a growing number of clients that we are helping in intensive care. We have helped hundreds and hundreds of members and clients over the years. You can join a growing number of clients to change your life for the better and to change your critically ill loved one’s life for the better, making sure you make informed decisions, have peace of mind, control, power, and influence, make sure your loved one gets best care and treatment always.

That’s why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. I also talk to doctors and nurses directly on your behalf or with you or on a three-way call and I ask all the questions that you have not even considered asking but must be asked when you have a loved one critically ill in intensive care. I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time, so that you can get a second opinion in real time. We also do medical record reviews after intensive care so that you get all your questions answered, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 e-books and 21 videos that I have personally written and recorded. All of that will help you to make informed decisions, have peace of mind, control, power, and influence.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

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

Take care for now.

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