Acute Prevention of the Heart Attack The identification of Prodromal Symptom Recognition as the “Rosetta Stone” in decoding the heart attack problem

Chest discomfort before severe chest pain represents a clinical ischemia marker and indicates live myocardium in jeopardy and often precedes cardiac arrest or acute myocardial infarction (MI). The intermittent or stuttering symptoms that precede MI are referred to as “prodromal symptoms”. These symptoms have been shown to correlate with cyclic ST changes and repeated episodes of spontaneous reperfusion and occlusion, occurring during a period of hours or days before the acute ischemia precedes to death or heart damage. These symptoms of premonitory angina have been associated with improved outcomes due to ischemic pre-conditioning or opening of collateral vascular channels around the area of ischemia. Acute prevention of an MI through prodromal symptoms recognition represents the opportunity for significantly reducing heart attack deaths. The early heart attack care (EHAC) program puts emphasis on prodromal symptom recognition and allows a shift in time backward to prevent the ischemic process from proceeding to MI. This strategy has been shown to pick up the 15% of the patients with ischemia in the low probability group and to reduce inappropriate admissions to the hospital as well as to reduce the number of patients with missed myocardial infarctions being sent home from the emergency department.