Heart Attack

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Heart Attack Treatment

A heart attack is a medical emergency! Hospitalization is required and, possibly, intensive care. Continuous ECG monitoring is started immediately, because life-threatening arrhythmias are the leading cause of death in the first few hours of a heart attack.

The goals of treatment are to stop the progression of the heart attack, to reduce the demands on the heart so that it can heal, and to prevent complications.

An intravenous line will be inserted to administer medications and fluids. Various monitoring devices may be necessary. A urinary catheter may be inserted to closely monitor fluid status.

Oxygen is usually given, even if blood oxygen levels are normal. This makes oxygen readily available to the tissues of the body and reduces the workload of the heart.

PAIN CONTROL MEDICATIONS

Sublingual (under the tongue) or intravenous (IV) nitrates such as nitroglycerin are given for pain and to reduce the oxygen requirements of the heart. Morphine or morphine derivatives are potent pain killers that may also be given for a heart attack.

BLOOD THINNING MEDICATIONS

If the ECG recorded during chest pain shows a change called "ST-segment elevation," clot-dissolving (thrombolytic) therapy may be initiated within 6 hours of the chest pain onset. This initial therapy will be administered as an IV infusion of streptokinase or tissue plasminogen activator, and will be followed by an IV infusion of heparin. Heparin therapy will last for 48 to 72 hours. Additionally, warfarin,taken orally, may be prescribed to prevent further development of clots.

Thrombolytic therapy is not appropriate for people who have had:

• A major surgery, organ biopsy, or major trauma within the past 6 weeks
• Recent neurosurgery
• Head trauma within the past month
• History of GI (gastrointestinal) bleed
• Brain tumor
• Stroke within the past 6 months
• Current severely elevated high blood pressure

Use of thrombolytic therapy can be complicated by significant bleeding.

A cornerstone of therapy for a heart attack is antiplatelet medication. Such medication can prevent the collection of platelets at a site of injury in a blood vessel wall -- like a crack in an atherosclerotic plaque. Platelets collecting and accumulating is the initial event that leads to clot formation. One antiplatelet agent widely used is aspirin. Two other important antiplatelet medications are ticlopidine (Ticlid) and clopidogrel (Plavix).

OTHER MEDICATIONS

• Beta-blockers (like metoprolol, atenolol, and propranolol) are used to reduce the workload of the heart.
• ACE Inhibitors (like ramipril, lisinopril, enalapril, or captopril) to prevent heart failure.

SURGERY AND OTHER PROCEDURES

Emergency coronary angioplasty may be required to open blocked coronary arteries. This procedure may be used instead of thrombolytic therapy, or in cases where thrombolytics should not be used. Often the re-opening of the coronary artery after angioplasty is ensured by implantation of a small device called a stent. Emergency coronary artery bypass surgery (CABG) may be required in some cases.