Heart Attack

Treatment

The treatment of a heart attack depends on how stable the person’s condition is and his or her immediate risk of death. Usually, the doctor will give the patient an aspirin to chew in the emergency room, because aspirin helps to prevent blood clotting.

The person also will be given oxygen to breathe, pain medication (usually morphine) for chest pain, beta-blockers to reduce the heart’s demand for oxygen, and, if blood pressure is not too low, nitroglycerin to temporarily increase blood flow to the heart. While in the hospital, patients often are given daily beta-blockers, ACE (angiotensin-converting enzyme) inhibitors, which help the heart work more efficiently, primarily by lowering blood pressure, and aspirin. Most heart attack patients also are given a prescription for a cholesterol-lowering medication.

If the diagnosis of heart attack is certain, then the patient will be considered for reperfusion therapy. The goal is to restore blood flow to the injured heart muscle as soon as possible to limit permanent damage. Reperfusion is best done mechanically. The patient is taken to the cardiac catheterization laboratory in the hospital and a catheter is threaded through a large blood vessel toward the heart. Dye is injected to locate the blockage in the coronary artery.

The next step is percutaneous transluminal coronary angioplasty (PTCA). In PTCA, a different catheter that has a small deflated balloon is threaded past the blockage, and the balloon is inflated to crush the clot and plaque. Most balloon catheters also have a wire mesh, called a stent, over the balloon. After the balloon is inflated to unclog the blocked artery, the stent remains in place to keep the artery open. Newer drugs called IIb/IIIa receptor inhibitors reduce clotting even more powerfully than aspirin. These drugs have been shown to be beneficial in patients who are about to undergo PTCA or stent placement. They include abciximab (ReoPro) and tirofiban (Aggrastat).

Reperfusion therapy can also be done with clot-dissolving drugs called thrombolytic agents. These include tissue plasminogen activator (tPA), streptokinase (Streptase), and anisoylated plasminogen streptokinase activator complex (APSAC). These drugs are often used if it would take too long to transfer a patient to a hospital where an angioplasty could be performed.

Much of the additional treatment for heart attack depends on whether the patient developed any complications. For example, additional drugs may be needed to treat dangerous cardiac arrhythmias (abnormal heartbeats), low blood pressure, and congestive heart failure.

When To Call A Professional

Seek emergency help immediately if you have chest pain, even if you think it is just indigestion or that you are too young to be having a heart attack. Prompt treatment increases your chance of limiting heart muscle damage, because reperfusion measures work best if they are started within 30 minutes after symptoms start.

Prognosis

About 15% of patients who suffer a heart attack die before they reach a hospital, and another 15% die after they arrive. Among the remaining 70% who survive hospitalization, about 4% (1 in 25) will die within the first year after discharge. However, this risk is not the same for all age groups. For example, for patients older than 65, the death rate is 20% within the first month after a heart attack, and 35% within the first year.

 

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