How a Heart Attack Is Treated

In This Article

An acute heart attack (also called a myocardial infarction) is a medical emergency in which one of the coronary arteries that supply blood to the heart has become blocked, causing an area of muscle to begin to die. Early and aggressive medical therapy is necessary to stabilize the cardiovascular system and to prevent or at least mitigate long-term complications.

Immediate Priorities

When someone arrives at the hospital with a possible heart attack, the first things medical personnel will do are:

  • Check vital signs (pulse and blood pressure)
  • Prepare to deal with any apparent life-threatening conditions such as ventricular fibrillation
  • Make a definitive diagnose of myocardial infarction

Next, it will need to be determined if a heart attack has happened, and if so which of two types of MI has occurred (or is in progress):

  • To diagnose the most severe form of a heart attack, an ST-segment elevation myocardial infarction (STEMI), in which the artery is totally blocked, a doctor typically needs only to observe a patient's symptoms and perhaps do an electrocardiogram (ECG)—a noninvasive test that provides a picture of the activity of the heart.
  • The less severe type of heart attack, a non-ST-segment elevation myocardial infarction (NSTEMI), isn't always as easy to diagnose, as the artery is only partially blocked. In this case, it's often necessary to do a blood test to look for an elevation in cardiac enzymes, proteins released into the bloodstream by damaged cardiac muscle cells.

Surgeries and Specialist-driven Procedures

In the event of a STEMI, immediate steps must be taken to unblock the artery and get blood flowing through it again as quickly as possible. This can be done with thrombolytic drugs (see below) or with a surgical procedure called angioplasty with stenting.

Most cardiologists will opt for angioplasty if the hospital catheterization lab (a special room equipped for this procedure) and experienced technicians can be made available immediately. This invasive approach would also be chosen if there is a good reason to avoid thrombolytic therapy in your case.

Rapid angioplasty with stenting is successful in opening a blocked artery about 80 percent of the time.

The disadvantages of this approach are that it is an invasive procedure and unless the hospital is gearing up to perform emergency angioplasty rapidly and efficiently, the opening of the blood vessel may be accomplished more quickly with thrombolytic therapy.

Medications

There are many medications that can be used during and immediately after a heart attack to stop the heart attack and to help prevent further damage to the heart.

Thrombolytic Therapy

This approach to treating an acute heart attack involves using medication to break up a blood clot using is most likely to be used if angioplasty can't be performed or isn't a safe option for a patient.

These powerful drugs, also known as thrombolytics or fibrinolytic agents, are given intravenously. They're nicknamed "clot busters" because they do just—dissolve blood clots that are in the process of forming. 

Studies have shown that approximately 50 percent of occluded arteries can be opened if such medications are given early in the course of a heart attack. The best results are obtained within the first three hours; relatively satisfactory results are seen between three to six hours; and some benefit is seen up to 12 hours, with little or no benefit after that.

Drugs Used During a Heart Attack

The type of drug used most often to break up a blood clot during a heart attack is tissue plasminogen activator (tPA). Specific tPA medications include:

  • TNKase (tenectaplase). The drug of choice In the U.S. because it appears to cause fewer bleeding consequences and is easier to administer than other thrombolytic drugs
  • Streptase (streptokinase). Used most frequently worldwide because it's relatively inexpensive
  • Kinlytic (urokinase for injection)
  • Activase (alteplase)
  • Retavase (reteplase)

The major side effect of thrombolytic therapy is bleeding, making it unsafe for patients at high risk of bleeding, such as those who've had recent surgery, have a history of stroke due to brain hemorrhage, or have very high blood pressure.

Other Medications

In addition to thrombolytics, other medications often are given to treat acute myocardial infarction.

Antiplatelets

The most common of these drugs, which reduce the stickiness of blood platelets thereby making it difficult for blood clots to form or get bigger, is aspirin. The typical dose is one-half or one whole uncoated adult aspirin, chewed or crushed, taken as soon as possible when a heart attack (or any acute coronary syndrome event) is suspected can significantly improve outcomes.

Anticoagulants

Examples of these drugs, also known as blood thinners, include heparin and Coumadin (warfarin). Given within the first 24 hours of an acute heart attack, a blood thinner helps prevent clotting and may lower the risk of long-term mortality.

Beta-Blockers

By impacting the effect of adrenaline, beta-blockers significantly improve the survival of patients with MIs and typically are recommended for anyone who has had a heart attack, starting the day after it occurs. According to the American Heart Association, the beta-blockers most often prescribed after a heart attack are:

  • Lopressor, Toprol XL (metoprolol)
  • Corgard (nadolol)
  • Inderal (propranolol)
  • Sectral (acebutolol)
  • Tenormin (atenolol)
  • Kerlone (betaxolol)
  • Ziac (bisoprolol/hydrochlorothiazide)
  • Zebeta (Bisoprolol)
  • Betapace (sotalol)

Angiotensin-Converting Enzyme (ACE) Inhibitors

These drugs expand blood vessels and allow blood to flow more easily. ACE inhibitors have been shown to significantly improve the outcome of patients who have large heart attacks or signs of heart failure, although they also can be beneficial in patients with less severe heart attacks. They usually are started during the first 24 hours after a heart attack. Example include Lotensin (benazepril), Vasotec (enalapril), and Altace (ramipril).

Statins

Statins appear to improve survival after an MI regardless of cholesterol levels, probably by reducing inflammation or stabilizing coronary artery plaques in some other way. Most often statins should be started before a heart attack patient leaves the hospital. Sometimes it's beneficial to begin them even sooner. The primary statins are:

  • Lipitor (atorvastatin)
  • Lescol (fluvastatin)
  • Mevacor (lovastatin)
  • Livalo (pitavastatin)
  • Pravachol (pravastatin)
  • Zocor (simvastatin)
  • Crestor (rosuvastatin)

A Word From Verywell

The first 24 hours after a heart attack are critical. Getting medical help as rapidly as possible is essential to preventing cardiac arrest, preserving heart muscle, and preventing further blood clots from forming. Both surgery and nedication can be highly effective if given rapidly enough. The most important thing is not which method is used, but to act quickly. Time is of the essence, and the method chosen should usually be whichever method is likely to open the artery more rapidly.

But even after a patient has successfully negotiated the first critical day, there is still a lot of work to do. A heart attack is not simply an isolated event that, once endured, can then be forgotten. Truly surviving a heart attack requires an ongoing effort, one that will not only save your life but also allow you to live a healthier and longer one than you might have otherwise.

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