How a Heart Attack Is Treated

Treatment of an acute heart attack (myocardial infarction, MI) must be early and aggressive. The blockage of one of the coronary arteries that supplies blood to the heart causes an area of muscle to begin to die, and the longer blood flow is hindered, the more damage that occurs. Medical therapy is used to stabilize the cardiovascular system and prevent or at least mitigate long-term complications. This may include angioplasty and the use of thrombolytics or other medications.

Immediate Priorities

When someone arrives at the hospital with a possible heart attack, medical personnel will immediately check the patient's vital signs (pulse and blood pressure) and prepare to deal with any apparent life-threatening conditions, such as ventricular fibrillation.

Next, the team will need to determine if a heart attack has happened and, if so, which of the 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.

Surgery

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 a particular case.

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

The disadvantages of this approach are that it is an invasive procedure. Also, 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 event and 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. These powerful drugs, also known as thrombolytics or fibrinolytic agents, are given intravenously and nicknamed "clot busters" because they do just—dissolve blood clots that are in the process of forming. 

Thrombolytic therapy is most likely to be used if angioplasty can't be performed or isn't a safe option for a patient.

The best results are obtained if the medication is given within the first three hours of a heart attack; relatively satisfactory results are seen between three to six hours; and some benefit is seen up to 12 hours after the event, with little or no benefit after that.

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

  • TNKase (tenectaplase): The drug of choice in the United States 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)

Studies have shown that approximately 50% of occluded arteries can be opened if thrombolytics are given early in the course of a heart attack.

The major side effect of thrombolytic therapy is bleeding, making it unsafe for patients at high risk of this complication, 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. 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. These drugs are typically recommended the first day after anyone has had a heart attack.

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.

ACE inhibitors are usually started during the first 24 hours after a heart attack. Examples include:

  • Lotensin (benazepril)
  • Vasotec (enalapril)
  • 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 medication can be highly effective if given early enough, and the method chosen should usually be whichever is likely to open the artery faster. Truly surviving a heart attack requires ongoing effort after that first critical day. Your doctor will work with you to determine the steps that need to be taken to prevent complications and another event.

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Article Sources

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