Treatment

A heart attack is a medical emergency. Delaying treatment can mean lasting damage to your heart or even death. The sooner treatment begins, the better your chances of recovering. Your treatment may begin in the ambulance or in the emergency room and continue in a special area called a coronary care unit (CCU).

Immediate Treatment in the Hospital

If you are having a heart attack, doctors will:

• Work quickly to restore blood flow to the heart
• Continuously monitor your vital signs to detect and treat complications

Restoring blood flow to the heart is vital to prevent or limit damage to the heart muscle and to prevent another heart attack. The main treatments are the use of thrombolytic (clot-busting) drugs and procedures such as angioplasty.

• Thrombolytic drugs (clot busters) are used to dissolve blood clots that are blocking blood flow to the heart. When given soon after a heart attack begins, these drugs can prevent or limit permanent damage to the heart. To be most effective, these drugs must be given within 1 hour after the start of heart attack symptoms.
• Angioplasty procedures are used to open blocked or narrowed coronary arteries. A tiny metal mesh tube, called a stent, may be placed in the artery to help keep it open.
• Coronary artery bypass surgery uses arteries or veins from other areas in your body to bypass your blocked coronary arteries.

The CCU is specially equipped with monitors that continuously measure your vital signs. Those that can show signs of complications include:

• EKG (electrocardiogram), which detects problems with the heart rhythm or function
• A blood pressure monitor
• Pulse oximetry, which measures the amount of oxygen in the blood and provides an early warning sign of a low level of oxygen in the blood

Medicines

Several kinds of medicines can be used in treating heart attacks:

• Beta blockers decrease the workload on your heart by slowing your heart rate. This makes your heart beat with less force and lowers your blood pressure. Some beta blockers are also used to relieve angina (chest pain), and they are used in heart attack patients to help prevent additional heart attacks. Beta blockers are also used to correct irregular heartbeat.
• Angiotensin-converting enzyme (ACE) inhibitors lower blood pressure and reduce the strain on your heart. These medicines are used in some patients after a heart attack to increase survival rate and help slow down further weakening of the heart.
• Nitrates, such as nitroglycerin, relax blood vessels and stop chest pain.
• Anticoagulants thin the blood and prevent clots from forming in your arteries.
• Antiplatelet medicines (such as aspirin and clopidigrel) stop platelets from clumping together to form clots. These medicines are given to people who have had a heart attack, have angina, or experience angina after angioplasty.
• Glycoprotein IIb-IIIa inhibitors are potent antiplatelet medicines given intravenously to prevent clots from forming in your arteries.
• Other medicines may be given to relieve pain and anxiety.
• Some medicines treat arrhythmias (irregular heart rhythms) that often occur during a heart attack.

Oxygen therapy also may be given while you are in the hospital.

Long-Term Treatment

The length of your hospital stay after a heart attack depends on your condition and response to treatment. Most people spend several days in the hospital after a heart attack. While you are in the hospital, your heart will be monitored, and you will receive needed medicines. You will probably have further testing, and you will be treated for any complications that arise.

While you are still in the hospital or after you go home after your heart attack, your doctor may order other tests, such as:

• Echocardiogram. In this test, ultrasound is used to make an image of your heart that can be seen on a video monitor. It shows how well the heart is filling with blood and pumping it to the rest of the body.
• Exercise stress test. Some heart problems are easier to diagnose when the heart is working hard and beating fast. During stress testing, a patient exercises, or is given medicine, to make the heart work harder and beat fast while heart tests are performed. During exercise stress testing, blood pressure and EKG readings are monitored while the patient runs on a treadmill or pedals a bicycle.
  
  In addition to an EKG, other heart tests, such as nuclear heart scanning or echocardiography, can also be done at the same time. During nuclear heart scanning, radioactive dye is injected into the bloodstream, and a special camera shows the flow of blood to the heart muscle. If a person is unable to exercise, a medicine can be injected into the bloodstream to make the heart work harder and beat fast. Nuclear heart scanning or echocardiography is then done.
  
  Two newer tests that are being done with stress testing are magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning of the heart. MRI shows detailed images of the structures and beating of the heart. PET scanning shows blood flow to the heart muscle and areas of damaged heart muscle.

After You Leave the Hospital

After a heart attack, your treatment may include cardiac rehabilitation (see section below) in the first weeks or months, checkups and tests, lifestyle changes, and medicines. You will need to see your doctor for checkups and tests to see how your heart is doing. Your doctor will most likely recommend lifestyle changes, such as quitting smoking, losing weight, changing your diet, or increasing your physical activity.

After a heart attack, most people take daily medicines that may include:

• Aspirin
• Medicines to lower cholesterol or blood pressure
• Other medicines to help reduce the heart's workload

Always take medicines as your doctor directs.

Cardiac rehabilitation

Your doctor may prescribe cardiac rehabilitation (rehab) to help you recover from a heart attack and to help prevent another heart attack. Almost everyone who has survived a heart attack can benefit from rehab.

The cardiac rehab team may include:

• Doctors
  • Your family doctor
  • A heart specialist
  • A surgeon
• Nurses
• Exercise specialists
• Physical therapists and occupational therapists
• Dietitians
• Psychologists or other behavior therapists

Rehab has two parts:

• Exercise training helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual ability, needs, and interests.
• Education, counseling, and training help you to understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.

Reference:

National Heart, Lung, and Blood Institute, USA.