Treatment Overview
When a
heart attack is in progress, you need to act quickly.
Prompt treatment with medicines, angioplasty combined with stenting, or surgery
to restore blood flow soon after symptoms first begin can prevent permanent
injury to the heart muscle and save your life.
Initial treatment
If you are having a
heart attack, the goal of your health care team will
be to prevent permanent heart muscle damage by restoring blood flow to your
heart as quickly as possible. If you are transported to the hospital in an
ambulance, you will be given
oxygen therapy and probably
nitroglycerin or a pain reliever, such as
morphine.
Also,
aspirin (which is usually chewed on the way to the
hospital or in the emergency room),
heparin, and
antiplatelet drugs are given to prevent clots from
growing. Other medicines will be given initially to decrease your heart's
workload, improve its pumping function, and treat life-threatening abnormal
heartbeats if they occur.
The time it takes to get to a hospital
is critical because
angioplasty with or without stenting to open blocked
arteries or "clot-busting"
thrombolytic medicines to dissolve clots are most
effective if used within the first several hours after symptoms start.
Thrombolytics are given through an
intravenous (IV) line and travel to the coronary
arteries where they break up clots.
Numerous studies have shown
that percutaneous coronary intervention (angioplasty
with or without
stenting) saves lives.
Although
angioplasty with or without stenting is usually the preferred treatment, it is
not available at all hospitals. So some communities are training paramedics to
identify people who have signs of heart attack so that they can be transported
directly to a heart center, even if it means bypassing a closer
hospital.
If you are treated at a hospital that has proper
equipment and staff, you may be taken to the
cardiac catheterization lab where your doctor will
evaluate your coronary arteries to determine whether angioplasty or
coronary artery bypass graft surgery is
appropriate.
If angioplasty with or without stenting is not
possible, either because of the location of the blockage or because of numerous
blockages, emergency coronary artery bypass surgery may be done.
If you are having unstable angina, you most likely will be admitted to the hospital and given
medicines, including aspirin, other antiplatelet medicines, and heparin. You
will be closely monitored and tested. If chest pain continues after the above
treatment and you are at high risk for heart attack, your doctor may decide to
perform coronary catheterization and plan for possible angioplasty and stent
placement to prevent a heart attack.
Ongoing treatment
After you have had a
heart attack, you will stay in the hospital for at
least a few days so your heart rate and rhythm, blood pressure, and medicines
can be closely monitored. You will stay in the hospital because after a heart
attack you are at high risk of having serious complications, such as
life-threatening
abnormal heart rhythms and
heart failure.
To reduce the risk of
complications, your doctor will start you on medicines.
Angiotensin-converting enzyme (ACE) inhibitors,
angiotensin II receptor blockers (ARBs), and
beta-blockers may improve your chance of survival
after a heart attack.
Cholesterol-lowering medicines called
statins are usually given to lower your LDL
cholesterol level to less than 100 mg/dL. Cholesterol-lowering medicines can
reduce the risk of heart attack and stroke.
Aspirin, other
antiplatelet medicines such as clopidogrel (Plavix),
or anticoagulants (such as warfarin) may be used after a
heart attack. These medicines are used to lower the risk of another heart
attack and to prevent blood clots from forming in the heart, which could break
loose and travel to the brain, causing a
stroke. If you take warfarin (Coumadin), see:
Anticoagulants: Vitamin K and your diet.
The amount of heart muscle that is permanently damaged
may be less than it appears immediately after a heart attack has occurred. Some
heart tissue may be "stunned myocardium," or heart muscle that is not able to
contract normally at first but is later able to function normally. Your heart's
pumping capacity will be closely monitored and your treatment adjusted as
needed during this time.
Research highlights the importance of
quitting smoking after a heart attack. People who continue to smoke after a
heart attack are much more likely than nonsmokers to have another heart attack.
Among those who stop smoking, their risk starts decreasing a lot in the first
year they stop smoking. Their risk keeps dropping until it becomes the same as
the risk for nonsmokers in about 3 years.
If you smoke, your doctor will strongly advise that you
quit and avoid secondhand smoke too. Your doctor may prescribe medicine and
therapy to help you do so. Studies show that
nicotine replacement therapy, use of the medicine
bupropion (such as Zyban or Wellbutrin), and
supportive therapy significantly increase long-term success in
quitting.3, 4 For more
information on how to quit, see the topic
Quitting Smoking.
After a heart attack,
you are a candidate for
cardiac rehabilitation to lower your risk of death
related to heart disease. Rehabilitation (rehab) and lifestyle changes are an
important part of your recovery after a heart attack. For more information, see
the topic
Cardiac Rehabilitation.
If you do not
participate in a cardiac rehab program, you will still need to learn about
necessary lifestyle changes, such as quitting smoking, eating a low-fat diet,
and perhaps starting an exercise program.
Avoid getting sick from
the
flu. Get a flu shot every year.
Treatment if the condition gets worse
Heart attacks
that damage crucial or large areas of the heart tend to cause more
complications later. If only a small amount of heart muscle dies, the heart may
still function normally after a heart attack.
Scar tissue
eventually replaces the areas of heart muscle tissue that are damaged by a
heart attack. Scar tissue limits your heart's ability to pump effectively.
Damage to the
left ventricle can limit the heart's capacity to pump.
This damage can lead to
heart failure.
If the heart attack
damaged the area of your heart that regulates your heart rate, your heart can
develop abnormal heart rhythms, called
arrhythmias. In this case, you may need a
pacemaker, which is a device that stimulates the heart
to beat and regulates the heart rate, and possibly medicines to control your
heart rhythms. Some arrhythmias also increase your risk for
stroke.
The chance that these
complications will develop depends on the amount of heart tissue affected by a
heart attack and whether medicines are given during and after a heart attack to
help prevent these complications. Other factors, such as your age and general
health, also determine your risk of complications and death.
Palliative care
If your condition gets worse, you
may want to think about
palliative care. Palliative care is a kind of care for
people who have illnesses that do not go away and often get worse over time. It
is different than care to cure your illness, called curative treatment.
Palliative care focuses on improving your quality of life—not just in your
body, but also in your mind and spirit. Some people combine palliative care
with curative care.
Palliative care may help you manage symptoms
or side effects from treatment. It could also help you cope with your feelings
about living with a long-term illness, make future plans for your medical care,
or help your family better understand your illness and how to support
you.
If you are interested in palliative care, talk to your
doctor. He or she may be able to manage your care or refer you to a doctor who
specializes in this type of care.
For more information, see the
topic
Palliative Care.