One of the most important aspects of treating myocardial infarction (heart attack) is speed. The faster you act to get help and treatment, the better your chances for survival and a full recovery. If you or someone you are with is experiencing heart attack symptoms, call 911 immediately.
Emergency personnel are trained to provide treatments even before a heart attack is diagnosed. These treatments include:
- oxygen therapy
The goals of these treatments include:
- stabilizing the heartbeat
- preventing more clotting
- easing chest pain
Automatic external defibrillators (AEDs) may be used to jolt your heart back into a normal rhythm. Morphine, oxygen, aspirin, and nitroglycerin are often used in the first 30 minutes following the start of heart attack symptoms to prevent more clotting and to treat pain.
Treatment will depend on how severe your heart attack is. There are many different kinds of heart attack treatments. These include medications, interventional procedures, and surgery.
Medication is usually the first treatment option. Other procedures may follow depending on the nature of the heart attack.
Medications can be an effective tool in treating a heart attack and preventing future attacks. The most commonly used medications for treatment of heart attack include the following.
Thrombolytic Medicines (Clot Busters)
Thrombolytic medicine is most effective if given within three hours of a heart attack. It’s beneficial if administered within 12 hours. It’s injected into the blood intravenously (IV). The medicine dissolves blood clots so blood can flow through the coronary artery again.
The standard thrombolytic medicines used are known as tissue plasminogen activators (tPA). These include:
- alteplase (Activase)
- anistreplase (Eminase)
- streptokinase (Streptase)
- urokinase (Abbokinase)
These drugs are used in combination with other treatments, and they can have adverse side affects like bleeding or hemorrhagic stroke. If blood flow does not return to normal, additional treatments or surgery may be required.
Beta blockers are a class of medications used to treat high blood pressure as well as other diseases and conditions. These medicines make it easier for your heart to do its job by blocking the effects of adrenaline and slowing the heart rate and the decreasing the force of heart muscle contradiction (i.e. the work the heart has to do). Beta blockers are used to relieve chest pain after heart attack. Some examples of beta blockers used to relieve chest pain in post–heart attack patients include:
- atenolol (Tenormin)
- propranolol (Inderal)
- metoprolol (Lopressor)
Like beta blockers, angiotensin-converting enzyme (ACE) inhibitors treat high blood pressure and other conditions. ACE inhibitors help relax and widen the blood vessels by blocking the production of an enzyme that causes the vessels to narrow. ACE inhibitors can improve blood flow, reduce strain on your heart, and help heal heart muscle damage after a heart attack. Some examples of ACE inhibitors include:
- benazepril (Lotensin)
- captopril (Capoten)
- enalapril (Vasotec)
- fosinopril (Monopril)
- lisinopril (Prinivil, Zestril)
- moexipril (Univasc)
- perindopril (Aceon)
- quinapril (Accupril)
- ramipril (Altace)
- trandolapril (Mavik)
Anticoagulants reduce the risk of clotting in heart attack patients. They are more commonly referred to as blood thinners. Examples of anticoagulants include:
- lepirudin (Refludan)
- warfarin (Coumadin)
Aspirin is the most well known type of antiplatelet medicine. These types of drugs prevent clotting in the arteries by keeping platelets from sticking together. Antiplatelet agents are typically used by people who have had a heart attack and are at risk for additional clotting. Antiplatelet medications can also be used to treat people with several risk factors for heart attack and with evident plaque buildup in the arteries. Besides aspirin, antiplatelet agents include:
- clopidogrel (Plavix)
- ticlopidine (Ticlid)
- eptafibitide (Integrilin)
These drugs lower cholesterol. They are commonly prescribed drugs for people with high cholesterol who have never had a heart attack. However some of them have been shown to improve survival when administered soon after a heart attack. These include:
- statins (Lipitor)
- niacin (vitamin B3)
- fibrates (Trilipix, Lofibra, Lopid)
- bile acid sequestrants (Questran, Welchol, Colestid)
Your doctors will determine if you need more than medication to treat your heart attack. The following procedures are commonly used.
Angioplasty and Stent
Angioplasty is a procedure to open the coronary arteries and restore blood flow to the heart. According to the National Institutes of Health, more than 1 million people in the United States undergo the procedure each year. During an angioplasty procedure, a small tube (catheter) with a balloon on the tip is threaded into the arteries. This is usually done through a vessel in the groin area or through an artery that starts in the wrist. When the balloon is in position in a coronary artery with a blockage, it’s expanded. It pushes plaque away, widens the artery, and allows blood flow to return to the heart. Sometimes a small mesh tube called a stent is placed into the artery to support the artery walls and reduce the chance of future narrowing or blockage.
Coronary Artery Bypass Surgery or Grafting
Bypass surgery is another common and effective way to restore blood flow to the heart after a serious heart attack. During the surgery, arteries or veins from other parts of the body (grafts) are used to create alternate routes for blood to flow around the blocked artery. The number of grafts used depends on how many arteries are blocked. A triple-bypass surgery is when three grafts are used to bypass three blocked areas in the coronary arteries.