Heart attack

Alternative Names

Treatment

If you had a heart attack, you will need to stay in the hospital, possibly in the intensive care unit (ICU). You will be hooked up to an ECG machine, so the health care team can look at how your heart is beating. Life-threatening arrhythmias (irregular heart beats) are the leading cause of death in the first few hours of a heart attack.

The health care team will give you oxygen, even if your blood oxygen levels are normal. This is done so that your body tissues have easy access to oxygen, so your heart doesn't have to work as hard.

An intravenous line (IV) will be placed into one of your veins. Medicines and fluids pass through this IV. You may need a tube inserted into your bladder (urinary catheter) so that doctors can see how much fluid your body gets rid of.

THROMBOLYTIC THERAPY

Depending on the results of the ECG, certain patients may be given blood thinners within 12 hours of when they first felt the chest pain. This is called thrombolytic therapy. The medicine is first given through an IV. Blood thinners taken by mouth may be prescribed later to prevent clots from forming.

Thrombolytic therapy is not appropriate for people who have:

• Bleeding inside their head (intracranial hemorrhage)
• Brain abnormalities such as tumors or blood vessel malformations
• Stroke within the past 3 months (or possibly longer)
• Head injury within the past 3 months

Thrombolytic therapy is extremely dangerous in women who are pregnant or persons who have:

• Severe high blood pressure
• Had major surgery or a major injury within the past 3 weeks
• Internal bleeding within the past 2-4 weeks
• Peptic ulcer disease
• A history of using blood thinners such as coumadin

MEDICINES FOR HEART ATTACKS

Many different medicines are used to treat and prevent heart attacks. Nitroglycein helps reduce chest pain. You may also receive strong medicines to relieve pain.

Antiplatelet medicines help prevent clot formation. Aspirin is an antiplatelet drug. Another one is clopidogrel (Plavix).

Beta-blockers (such as metoprolol, atenolol, and propranolol) help reduce the strain on the heart and lower blood pressure.

ACE inhibitors (such as ramipril, lisinopril, enalapril, or captopril) are used to prevent heart failure and lower blood pressure.

SURGERY AND OTHER PROCEDURES

A procedure called angioplasty may be needed to open blocked coronary arteries. This procedure may be used instead of thrombolytic therapy. Angioplasty with stenting can be a life-saving procedure if you are having a heart attack. However, for persons with coronary heart disease, recent studies show that medicine and angioplasty with stenting have equal benefits. Angioplasty with stenting does not help you live longer, but it can reduce angina or other symptoms of coronary artery disease.

Some people may need emergency coronary artery bypass surgery (CABG).

Support Groups

See:Heart disease -- resources

Outlook (Prognosis)

How well you do after a heart attack depends on the amount and location of damaged tissue. Your outcome is worse if the heart attack caused damage to the signaling system that tells the heart to contract.

About a third of heart attacks are deadly. If you live 2 hours after an attack, you are likely to survive, but you may have complications. Those who do not have complications may fully recover.

Usually a person who has had a heart attack can slowly go back to normal activities, including sexual activity.

Possible Complications

• Blood clot in the lungs (pulmonary embolism)
• Cardiogenic shock
• Congestive heart failure
• Damage extending past heart tissue (infarct extension)
• Damage to heart valves or the wall between the two sides of the heart
• Inflammation around the lining of the heart (pericarditis)
• Irregular heart beats, including ventricular tachycardia and ventricular fibrillation
• Side effects of drug treatment

When to Contact a Medical Professional

Immediately call your local emergency number (such as 911) or go to the hospital emergency room if you have symptoms of a heart attack.

References

Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.

Pollack CV Jr. 2004 American College of Cardiology/American Heart Association guidelines for the management of patients with ST-elevation myocardial infarction: implications for emergency department practice. Ann Emerg Med. 2005; 45(4): 363-76.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Clinical Guidelines/Evidence Reports. 2003 May; 3(5233); 1.

Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].