Heart attack - Choosing treatments

Heart attack care is best considered in terms of immediate and later treatment. Early treatment involves restoring bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. flow through the blocked coronaryRelating to the arteries supplying the heart itself. arteryA blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood., as well as providing supportive care such as oxygen and pain relief. Later treatment, which takes place once the immediate threat has passed, focuses on steps to deal with the underlying coronaryRelating to the arteries supplying the heart itself. arteryA blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood. disease and lower the risk of a repeat heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction..

During the emergency stage, the immediate care of a person who has had a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. can include:[1,2]

Reperfusion therapy

If the heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. is caused by a bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clot, which is almost always the case, then breaking up the clot to restore bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. flow is vital. This is called reperfusionRestoration of blood flow through a previously blocked vessel. therapy. There are two main ways to disperse a bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clot: angioplastyThe mechanical widening or clearing of a narrowed or obstructed blood vessel, performed during angiography, which is used to help with visibility., which breaks up the clot mechanically, and so-called 'clot-busting' drugs, called thrombolyticsA medication that breaks up blood clots.. [1]

Learn more about interventions to disperse the blood clot.

High-flow oxygen

High-flow oxygen is given to people during or immediately after a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction.. Because the damage to the heart muscleTissue made up of cells that can contract to bring about movement. is essentially caused by lack of oxygen, it is thought that providing extra oxygen may limit the extent of injury.[2] High-flow oxygen is given using a special mask that allows the inhalation of up to 100 per cent oxygen.

Aspirin, beta-blockers and nitrates

Drug treatment that may be used to try to keep the coronaryRelating to the arteries supplying the heart itself. arteries open includes antiplatelet therapyTherapy to prevent the clustering of platelets (platelet adhesion) in the blood, so preventing the formation of clots., such as aspirin, and anticoagulants. Other medicines may be given as an additional measure (known by doctors as adjunctive therapy) include beta-blockersA group of drugs that block beta-receptors to slow the heart rate, or constrict the airways and arteries. and nitrates.[1]

Pain relief

Pain relief for people suspected of heaving a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. is usually given in the form of intravenous morphine or other opiate drugs. As well as relieving the person's pain, morphine offers a number of other benefits: it lowers the person's adrenalineA hormone produced by the adrenal glands, which stimulates increases in the heart rate, breathing and metabolic rate. levels and reduces the risk of developing abnormal heart rhythms, for example.[1] Morphine causes the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessels to dilate, and also brings about small reductions in heart rate and bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure.[2]

The potential side effects of morphine include low bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure, nausea and vomiting, and a reduction in the rate of breathing (the respiratory rate).[6] It is usually given therefore with anti-nausea medication.

Identifying and treating any complications

Treating a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. also involves looking for and addressing any early complications such as abnormal heart rhythms (arrhythmias) and heart failureFailure of the heart to pump adequately..[1]

Learn more about the possible complications of a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., and how they may be treated.

There are many aspects to the medical care of a person who has experienced a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction.. These pages will discuss, in greater depth:

  • Reperfusion therapy - that is, methods of dispersing the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clot to restore bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. flow to the heart, including thrombolysisBreaking up a blood clot by administering medications called thrombolytics. and angioplastyThe mechanical widening or clearing of a narrowed or obstructed blood vessel, performed during angiography, which is used to help with visibility.
  • Coronary artery bypass graft surgery
  • Medication to help keep the coronary arteries clear, including aspirin
  • Additional medicines including beta-blockersA group of drugs that block beta-receptors to slow the heart rate, or constrict the airways and arteries. , nitrates, ACE inhibitors and statinsA class of drugs that inhibit cholesterol formation in the liver.
  • Implantable cardiac defibrillators.

We will also touch on the long-term steps that can be taken to help prevent another heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. in the future, although more information on this (known as secondary prevention) will be given in the next section.

References: 
  1. Boon NA, Colledge NR and Walker BR. Davidson's Principles and Practice of Medicine. Churchill Livingstone Elsevier. 2006; 20th edition.
  2. Unstable anginaA central chest pain caused by insufficient oxygen supply to the heart. and non-ST-segment myocardial infarctionDeath of an area of heart muscle due to poor blood supply.: an evidence-based approach to management. Kou V and Nassisi D. The Mount Sinai Journal of Medicine 2006;73(1):449-68.