A heart attack is a medical emergency and needs to be diagnosed and treated immediately to increase the chance of a patient surviving. When a patient presents with a heart attack, an ambulance should be called and critical care services alerted as soon as possible.
On admission to hospital, the treatment approach to heart attack depends on several factors. An outline of the steps taken to manage heart attack is given below:
- Ideally, the patient is given an aspirin tablet (300 mg) to chew on and swallow as soon as symptoms develop. At this dose, the aspirin acts as an anti-platelet agent and thins the blood, therefore reducing the risk of heart attack.
- Nitroglycerin may be administered to dilate the arteries in the heart.
- The patient may be given an oxygen mask.
- An electrocardiogram (ECG) is performed either in the ambulance during transit to the hospital or immediately after hospital admission. The ECG is used to detect the occurrence of a heart attack as well as to determine the type and severity of the heart attack. ST segment elevation myocardial infarction or STEMI is the most serious form of heart attack. All other heart attacks are classified as non-ST segment elevation myocardial infarction or NSTEMI.
- The treatment options for a heart attack depend on whether it is a STEMI or an NSTEMI. In the case of STEMI, the patient is assessed for immediate treatment to unblock the coronary artery. The treatment will depend on when the symptoms started and how soon treatment can be performed. If symptom onset was within the last 12 hours, primary percutaneous coronary intervention (PCI) is usually advised. In cases where symptom onset was within the last 12 hours but PCI cannot be accessed quickly, medication that breaks down blood clots is offered. Medications that can break down the blood clots are called thrombolytics or fibrinolytics. Examples include reteplase, alteplase and streptokinase.
If the symptoms began more than 12 hours previously, an angiogram will be performed to determine the best treatment course which may include a combination of medication and PCI or coronary bypass surgery.
- PCI is the term used to describe emergency treatment of STEMI using coronary angioplasty. Coronary angiography is usually performed first to assess the patient’s suitability for PCI. This shows the sites and extent of blockage within the coronary arteries.
- Coronary angioplasty is a procedure that is performed to open up the narrowed coronary arteries. Here, a thin tube called a catheter is threaded into the heart via a blood vessel in the arm or groin, under X-ray guidance. It contains a sausage-shaped balloon at the end. Once in position, the balloon is inflated inside the narrowed part of the artery to open it up. It is then replaced by a stent (flexible metal mesh) that will hold the artery open from within after the catheter has been withdrawn.
- When coronary angioplasty is not possible, an alternative surgical procedure called coronary artery bypass graft (CABG) or cardiac bypass surgery is performed. Here, a part of a blood vessel or graft is taken from another body part such as the chest or leg and used to create a bypass between the aorta and the coronary artery above and below the narrowed area or blockage, therefore creating an alternative path for blood flow.
- Examples of medications that may need to be continued after a heart attack has occurred include:
- Beta blockers such as metoprolol
- ACE inhibitors such as enalapril and other blood pressure controlling medications
- Anticoagulants such as aspirin and clopidogrel
- Statins to control cholesterol levels
Reviewed by Sally Robertson, BSc