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Heart Attack Treatment

Benjamin McDonald, MD, edited by Ann Witt, MD

The treatment of a heart attack generally begins immediately after diagnosis. The sooner the blockage constricting the coronary arteries is removed, the less permanent damage your heart muscle will incur. The prognosis (outcome) for heart attack patients is improved if patients receive treatment for their condition promptly after the onset of symptoms.

pills spilling from bottleHeart attacks are often treated with a combination of medicines and other medical procedures designed to restore blood flow to affected ares of the heart muscle. Medications used to treat heart attacks include beta-blockers (to slow your heart down so it doesn't work as hard), thrombolytics (to break-up existing clots), and aspirin or antiplatelet medicines (to help stop more blood clots from forming). Other drugs may also be used during or after your heart attack to ease the stress of the workload on your heart. They will lessen your pain, dilate your blood vessels, and protect and treat you against heart dysrhythmias (irregular heart beats). You may also receive oxygen, as your body does not receive it as efficiently during a heart attack, despite your increased need.

Medical procedures used to treat heart attacks include angioplasty with stent placement and bypass surgery. Generally, these procedures are performed by cardiac specialist surgeons in the hospital. Most often these surgical procedures are performed when doctors believe that the medicines alone have not worked sufficiently to restore your health. While these procedures often result in successful outcomes, it is possible that artery blockages will return if post-surgery regimes and lifestyle changes are not followed thereafter.

  • Angioplasty/Stents. Angioplasty is a surgical procedure that is used to gain reperfusion (resumption of normal blood flow) in areas of arterial blockage. This procedure can be performed during an acute heart attack. It is also performed in patients who are found to have blockage in an effort to prevent further heart attacks. During the procedure, a doctor inserts a catheter (a thin tube) into your artery, most likely entering your body through an incision in the groin area. The doctor then performs an angiogram during which he/she injects dye into your bloodstream so as to check blood flow in your coronary arteries and further pinpoint the region that is blocked. Once the blocked area is located, a small balloon inside the catheter is moved to the site of blockage and inflated. This action opens up the narrow area in the artery, creating a greater interior space where blood can flow. If necessary, a stent (a mesh tube) can be placed in the narrowed area to keep the artery open for blood flow. After the procedure, the doctor monitors coronary blood flow to ensure adequate reperfusion. Typically, patients are put under general anesthesia (i.e., are asleep) while undergoing angioplasty with a stent placement. Most people will be in the hospital for a few days following the procedure.
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  • Bypass Surgery. While bypass surgery can be performed during an acute heart attack, it is more commonly performed when the patient is stable. Typically, bypass surgery is used if lifestyle changes, medications or angioplasty cannot treat the coronary artery disease. Patients who receive bypass surgery often have multiple blockages in their coronary arteries.

    During the surgery, patients receive general anesthesia and are asleep. A breathing tube is inserted, and breathing and circulatory functions are usually regulated by a heart-lung machine. First, the breastbone is separated and the ribs are spread apart to give surgeons direct access to your heart. Next, a portion of an artery or vein is taken from another part of your body (usually the chest or leg) and grafted (sewn into) to the blocked artery in a fashion that allows blood to flow freely around the blockage. An average bypass operation will often last between two and six hours.

    After bypass surgery is complete, patients are taken to the intensive care unit of the hospital where they are often kept for a day or so of careful observation. Heart rate and blood pressure are monitored very closely during this stage. Also, the breathing tube that was inserted for the surgical procedure remains in place until the anesthesia has worn off and the patient can breathe on his or her own again. Patients may feel pain or discomfort around the areas of incision when they wake up. Patients generally remain in the hospital for several more days after ICU monitoring is complete so that doctors can become confident that no complications have occurred or will occur from the procedure. Patients can return to most of their regular activities in about six weeks, but full recovery can take several months.