A heart attack is a medical emergency. Delaying treatment can mean lasting damage to your heart or even death. The sooner treatment begins, the better your chances of recovering. Your treatment may begin in the ambulance or in the emergency room and continue in a special area called a coronary care unit or CCU.
In the Hospital
If you are having a heart attack, doctors will:
- Work quickly to restore blood flow to the heart
- Continuously monitor your vital signs to detect and treat complications
Restoring blood flow to the heart is vital to prevent or limit damage to the heart muscle and to prevent another heart attack. The main treatments are the use of thrombolytic (“clot-busting”) drugs and procedures such as angioplasty.
- Thrombolytic drugs (“clot-busters”) are used to dissolve blood clots that are blocking blood flow to the heart. When given soon after a heart attack begins, these drugs can limit or prevent permanent damage to the heart. To be most effective, they need to be given within 1 hour after of the start of heart attack symptoms.
- Angioplasty procedures are used to open blocked or narrowed coronary arteries. A stent, which is a tiny metal mesh tube, may be placed in the artery to help keep it open.
- Coronary artery bypass surgery uses arteries or veins from other areas in your body to bypass your blocked coronary arteries.
The CCU is specially equipped with monitors that continuously measure your vital signs. Those that can show signs of complications include:
- EKG, which detects any heart rhythm (Arrhythmia) or functional problems
- Blood pressure
- Pulse oximetry, which measures the amount of oxygen in the blood and provides an early warning sign of a low level of oxygen in the blood.
Medications used in treating heart attacks include:
- Beta blockers to decrease the workload on your heart by slowing your heart rate. This makes your heart beat with less force and lowers your blood pressure. Some beta blockers are also used to relieve Angina ( Chest pain ) and in heart attack patients to help prevent additional Heart Attacks. They are also used to correct irregular heartbeat.
- Angiotensin-converting enzyme (ACE) inhibitors to lower blood pressure and reduce the strain on your heart. They are used in some patients after a heart attack to increase survival rate and help slow down further weakening of the heart.
- Nitrates, such as nitroglycerin, to relax blood vessels and stop Chest pain .
- Anticoagulants (an-ty-ko-AG-u-lants) to thin the blood and prevent clots from forming in your arteries.
- Antiplatelet (an-ty-PLAYT-lit) medications (such as aspirin and clopidigrel) to stop platelets from clumping together to form clots. These medications are given to people who have had a heart attack, have angina, or who experience angina after angioplasty.
- Glycoprotein IIb-IIIa inhibitors, which are potent antiplatelet medicines given intravenously to prevent clots from forming in your arteries.
- Medicines to relieve pain and anxiety.
- Medicines to treat Arrhythmias (irregular heart rhythms), which often occur during a heart attack.
- Oxygen therapy.
The length of your hospital stay after a heart attack depends on your condition and response to treatment. Most people spend several days in the hospital after a heart attack. While in the hospital, your heart will be monitored, and you will receive needed medications. You will probably have further testing, and you will be treated for any complications that arise.
While you are still in the hospital or after you go home after your heart attack, your doctor may order other tests, such as:
- Echocardiogram. In this test, ultrasound is used to make an image of your heart that can be seen on a video monitor. It shows how well the heart is filling with blood and pumping it to the rest of the body.
- Exercise stress test. This test shows how well your heart pumps at higher workloads when it needs more oxygen. EKG and blood pressure readings are taken before, during, and after exercise to see how your heart responds to exercise. The first EKG and blood pressure reading are done to get a baseline. Readings are then taken while you walk on an exercise treadmill or pedal a stationary bicycle. The test continues until you reach a heart rate set by your doctor. The exercise part is stopped if chest pain or a very sharp rise in blood pressure occurs. Monitoring continues for 10 to 15 minutes after exercise or until your heart rate returns to baseline.
Stress tests are used to assess the possibility of coronary heart disease. If the results of this procedure suggest the presence of coronary artery disease, a subsequent referral for cardiac catheterization is likely.
Several types of stress tests may be used. In some cases, a patient simply walks on a treadmill while connected to an electrocardiogram (ECG or EKG). In other cases, a drug is infused into the bloodstream to increase the heart rate or to affect the flow of blood within the heart and an echocardiogram is used to obtain images of the heart.
Nuclear stress test involves injecting a radioactive substance into a vein and using a special camera to obtain images of the heart during rest and immediately following exercise on a treadmill.
Cardiac Rehabilitation (Rehab)
Your doctor may prescribe cardiac rehabilitation (rehab) to help you recover from a heart attack and help prevent another heart attack. Almost everyone who has survived a heart attack can benefit from rehab.
The cardiac rehab team may include:
- Doctors o Your family doctor o A heart specialist o A surgeon
- Exercise specialists
- Physical therapists and occupational therapists
- Psychologists or other behavior therapists.
Rehab has two parts:
- Exercise training to help you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual ability, needs, and interests.
- Education, counseling, and training to help you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.
After You Leave the Hospital
After a heart attack, your treatment may include cardiac rehab in the first weeks or months, checkups and tests, lifestyle changes, and medications. You will need to see your doctor for checkups and tests to see how your heart is doing. Your doctor will most likely recommend lifestyle changes, such as quitting smoking, losing weight, changing your diet, or increasing your physical activity.
After a heart attack, most people take daily medications. These may include:
- Medicines that lower your cholesterol or your blood pressure
- Other medicines to help reduce your heart’s workload.
Always take medications as your doctor directs.
Revision date: July 3, 2011
Last revised: by Jorge P. Ribeiro, MD