Heart Attack - Treatment

The first stage in treating a heart attack usually involves steps simply to keep the patient alive. If the patient has stopped breathing, cardiopulmonary resuscitation (CPR; pronounced car-dee-oh-PULL-mon-air-ee ree-sus-i-ta-shun) may be needed. CPR may involve breathing into the patient's mouth or pushing on the chest to restore breathing.

Once a patient has reached the hospital, a number of other emergency treatments may be necessary. For example, defibrillation may be required. Defibrillation (pronounced DEE-fib-ri-lay-shun) is used if the patient's heart is beating in an irregular pattern. An electric shock is applied to the patient's chest. The shock causes the heart to stop beating briefly. The heart then begins to beat again, in a more regular pattern.

A patient may also require oxygen therapy. In oxygen therapy, the patient is allowed to breathe air to which extra oxygen has been added. The extra oxygen makes it easier for the heart to work. Oxygen therapy can reduce the damage done to the heart.

Drug Treatments

A variety of drugs may be given following a heart attack. Some examples of these drugs are:

• Thrombolytics. Thrombolytic (pronounced throm-buh-LIH-tik) drugs are chemicals that dissolve blood clots. The most widely used of these drugs is tissue plasminogen activator (tPA). Patients who receive tPA within hours after a heart attack have a greatly increased chance of survival.
• Anticoagulants. Anticoagulants are drugs that thin the blood. Blood thinners reduce the chance that new blood clots will form. Aspirin is one of the most common and most effective blood thinners. Two other blood thinners are warfarin and heparin.
• Pain relief. Nitroglycerin (pronounced nite-roh-GLIS-er-in) tablets are commonly used to treat pain. In more severe cases, morphine may be needed to control pain.

• Tranquilizers . Heart attack patients are often extremely upset. Tranquilizers such as diazepam (pronounced di-AZE-uh-pam, trade name Valium) can help relieve emotional distress.
• Beta-blockers. Beta-blockers slow down the heart rate. They give the heart a chance to start healing. They may also prevent the development of an irregular heart beat.
• Vasodilators. Vasodilators cause blood vessels to open up. This makes it easier for blood to flow through them and reduces the work the heart has to do.
• Drugs that control arrhythmia (pronounced uh-RITH-mee-uh). These drugs help the heart to pump at a regular rate. They reduce the risk that abnormal and potentially fatal irregular heart rhythms may develop.

The key to surviving a heart attack is to open the blood vessels to the heart again. In many cases, thrombolytics and anticoagulants can achieve this goal. When they cannot, surgery may be necessary.

Surgery

Two forms of surgery are often used with heart attack patients. The first is called coronary angioplasty (pronounced AN-jee-o-PLAS-tee). The tool used for coronary angioplasty is a catheter with an empty balloon attached at one end. The catheter is a thin plastic tube that can be inserted into a patient's artery, usually in the thigh or arm. It is then threaded up the artery until it gets to the blocked coronary artery.

At that point, the balloon is inflated. The inflated balloon pushes on the plaque that is blocking the artery and opens up the artery. Blood is able to flow more freely into the heart. The balloon is then deflated, and the catheter removed from the person's body.

Angioplasty is initially successful in about 90 percent of all cases. In about one-third of all cases, the artery narrows again after the procedure. In such cases, the procedure can be repeated.

The second surgical procedure is called bypass surgery. The purpose of bypass surgery is to provide a new pathway for blood to reach the heart. The procedure requires three steps. First, a section of healthy vein is removed from some part of the patient's body, such as a leg or arm. Then a cut is made just below and just above the blockage in the patient's coronary artery. Finally, the healthy vein is attached to the coronary artery. The attached vein provides a new pathway around the blocked section of the artery.

Coronary bypasses are completely successful in about 70 percent of all cases. In another 20 percent of cases, partial relief is obtained. Five years after surgery, the survival rate (the number of patients still alive) for patients who have had a coronary bypass is about 90 percent. It is as high as 80 percent even after ten years.