Treatment of acute heart attack (myocardial infarction, MI) must be early and aggressive. Drug therapy is used to stabilize the cardiovascular system and prevent or at least reduce long-term complications. This may include angioplasty and the use of thrombolytics or other priority medications for heart attacks.
A heart attack requires urgent treatment because a blockage in one of the coronary arteries that supply blood to the heart can cause muscles in a certain area to start dying—the longer the blood flow is blocked, the more damage that occurs.
The first few hours after a heart attack are crucial. Getting medical help as soon as possible is critical to preventing cardiac arrest, protecting the heart muscle, and preventing further blood clots from forming. In fact, national guidelines recommend opening the affected coronary artery within 90 minutes for best results.
If you arrive at the hospital with a possible heart attack, medical staff will check your vital signs (pulse and blood pressure) right away and be prepared for any apparent life-threatening conditions, such as ventricular fibrillation.
An electrocardiogram (ECG) and cardiac enzyme tests will also be performed. High-sensitivity cardiac troponin levels may be checked because they are the biomarker of choice to detect or rule out myocardial damage (cardiomyocyte damage).
Treatment begins as soon as a heart attack is suspected. This can include:
- giving aspirin to prevent further blood clotting
- Oxygen therapy
- Nitroglycerin improves blood flow
- Chest Pain Treatment
Your medical team will also determine what type of heart disease has occurred:
- ST-segment elevation myocardial infarction (STEMI), when the ST segment is elevated on an electrocardiogram, is usually caused by severe blockage of a single coronary artery (called the “culprit” vessel).
- In non-ST-segment elevation myocardial infarction (NSTEMI), when there is no ST-segment elevation on the ECG, the blocked artery is likely to be one of several types of blockages called diffuse coronary artery disease.
Based on the diagnosis, the medical team will start treatment to restore blood flow to the blocked or partially blocked blood vessel. This may include procedures or medications.
Both surgery and medication can be very effective if done early enough, and the method of choice should generally be the one that may open the artery more quickly.
Why the first few hours of a heart attack matter
In the event of STEMI or NSTEMI, immediate steps must be taken to unclog the artery, allow blood to flow through it again as quickly as possible, and prevent damage.
A major treatment is a non-surgical procedure called coronary angioplasty, also known as percutaneous coronary intervention (PCI). A thin tube with a balloon is passed through the blood vessel to the blocked artery. The balloon is then inflated to push the clot against the artery wall to restore blood flow. Stents can be placed after surgery to keep blood vessels open.
Coronary artery bypass grafting may be considered for patients who are not candidates for PCI or who have cardiogenic shock. In this procedure, healthy veins in your body are harvested and then reconnected in the affected area to bypass the blockage and restore blood flow to the heart.
Depending on the severity, patients may also benefit from PCI for partially blocked vessels. Approximately 32% to 40% of patients with NSTE acute coronary syndrome will undergo PCI in the hospital.
Stent vs Bypass Surgery: Which Is Better?
There are many medications that can be used during and immediately after a heart attack to stop the event and help prevent further damage to the heart.
This treatment for acute heart attack involves the use of drugs to break up blood clots. These powerful drugs, also known as thrombolytics or fibrinolytics, are only used in STEMI events. They’re given intravenously and are called “clot busters” because that’s what they do – dissolve a blood clot that’s forming.
Thrombolysis is most likely to be used in patients with STEMI if angioplasty is not feasible or a safe option. The best results are obtained if the drug is given as soon as possible after the onset of chest pain, usually within less than 12 hours.
Tissue plasminogen activator (tPA) is a thrombolytic agent most commonly used to destroy blood clots during a heart attack.
The major side effect of thrombolytic therapy is bleeding, so it is not safe for patients at high risk for this complication, such as those who have recently undergone surgery, have a history of stroke with cerebral hemorrhage, or have very high blood pressure.
The most common of these drugs — which reduce the stickiness of platelets, thereby making it difficult for blood clots to form or grow — is aspirin.
Taking half or one whole uncoated adult aspirin tablet, chewed or crushed as soon as possible when a heart attack (or any acute coronary syndrome event) is suspected, significantly improves outcomes.
Heart attack patients often receive dual antiplatelet therapy, which means taking two types of antiplatelet drugs to prevent blood clotting. In addition to aspirin, your healthcare provider will also prescribe P2Y12 inhibitors, such as clopidogrel, prasugrel, or ticagrelor.
You should discuss with your healthcare provider whether dual antiplatelet therapy is right for you.
Like antiplatelet drugs, anticoagulants are classified as blood thinners because they slow your body’s ability to make clots. Blood thinners given within the first 24 hours of an acute heart attack can help prevent blood clotting in the arteries and may reduce the risk of long-term death.
These drugs include:
- Coumarin (Warfarin)
- Eliquis (apixaban)
- Xarelto (rivaroxaban)
Eliquis, Xarelto, and similar drugs are sometimes called novel oral anticoagulants (NOACs).
How NOAC stacks up with traditional blood thinners
By affecting the action of epinephrine, beta-blockers can significantly improve survival in patients with myocardial infarction. These medications are usually recommended on the first day after your heart attack.
According to the American Heart Association, the most commonly prescribed beta-blockers after a heart attack are:
- Lopressor, Toprol XL (Metoprolol)
- Kogard (Nadorol)
- Inderal (Propranolol)
- Sectral (Bubutolol aceto)
- Tylenol (Atenolol)
- Cron (Betaxolol)
- Ziac (bisoprolol/hydrochlorothiazide)
- Zebeta (bisoprolol)
- Betapace (sotalol)
Angiotensin-Converting Enzyme (ACE) Inhibitors
These drugs dilate blood vessels, allowing blood to flow more easily. ACE inhibitors have been shown to significantly improve outcomes in patients with severe heart attacks or signs of heart failure, although they may also benefit patients with less severe heart attacks.
ACE inhibitors are usually started within the first 24 hours after a heart attack. Examples include:
- Lottin (Benazepril)
- Vasotec (enalapril)
- Altace (Ramipril)
Statins appear to improve survival after a heart attack regardless of cholesterol levels, possibly by reducing inflammation or otherwise stabilizing coronary plaque.
In most cases, statins should be started before heart patients are discharged from the hospital. Sometimes it is beneficial to start them earlier. The main statins are:
- Lipitor (atorvastatin)
- Lescol (fluvastatin)
- Mevacor (lovastatin)
- Livalo (pitavastatin)
- Pravastatin (pravastatin)
- Zocor (simvastatin)
- Crestor (rosuvastatin)
Surviving a heart attack after the first critical day requires constant effort. Your healthcare provider will work with you to determine the steps you need to take to prevent complications and other events.
Frequently Asked Questions
What should I do if I have a heart attack when I am alone?
Call 9-1-1 immediately – don’t try to drive to the emergency room. While you wait for help:
- Call family or friends to wait with you.
- If you are already taking nitroglycerin, take it as directed.
- Take 325 milligrams (mg) of aspirin with or without nitroglycerin. It works faster if you chew the tablet instead of swallowing it whole.
- Make sure your door is unlocked so emergency teams and friends or family can enter.
- Wrap in a blanket to keep warm.
- Sit up comfortably and try to stay calm.
Are heart attacks always fatal?
Will not. In fact, about 80% of acute myocardial infarction patients survive for more than a year. Those who do not survive tend to have certain risk factors, such as a previous heart attack and chronic diseases such as diabetes, liver disease or cancer.
Why do women delay getting treatment for a heart attack?
Women waited, on average, 37 minutes longer than men to seek medical attention for a heart attack. Research suggests that they may delay seeking help because they don’t think their symptoms indicate a heart attack. They also choose to wait to see if their symptoms go away, or if they don’t mind their discomfort at all.
How much does heart disease treatment cost?
In the United States, the average cost of treatment for a heart attack is between $17,000 and $30,000, according to a review of 114 studies. Of course, what a patient actually pays depends on their health insurance (if any) and other factors.
prevent another heart attack