Heart Attack Treatment

  • Treatment

    Heart attacks are life threatening. If you are experiencing chest pain or other symptoms of a heart attack, call for emergency medical services, which is 911 in most communities. Sit down and wait for emergency medical caregivers to arrive; do not try to drive yourself to the hospital. Emergency medical services can begin treating you immediately. Because the most damage occurs during the first two hours of a heart attack, a delay in calling for help may result in a poorer prognosis or even death.

    Don’t try to diagnose yourself. Many conditions can cause symptoms similar to a heart attack. Only 10% to 20% of chest-pain patients admitted to emergency rooms are actually having a heart attack, so an evaluation and testing should be performed promptly after your arrival at the emergency room. Treatment is aimed at decreasing the amount of permanent tissue damage by returning an adequate blood supply to your heart muscle. The artery must be opened by drug therapy or an invasive procedure as quickly as possible. Early treatment can decrease your long-term chances of dying by about 50%.

    Chew aspirin at home before the paramedics arrive, unless you have had serious trouble with stomach bleeding. It can decrease additional clot formation and may lower your risk of death from the heart attack.

    After surviving a heart attack, you should modify your diet to include more fruits, vegetables, and whole grains, and fewer saturated fats and cholesterol. Developing an exercise regimen in addition is sure to help the extra pounds disappear. Your health care professional can help you get started on an exercise program and a proper diet. If you have been eating high-fat foods for years and are not used to getting regular exercise, it may take you a while to adapt to the changes. However, it is very important that stick to a plan.

    If you are a smoker, you should stop smoking immediately. Smoking doubles your chances for having a heart attack.

    Understand what foods are heart-healthy and why. If faced with the choice between red meat (high in saturated fat) and shellfish (high in cholesterol), learn how to make the right decision. There are two main types of cholesterol. The “good” cholesterol (HDL) helps to carry away the buildup of “bad” cholesterol (LDL) that collects in the arteries and forms plaque. Your body regulates the amount of cholesterol in the bloodstream on its own, but diet does contribute to blood cholesterol levels. The type of fat a food contains determines what kind of effect it will have on raising your blood cholesterol. Foods high in saturated fat, like red meat, palm kernel oils, butter, and other high fat dairy products are the worst for you in terms of raising cholesterol. High cholesterol foods like eggs and shellfish should be avoided or eaten in moderation. Monounsaturated fats, like olive oil, are a better choice because they do not increase your bad cholesterol levels. “Good” cholesterol levels are raised by an exercise program and by quitting smoking.

    A cardiac rehabilitation program will help you learn about lifestyle changes that can decrease your chance of a second heart attack. The program instructors will monitor you while you gradually increase physical activity. Your doctor can recommend one for you.

    Your doctor is the best source of information on the drug treatment choices available to you.

    An angioplasty is a moderately invasive procedure that may be done if you have had a heart attack, but only under certain circumstances. Angioplasty is considered an alternative option to clot-dissolving drugs. This is usually done within 12 hours by a skilled doctor (an interventional cardiologist) who performs at least 75 of these procedures a year, and at a medical center where more than 200 angioplasties are performed each year. A specially trained doctor inserts a flexible tube (catheter) in an artery in the groin, threads the device through the arteries to the heart, and inflates a balloon at the clogged area. After opening the blockage, the doctor may insert a stent, a device designed to hold the artery open.

    Should you continue to experience chest pain, or if you have large areas of heart tissue that have not received enough oxygen, you may be in need of bypass surgery Figure 04. Bypass surgery is a highly invasive procedure where the chest is opened and the doctors work directly on the heart muscle. It is usually done on patients whose blockages are not treatable by angioplasty, or because multiple vessels are seriously diseased. During a bypass procedure, a surgeon will attach a section of artery or vein in front of the diseased and narrowed artery to carry blood around the blockage, thereby creating an alternate route for the blood flow. The doctor will need to borrow these arteries or veins from another part of your body, usually the leg. Or, an artery known as the internal mammary artery (IMA) may be detached from the chest wall and the open end attached to the coronary artery below the blocked area. Either way, blood can then use this new path to once again flow freely to the heart muscle.

    You can have just one artery bypassed, or several, depending on how many are blocked. The operation is usually not done during a heart attack, but before a heart attack occurs or within the weeks or months following one, in order to prevent another. The surgery usually lasts between three and six hours, during which time your heart may be stopped and chilled so that its oxygen requirement is very low. A heart/lung machine will pump and oxygenate your blood for you.

    Click to enlarge: How bypass surgery works (animation and audio)

    Figure 04. How bypass surgery works (animation and audio)

    Although bypass surgery is a major operation, most patients report that, overall, they feel much better once they have healed because they no longer have chest pain. Exercise will be easier to do, and you will probably not get out of breath as quickly. However, the recovery time is substantial, spanning a period of four to six weeks, possibly more depending on your general health.

    Always check with your doctor before taking any type of herbal remedy. Those that contain ephedra may trigger angina or a heart attack and can occasionally lead to death.

    Complications of a heart attack can be life-threatening, but you will be watched very carefully for any warning signs of trouble both in the hospital and once you have left. Almost all heart attack patients are at risk for developing an irregular heart rhythm (arrhythmia). An electronic device called a defibrillator, used to restore the heart’s normal rhythm by applying an electric shock to it, may be used if the abnormal heartbeat becomes life-threatening.

    Congestive heart failure (CHF) may occur when a large area of tissue has died and the heart muscle is not able to pump adequately. Because the heart is not able to pump adequately, fluid can build up in the lungs and other tissues. Symptoms of CHF include shortness of breath and an increased heart rate. Medication for congestive heart failure may be required.

    Your prognosis varies depending on the level of permanent damage to the heart muscle and other factors. Factors such as how well the left side of the heart is functioning or pumping, whether or not there are areas of the heart still not receiving enough oxygen, how stable the electrical system that controls the heart rhythm is, and the progression of plaque buildup in the arteries will all be factors to your prognosis. A poorer prognosis is more likely if you experience problems with irregular heart rhythms and/or if your heart has lost much of its ability to pump blood (pump failure).

    Careful monitoring in a coronary or intensive care unit is crucial, especially during the first 24 hours after your heart attack. You will rest in bed for the first 12 to 24 hours, since activity makes the heart work harder and can increase the amount of damage already done. You can typically get up to a chair or sit on the edge of the bed within the first 24 hours, and should be walking a few times daily within four to five days.

    Several days after a heart attack, you will usually have some type of stress testing. During stress testing, you will exercise or receive drugs that mimic the effect of exercise on the heart. This allows your doctor to evaluate how well your heart functions when additional demands are placed on it. Testing will depend on your condition and the length of time since your heart attack. These tests help your doctor to determine the extent of the damage to your heart, how well your heart is functioning, if you experience chest pain with increased activity, and how much you may be capable of doing.

    A health care professional will start you on a special diet while you are in the hospital, and will recommend that you change your eating and exercise habits once you have returned home. Doctors will usually start you on a clear liquid diet when your pain is under control and the risk of vomiting subsides. Once you are able to tolerate liquids, you will advance to a heart-healthy diet. The cardiac diet gets half its calories from complex carbohydrates, contains less than 30% of daily calories from fats, is low in saturated fats, includes food with plenty of potassium, magnesium, and fiber (such as fruits, vegetables and whole grains), and includes very little salt.

    After you are discharged from the hospital, you are likely to be prescribed a number of medications designed to aid in your recovery, and to help prevent a second heart attack. You will probably receive drugs that help control high blood pressure and cholesterol levels in addition to other heart medications.

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