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Heart attack - Treatment

Alternative Names

Myocardial infarction; MI; Acute MI; ST-elevation myocardial infarction; non-ST-elevation myocardial infarction

Treatment:

You will most likely first be treated in the emergency room.

  • You will be hooked up to a heart monitor, so the health care team can look at how your heart is beating.
  • The health care team will give you oxygen so that your heart doesn't have to work as hard.
  • An intravenous line (IV) will be placed into one of your veins. Medicines and fluids pass through this IV.
  • You may get nitroglycerin and morphine to help reduce chest pain.

Abnormal heartbeats (arrhythmias) are the leading cause of death in the first few hours of a heart attack. These arrythmias may be treated with medications or cardioversion.

EMERGENCY TREATMENTS

Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. Usually a small, metal mesh tube called a stent is placed at the same time.

  • Angioplasty is often the first choice of treatment. It should be done within 90 minutes after you get to the hospital, and no later than 12 hours after a heart attack.
  • A stent is a small, metal mesh tube that opens up (expands) inside a coronary artery. A stent is often placed after angioplasty. It helps prevent the artery from closing up again.

You may be given drugs to break up the clot. It is best if these drugs are given within 3 hours of when you first felt the chest pain. This is called thrombolytic therapy.

Some patients may also have heart bypass surgery to open narrowed or blocked blood vessels that supply blood to the heart. This procedure is also called open heart surgery.

AFTER YOUR HEART ATTACK

The following drugs are given to most people after they have a heart attack. These drugs can help prevent another heart attack. Ask your doctor or nurse about these drugs:

  • Antiplatelet drugs (blood thinners) such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin), to help keep your blood from clotting
  • Beta-blockers and ACE inhibitor medicines to help protect your heart
  • Statins or other drugs to improve your cholesterol levels

You may need to take some of these medicines for the rest of your life. Always talk to your health care provider before stopping or changing how you take any medicines. Any changes may be life threatening.

After a heart attack, you may feel sad. You may feel anxious and worry about being careful in everything you do. All of these feelings are normal. They go away for most people after 2 or 3 weeks. You may also feel tired when you leave the hospital to go home.

Most people who have had a heart attack take part in a cardiac rehab program. While under the care of a doctor and nurses, you will:

  • Slowly increase your exercise level
  • Learn how to follow a healthy lifestyle

LIVING A HEALTHY LIFESTYLE

To prevent another heart attack:

  • Keep your blood pressure, blood sugar, and cholesterol under control.
  • Don't smoke.
  • Eat a heart-healthy diet rich in fruits, vegetables, and whole grains, and low in animal fat.
  • Get plenty of exercise, at least 30 minutes a day, at least 5 days a week (talk to your doctor first).
  • Get checked and treated for depression.
  • Limit yourself to no more than one drink a day for women, and no more than two drinks a day for men.
  • Stay at a healthy weight. Aim for a body mass index (BMI) of between 18.5 and 24.9.

Support Groups:

See: Heart disease -- resources

Expectations (prognosis):

After a heart attack, your chance of having another one is higher.

How well you do after a heart attack depends on the damage to your heart muscle and heart valves, and where that damage is located.

If your heart can no longer pump blood out to your body as well as it used to, you may have heart failure. Abnormal heart rhythms can occur, and they can be life threatening.

Usually a person who has had a heart attack can slowly go back to normal activities, including sexual activity.

Calling your health care provider:

Immediately call your local emergency number (such as 911) if you have symptoms of a heart attack.

  • Reviewed last on: 5/23/2011
  • Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr., et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am coll Cardiol. 2007;50:e1-e157.

Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients WithST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention(updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009 Dec 1;120(22):2271-306. Epub 2009 Nov 18.

Antman EM. ST-segment elevation myocardial infarction: pathology, pathophysiology, and clinical features. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsever; 2011:chap 54.

Cannon CP, Braunwald E. Unstable angina and non-ST elevation myocardial infarction. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsever; 2011:chap 56.

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