Heart Attack Treatment

You will likely stay in the hospital for 3 to 5 days, unless your heart attack led to other problems that need treatment.

You will be given oxygen through a flexible plastic tube that rests beneath the nose or by a face mask, and an electrocardiogram (ECG) will be performed as quickly as possible. The ECG gives a picture of the flow of electrical activity that causes the heart to beat. Damaged areas usually show an abnormal pattern. The ECG may be repeated.

Blood is drawn and sent to the laboratory to look for substances in the blood that are released by damaged heart tissue (cardiac enzymes or proteins). An intravenous line (IV) is started so that medicines can be given directly into the veins. Nitroglycerin is given either through the IV or under the tongue to relieve chest pain. Morphine may also be given to help relieve chest pain and ease your anxiety. You will be given aspirin to chew and swallow to help stop new blood clots from forming. For a heart attack beta blocker medication may be prescribed within 24 hours to slow heart rate and prevent more muscle injury.

There are different types of myocardial infarction (MI), based on what is seen on the ECG. The two main types are called ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI). Your treatment will depend upon the type of MI you have.

Early catheterization — with this approach, you are taken for a cardiac catheterization within the first hours or days of being in the hospital. A small plastic tube (catheter) is threaded through a blood vessel (artery), usually in the groin, to the coronary arteries. A dye is injected that allows the arteries to be seen on X-ray.

If blockages or narrowing are found, a procedure known as percutaneous coronary intervention (also known as stenting) may be done. With this procedure, a tiny catheter with a balloon at the end of it is advanced into the narrowed coronary artery. The balloon is then inflated, which helps open up the narrowed artery. A stent (an expandable metal tube) is placed in the artery to prevent the narrowing from recurring.

In some cases, the X-ray reveals that the blockages cannot be opened with stenting. In these instances, coronary artery bypass graft surgery (CABG, often pronounced “cabbage”) may be an option. During the CABG operation, a blood vessel (vein or artery) is taken from the leg or the chest and used as a detour around the blocked coronary artery. A similar approach for treatment of myocardial infarction is used at most places in the United States, including New York, Connecticut and Vermont.

Treatment of ST-elevation heart attack — If your ECG indicates that you are having an ST-elevation heart attack, or STEMI, you will be given many of the same medications as for NSTEMI while doctors are deciding how best to quickly open the blocked coronary artery.

Opening the blocked artery is called “reperfusion therapy.” The more quickly this therapy is given, the better the chance of saving areas of your heart that might otherwise be damaged. In general, the best outcome occurs when the artery is opened within four hours of your first heart attack symptoms, preferably within 90 to 120 minutes.

Reperfusion therapy can occur in one of two ways. The preferred method is percutaneous coronary intervention, which is explained separately.

However, not every hospital is equipped to do percutaneous coronary intervention in a timely manner. In this case, an acceptable alternative treatment is to use a medicine that dissolves blood clots. The clot-busting drugs, called thrombolytic or fibrinolytic agents, should be given within 30 minutes of arrival at the hospital. However, these drugs cannot be given to certain patients, including those who have active bleeding, a high blood pressure reading, recent trauma, or a history of stroke. They are also not recommended in the treatment of NSTEMI.

In some people with STEMI, urgent bypass surgery is needed.