Treatment - Heart attack

The treatment options for a heart attack depend on the type of heart attack you have had.

For example:

• an ST segment elevation myocardial infarction (STEMI)
• another type of heart attack

A STEMI is the most serious form of heart attack. You will need emergency assessment and treatment. It's important you're treated quickly to minimise damage to your heart.

Before you go to hospital

Sit and rest while waiting for the ambulance to arrive.

Take an adult aspirin, if you have one, unless you have been told not to or are allergic to aspirin.

When you arrive at hospital

The doctor or nurse will carry out an electrocardiogram (ECG) at the hospital. They will also give you oxygen and pain relief.

They'll place a small plastic tube, called an IV, in one of your veins. This is so the doctors and nurses can give you fluids or medicines if you need them.

If the doctor confirms that you have had a heart attack, they will need to unblock your artery. You'll need this done as quickly as possible.

The doctor will do an emergency angioplasty and possible stenting of the artery to open it. This will restore the blood supply to your heart.

If the doctor does not do that, you may get a drug called thrombolysis. They will inject this into a vein. This will dissolve the blood clot. It helps restore the blood supply to the heart.

Treatment for a STEMI

You'll have tests for treatment to unblock the coronary arteries if:

• you have symptoms of a heart attack
• an ECG shows you have a STEMI

The treatment used will depend on:

• when your symptoms started
• how soon you can access treatment

If your symptoms started in the past 12 hours

You'll usually have primary percutaneous coronary intervention (PCI). If you cannot access PCI quickly – you'll get medication to break down blood clots.

If your symptoms started more than 12 hours ago

You may have a different procedure, especially if symptoms have improved. The doctor will decide the best course of treatment after you have an angiogram.

Treatment may include:

• medication
• PCI
• bypass surgery

Primary percutaneous coronary intervention (PCI)

Primary PCI is the term for emergency treatment of STEMI. You have a procedure to widen the coronary artery first to see if you are suitable for PCI. This procedure is called coronary angioplasty.

You may also be given blood-thinning medicines to prevent further clots from forming, such as low-dose aspirin.

You might need to take some of these medications for some time after PCI.

Coronary angioplasty

Coronary angioplasty can be complex and requires specialist staff and equipment. Not all hospitals have the facilities. You'll need to go urgently, by ambulance or helicopter, to a specialist centre near you.

What happens during coronary angioplasty

A tiny tube known as a balloon catheter will be put into a large artery in your groin or arm. The catheter passes through your blood vessels and up to your heart. This is done over a fine guide-wire, using x-rays to guide it. It is then moved into the narrowed section of your coronary artery.

Once in position, the balloon is inflated inside the narrowed part of the coronary artery to open it wide. A stent (flexible metal mesh) is usually inserted into the artery to help keep it open afterwards.

Medicine to break down blood clots

Medicines used to break down blood clots are called thrombolytics or fibrinolytics. They are usually given by injection.

Thrombolytics, or fibrinolytics, target and destroy a substance called fibrin. Fibrin is a tough protein that makes up blood clots. It acts like a sort of fibre mesh that hardens around the blood.

Examples of these types of medications include:

• reteplase
• alteplase
• streptokinase

You may also be given an extra medication called a glycoprotein IIb/IIIa inhibitor. You will get this if you have an increased risk of experiencing another heart attack.

Glycoprotein IIb/IIIa inhibitors do not break up blood clots. But they prevent blood clots from getting bigger. They're an effective method of stopping your symptoms getting worse.

Coronary artery bypass graft

A coronary angioplasty may not always be possible. This is if your arteries are different from normal.

They may be different if there are:

• too many narrow sections in your arteries
• lots of branches coming off your arteries that are also blocked

In this case, your doctor may consider a coronary artery bypass graft (CABG). A CABG involves taking a blood vessel from another part of your body to use as a graft. It is usually taken from your chest or leg.

The graft bypasses any hardened or narrowed arteries in the heart. A surgeon will attach one part of the new blood vessel to the aorta. They'll attach the other to the coronary artery beyond the narrowed area or blockage.

Treating NSTEMI or unstable angina

The results of your ECG may show you have a less serious type of heart attack.

This is called a non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina.

In this case, your doctor will usually recommend blood-thinning medication, including aspirin.

In some cases, you might have further treatment along with these medications. These could include coronary angioplasty or coronary artery bypass graft.

After having a treatment procedure for a heart attack

Once you have had treatment you will spend time recovering in a special hospital ward. This is called the Coronary Care Unit (CCU). You will be there for a few days. This is so that doctors and nurses keep an eye on you during your recovery.

The days after treatment are when you are at most risk of developing complications. Complications could be a very fast or very slow heart rate. There are other complications too.

During this period you will:

• be examined by a doctor or nurse at least once a day
• have regular ECG tests
• have blood tests to work out how much damage the heart attack caused
• have chest x-rays taken, if necessary

Your doctor might also carry out an echocardiogram (ECHO). This is to find out how well your heart muscle is working. An ECHO is an ultrasound examination of your heart.

The number of monitors and drips attached to you may worry you and your family. But, remember this is normal. It should not alarm you.

The Coronary Care Unit (CCU)

The CCU is a special ward for caring for people with heart conditions.

Nurses and doctors in this unit are specially trained to deal with heart attacks.

They will use equipment to check your heart rhythm, blood pressure and other factors. These monitors will sound an alarm if there are changes which suggest a possible problem.

While in the CCU, you will not be allowed many visitors. This is so that you can rest.

Your stay in hospital after a heart attack

Once your condition is stable, you will move from the CCU to a cardiac ward. After that you will be able to go home.

At this stage, doctors will have a better idea of what caused your heart attack. You will then start receiving treatment for these conditions.

In some hospitals you will have a visit from a member of the cardiac rehabilitation team. They will discuss a cardiac rehabilitation programme with you.

Before you leave hospital you may also have an angiogram. An angiogram is a specialised x-ray.

Read more about cardiac rehabilitation from the Irish Heart Foundation