A heart attack is a medical emergency! Hospitalization is usually required for 1 to 14 days. Treatment may include intensive care. Continuous ECG monitoring is started immediately, because life-threatening arrhythmias are the leading cause of death in the first few hours of a heart attack.
The goals of treatment are to stop the progression of the heart attack, to reduce the demands on the heart so that it can heal, and to prevent complications.
An intravenous line will be inserted to administer medications and fluids. Various monitoring devices may be necessary. A urinary catheter may be inserted to closely monitor fluid status.
Oxygen is usually given, even if blood oxygen levels are normal. This makes oxygen readily available to the tissues of the body and reduces the workload of the heart.
MEDICATIONS
Morphine or morphine derivatives are potent analgesics, often given for pain. Sublingual (under the tongue) or intravenous (IV) nitrates such as nitroglycerin are also given for pain and to reduce the oxygen requirements of the heart.
If the ECG recorded during chest pain shows a change called "ST-segment elevation," clot-dissolving (thrombolytic) therapy may be initiated within 6 hours of thechest pain onset. This initial therapy will be administered as an IV infusion of streptokinase or tissue plasminogen activator, and will be followed by an IV infusion of heparin. Heparin therapy will last for 48 to 72 hours. Additionally, warfarin may be prescribed to prevent further development of clots.
Thrombolytic therapy is not appropriate for people who have had:
- A major surgery, organ biopsy, or major trauma within the past 6 weeks
- Recent neurosurgery
- Head trauma within the past month
- History of GI (gastrointestinal) bleed
- Intracranial tumor
- Stroke within the past 6 months
- Current severe hypertension
Possible complications of thrombolytic therapy include bleeding and hemorrhage.
A cornerstone of therapy for a heart attack is antiplatelet medication (a medication that can prevent platelet aggregation which is the initial event in the circulation leading to clot formation). One antiplatelet agent widely used is aspirin, given at a dose of 160 mg/day. Another antiplatelet medication in use is ticlopidine. More recently, a medication called clopidogrel has shown in clinical studies to be even more effective than aspirin to reduce the occurrence of new heart attacks.
Other medications that may be prescribed include the following:
- Beta-blockers, to reduce the workload of the heart
- Glycoprotein IIb/IIIa inhibitors
- Calcium channel blockers
- Anti-arrhythmics
- Diuretics.
In the first 24 hours of a heart attack that compromises the anterior wall of the heart or is complicated by heart failure, drugs called ACE inhibitors may be recommended.
PROCEDURES
Emergency coronary angioplasty may be required to open blocked coronary arteries. This procedure may be used instead of thrombolytic therapy, or in cases where such therapy is contraindicated. Often the re-opening of the coronary artery after angioplasty is ensured by implantation of a small device called a stent. Emergency coronary artery bypass surgery (CABG) may be required in some cases.
Activity may be restricted initially, then gradually increased.
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