Heart Attack - Treatment

The treatment of heart attack is aimed at restoring the blood flow to the affected region of the heart. The sooner the treatment begins the better is the recovery.

The first 24 hours after heart attack is the time of highest risk for sudden cardiac death, and the first six hours are crucial for limiting the damage on the heart muscles. Medications as well as surgical procedures are used to treat heart attacks.

• Medications

a. Thrombolytic therapy must be administered with 6 hours after onset of the chest pain. The clot busters dissolve blood clots and when given soon after a heart attack begins they can limit damage to the heart. They are most effective when given within 1-2 hours from the start of the heart attack. There are various drugs that dissolve clots, but tissue plasminogen activator (TPA) is currently used most often. Others include Streptokinase (SK), Reteplase, Tenecteplase, Urokinase, Lanoteplase, and Staphylokinase.

b. Aspirin and antiplatelet drugs are given to prevent blood clotting.

c. Drugs like beta-blockers and ACE inhibitors are given following heart attacks to prevent repeat heart attacks.

d. Anticoagulants like heparin that prevent clots from reforming are also used in the treatment of heart attacks.

e. Nitrates like nitroglycerin are used in the treatment of heart attacks to relax blood vessels and stop chest pain.

• Angioplasty

This is used in the treatment of heart attack when the clot is not dissolved by medications. Angioplasty is done when there is a discrete block in the artery supplying the heart. Stents are placed after the block is removed to prevent restenosis in the affected regions.

• Atherectomy

When the plaques are too hard to be treated with angioplasty, atherectomy is done to remove the plaques. A laser catheter or a rotating shaver is used to remove the plaque. Balloon angioplasty or stenting may be used after an atherectomy.

• Coronary artery bypass graft (CABG)

This is done when there is a diffuse block in the artery. Arteries or veins taken from other parts of the body are used to bypass the diseased vessel and reroute the blood supply.