Attack (Myocardial Infarction)
Conventional Treatments For Heart
After it is verified that you indeed is having a heart attack, the immediate goal of treatment is to quickly open the blocked artery and restore blood flow to the heart muscle. This process is called "reperfusion."
Prompt reperfusion minimizes the damage to heart muscle and preserves the pumping function of the heart. Delay in establishing reperfusion can result in irreversible
damage to the heart muscle cells and reduced pumping force of the remaining heart muscle.
It is best if reperfusion can be established in the first 4- 6 hours of a heart attack.
There are different treatment options
available. These may be broadly classified as surgical approaches and
drug therapy. A combination may also be chosen. What option is selected
depends on the facilities available at the hospital and the diagnosis of
the emergency room physician.
Angioplasty or PTCA
(percutaneous transluminal coronary angioplasty)
The most direct method of opening a blocked artery, provided the hospital has a cardiac catheterization facility, is to perform an immediate coronary angiogram and
angioplasty also known as PTCA (percutaneous transluminal coronary angioplasty).
Angioplasty is effective in up to 95% of cases. The blood flow can be
restored in within 60 minutes in this case. There is another benefit to
angiogram. It allows the doctor to evaluate the status of the other coronary
arteries. This will be helpful in determining the long- term treatment
Very often, when angiogram or PTCA is performed, the doctors will elect
to install a concave tube called stent at the place where there was a
blockage. This will minimize the arteries from getting clogged again.
The doctors also may give the patients "super aspirins"
(blood thinning drugs that work against the clotting of the blood).
These are given at the time of PTCA or coronary stenting.
Drug Therapy or
Drug therapy is another option for heart attack patients. In case of an acute heart attack,
the victims may be given certain clot dissolving medicines (thrombolytic agents).
Examples of such drugs are:
Tissue plasminogen activator (TPA)
These medications, given intravenously,
can successfully open up to 80% of acutely occluded coronary arteries. The earlier these agents are administered, the better the success at
opening the artery, and the more effective the preservation of heart muscle.
To minimize major damage to the heart, these should be administered
within 6 hours of heart attack.
PTCA may be performed in patients who fail to respond to thrombolytic therapy. Thrombolytic therapy carries a significant bleeding
risk. Patients with recent surgery or major trauma, recent stroke, bleeding ulcer, or other related
conditions are not candidates for this therapy.
Aspirin reduces the tendency of platelets in the blood to clump and clot.
It is often given in conjunction with other reprefusion therapies to decrease the possibility of recurrent closure of the artery and
to improve the chance of survival. Aspirin is given to all patients with a heart attack, unless there is a history of significant intolerance to aspirin.
Heparin is given intravenously as a blood-thinning agent to prevent blood clots and to maintain an open artery during the initial 24-72 hours.
Nitroglycerin opens the blood vessel by relaxing the muscular wall of the blood
vessel. It is given intravenously to prevent blood vessel spasm and to minimize the size of the heart attack.
ACE (angiotensin converting enzyme)
ACE (angiotensin converting enzyme) inhibitors are often given orally after a large heart attack to improve the heart muscle healing process. Examples of ACE inhibitors include:
(Zestril and Prinvil).
These medications reduce the stress load to the heart, thereby helping the damaged heart muscle to recover.
Beta Blocking Agents
Beta blocking agents (eg., propanalol, metoprolol, and atenelol) are often given during the acute heart attack to decrease the amount of muscle damage.
Long term administration of these agents following a heart attack has been shown to improve survival and reduce the risk of future heart attacks.
Bypass Graft (CABG) Surgery
The bypass surgery is performed when PTCA is technically difficult or dangerous to
perform or when PTCA and thrombolytic medications fail to achieve reperfusion or maintain open arteries.