This post will enlighten you on the following:
- What is the initial emergency treatment given at the hospital to a heart attack patient?
- What is the specific medical treatment for a heart attack?
- What are the surgical treatment options for heart attack?
The main cause of a heart attack is obstruction, complete or partial, of blood supply to a particular part of the heart wall. The primary objective in the treatment of heart attack either conservative or surgical is to:
- Restore as quickly as possible blood supply to that part of the heart, which has been affected by the blocked coronary artery
- Dissolve the clot or prevent its formation
- Prevent the platelets from sticking to the cholesterol plaque
- Stabilize the plaque to prevent its rupture and further ischemia of the heart
This has to be done on a war footing as more heart muscle may get damaged, which can become permanent if the blood supply is not restored quickly. A permanently damaged heart muscle becomes an infarct (dead heart muscle tissue).
Heart attack treatment options
Before we go to the treatment options, the patient during his stay at the hospital and later after discharge is put on certain dietary restrictions depending on his medical history of any comorbidities. This stays part of his treatment throughout his life.
The treatment of heart attack can be categorized into three steps:
- A) Emergency treatment
- B) Medical treatment
- C) Surgical treatment may be required in some cases
A) Emergency treatment of heart attack at the hospital
- Intensive care. The heart attack patient is admitted to the ICCU ward of the hospital, and connected to the ECG monitoring machine for continuous monitoring of his heart activity.
- Oxygen is administered to the patient so that the blood stays rich in oxygen content. This ensures adequate oxygen supply to the body tissues, thereby reducing the demand of the body for blood supply on the heart. This lessens the workload on the heart.
- Nitroglycerine is administered to increase the blood supply to the heart as it acts as a vasodilator (dilates the blood vessels).
- I.V. fluids are started to infuse the patient and keep the intravenous route open for administering any intravenous drugs urgently if required.
- Aspirin is given because of its anti-clotting properties. This maintains blood supply and prevents further narrowing of the artery.
- Chest pain is treated with pain relievers such as morphine or pethidine to ease the patient’s discomfort.
All the above steps are carried out within minutes of admission with more than one paramedic attending to the patient.
B) Medication for heart attack
Medicines aim to restore blood supply, which has been disturbed by the blood clot in the coronary artery.
Thrombolytic agents, also called clot busters, are ideally administered within an hour of an attack for maximum efficacy. They help by dissolving the clot in the coronary artery and restoring blood supply. They are, however, contraindicated in patients having
- history of internal bleeding,
- brain tumor,
- peptic ulcer
- recent history of some major surgery and
- in pregnant ladies
Beta-blockers such as atenolol and propranolol, work by reducing the load on the heart by lowering the blood pressure, reducing chest pain, and preventing arrhythmias, which are the major complications of a heart attack, and which can cause the death of the patient.
Ace inhibitors such as ramipril, relax the blood vessels and thereby reduce the load on the heart. They also help reduce blood pressure.
Cholesterol reducing agents are given when the patient’s cholesterol blood level is high and the arterial block has been caused by a plaque in the artery.
Post heart attack treatment continues even after discharge from the hospital at home with regular follow-ups with the physician.
C) Surgery for heart attack
Surgical treatments for heart attack consist of either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). These surgical options are indicated when there are several blockages in the main coronary arteries and the pumping action of the heart has become weak.
CABG is also indicated in some cases where PCI may not be an option for treatment.
Coronary angioplasty or stent surgery
Coronary angioplasty or percutaneous coronary intervention (PCI) is done to insert a stent in the narrowed portion of the artery. It is performed after an angiography has confirmed the presence and the location of the clot.
It is a non-surgical procedure, in which a catheter is inserted through the femoral vein and guided under visual monitoring into the heart and to the site of coronary artery blockage.
This catheter has an attachment at the distal end whereby a balloon is inflated and the plaque is flattened against the artery wall.
The artery lumen is opened and blood flow is restored. With the help of the catheter, a stent may be placed at the site of the blockage to keep the artery open.
Coronary bypass surgery
Coronary bypass surgery or coronary artery bypass grafting (CABG) in a patient with a heart attack is done to bypass the site of the blockage.
Required lengths of a healthy vein or artery are removed from elsewhere in the body and anastomosed in such a fashion so that a bypass is created around the blocked part of the artery to allow the blood flow to resume to the affected part via the new pathway.
The aims of coronary artery bypass grafting are :
- To improve patient’s quality of life and provide a more active lifestyle by relieving symptoms,
- To improve the pumping action of the heart,
- To reduce the risks of mortality, and
- To treat or prevent any heart attack complications that may or may not have developed
About heart attack treatment in women
Heart attack is often considered a privilege of the male gender. However, more women die of heart attacks in the United States than men.
This is primarily due to women not being prompt in seeking medical aid when symptoms set in. This results in delayed diagnosis and treatment, which increases the chances of mortality.
The efficacy of the heart attack treatment is most when it is started within 30 minutes of the onset of heart attack symptoms. This also ensures fewer incidences of complications setting in, some of which can be fatal. Prompt treatment greatly improves the prognosis and maximizes the chances of long quality life for the patient.
