Treatment for a Heart Attack (myocardial infarction)
The goal of treatment for a heart attack is to relieve pain, preserve the heart muscle function, and prevent death.
Treatment in the emergency department may include:
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Intravenous therapy such as nitroglycerin and morphine.
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Continuous monitoring of the heart and vital signs.
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Oxygen therapy improves oxygenation to the damaged heart muscle.
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Pain medication decreases pain, and, in turn, decreases the workload of the heart, thus, the oxygen demand of the heart decreases.
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Cardiac medication, such as beta-blockers, promote blood flow to the heart, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure.
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Fibrinolytic therapy is the intravenous infusion of a medication which dissolves the blood clot, thus, restoring blood flow.
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Antithrombin/antiplatelet therapy is used to prevent further blood clotting.
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Antihyperlipidemics are medications used to lower lipids (fats) in the blood, particularly Low Density Lipid (LDL) cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor), atorvastatin (Lipitor), and pravastatin (Pravachol), among others. Bile acid sequestrants—colesevelam, cholestyramine, and colestipol—and nicotinic acid (niacin) are two other types of medications that may be used to reduce cholesterol levels.
Additional procedures to restore coronary blood flow may be used. Those procedures include:
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Coronary angioplasty. With this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. This is often followed by the insertion of a stent into the coronary artery to help keep the vessel open. Although angioplasty is performed in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. PCI is also called percutaneous transluminal coronary angioplasty (PTCA). There are several types of PTCA procedures, including:
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Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked area.
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Coronary artery stent. A tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
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Atherectomy. The blocked area inside the artery is cut away by a tiny device on the end of a catheter.
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Laser angioplasty. A laser used to "vaporize" the blockage in the artery.
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Coronary artery bypass. Most commonly referred to as simply "bypass surgery" or CABG (pronounced "cabbage"), this surgery is often performed in people who have angina (chest pain) and coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft.