If there is the slightest suspicion heart attack has occurred, emergency medical care should be called immediately. Every minute counts. To emphasize the urgency of the call, mention the possibility of a heart attack. Until the emergency medical care arrives, the patient should remain as calm as possible. This is not easy, because a heart attack may evoke a fear of dying. The reassuring care of those around them, and breathing calmly and deeply may help. To facilitate breathing, the patient should sit up and tight clothing should be loosened. If the patient has lost consciousness and you cannot feel their pulse, perform cardiac massage until the emergency physician arrives.
The emergency team will provide the patient with oxygen and establish vascular access in order to deliver medication quickly if needed. Then an electrocardiogram will be performed and the heart rate and rhythm are monitored. In addition, blood pressure and the blood’s oxygen levels are checked continuously.
Depending on the patient’s symptoms, condition and medical history, medication will be administered to dilate the blood vessels, lower the blood pressure, prevent thrombosis and slow the heart beat or, if necessary, accelerate it. In addition, painkillers, sedatives and drugs that prevent nausea and vomiting may be administered.
In the case of cardiac arrest (when the heart stops pumping), a defibrillator will be used to give the heart an electric shock in order to restart the heartbeat and to resuscitate the patient.
After providing life-saving measures, blood flow to the affected sections of the heart has to be restored (reperfusion therapy). In order to do this, the blocked coronary arteries have to be reopened. If the heart attack was caused by a blood clot (thrombus), the physician may try to dissolve the clot with medication.
The treatment of choice, however, is to mechanically open the blocked coronary artery with balloon dilatation or stenting. These treatments are performed in a catheterization laboratory.
For more details about balloon dilatation and stenting procedures, please click here.
If a minimally invasive procedure is not possible, a bypass surgery has to be performed. In this procedure, a new route for the blood is provided by implanting a segment of a healthy vessel from another part of the patient´s body.
See the coronary artery disease section for more details.
After blood flow is restored in the affected sections of the heart, the patient is given medication to prevent a relapse. The medical treatment has four pillars:
- Drugs inhibiting coagulation and preventing the formation of blood clots. This is particularly important in patients who had a stent implantation because of the associated risk of blood clots formation.
- Medication dilating the vessels and relieving the heart´s workload.
- Antihypertensive drugs to lower blood pressure.
- Medication that lowers blood lipids.
Following hospitalization, recovery in a specialized care center is recommended. Therapeutic exercise, health education and emotional support may help the patient recover.
If patients suffer from heart rhythm disorders (Link to heart rhythm disorders) or severe heart failure after the acute phase of a myocardial infarction, an implanted pacemaker (Link to Pacemaker Implantation procedure?) may be indicated.
After returning home, the patient should continue to take their prescribed medication. Regular check-ups by a physician are mandatory after a heart attack. In addition, patients should enjoy a lifestyle with regular and guided physical activities, a healthy diet, refrain from smoking and reduce stress.