NewYork-Presbyterian. The University Hospital of Columbia and Cornell.

Cardiology

Treating a Heart Attack

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:

• intravenous therapy (nitroglycerin, morphine)
• continuous monitoring of the heart and vital signs
• oxygen therapy to improve oxygenation to the damaged heart muscle
• pain medication by decreasing pain, the workload of the heart decreases, thus, the oxygen demand of the heart decreases

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• cardiac medication such as beta-blockers or calcium channel blockers to promote blood flow to the heart, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure
• fibrinolytic therapy intravenous infusion of a medication which dissolves the blood clot, thus, restoring blood flow
• antithrombin/antiplatelet therapy used to prevent further blood clotting
• antihyperlipidemics - 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.

Once the condition has been diagnosed and the patient stabilized, additional procedures to restore coronary blood flow may be utilized. Those procedures include:

• coronary angioplasty- with this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. 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 PCI procedures, including:
  • balloon angioplasty - a small balloon is inflated inside the blocked artery to open the blocked area.
  • atherectomy - the blocked area inside the artery is cut away by a tiny device on the end of a catheter.
  • laser angioplasty - a laser used to "vaporize" the blockage in the artery.
  • 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.
• coronary artery bypass - Most commonly referred to as simply "bypass surgery," 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.