Heart attack : Treatment

The treatment options for a heart attack depend on whether you've had an ST segment elevation myocardial infarction (STEMI), or another type of heart attack.

A STEMI is the most serious form of heart attack and requires emergency assessment and treatment. It's important you're treated quickly to minimise damage to your heart.

If you have symptoms of a heart attack and an electrocardiogram (ECG) shows you have a STEMI, you'll be assessed for treatment to unblock the coronary arteries.

The treatment used will depend on when your symptoms started and how soon you can access treatment.

  • If your symptoms started within the past 12 hours – you'll usually be offered primary percutaneous coronary intervention (PCI).
  • If your symptoms started within the past 12 hours but you can't access PCI quickly – you'll be offered medication to break down blood clots.
  • If your symptoms started more than 12 hours ago – you may be offered a different procedure, especially if symptoms have improved. The best course of treatment will be decided after an angiogram and may include medication, PCI or bypass surgery.

Primary percutaneous coronary intervention (PCI)

Primary PCI is the term for emergency treatment of STEMI, using a procedure to widen the coronary artery (coronary angioplasty).

Coronary angiography is performed first to assess your suitability for PCI.

You may also be given blood-thinning medication to prevent further clots from developing, such as:

Some of these medications may be continued for some time after PCI.

Coronary angioplasty

Coronary angioplasty is a potentially complex type of procedure that requires specialist staff and equipment, and not all hospitals have the facilities.

This means you'll need to be taken urgently, by ambulance, to one of the specialist centres (Heart Attack Centres) that now serve most of the UK's regions.

During coronary angioplasty, a tiny tube known as a balloon catheter, with a sausage-shaped balloon at the end, is put into a large artery in your groin or arm. The catheter is passed through your blood vessels and up to your heart, over a fine guidewire, using X-rays to guide it, before being moved into the narrowed section of your coronary artery.

Once in position, the balloon is inflated inside the narrowed part of the coronary artery to open it wide. A stent (flexible metal mesh) is usually inserted into the artery to help keep it open afterwards.

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Medication to break down blood clots

Medications used to break down blood clots, known as thrombolytics or fibrinolytics, are usually given by injection.

Thrombolytics, or fibrinolytics, target and destroy a substance called fibrin. Fibrin is a tough protein that makes up blood clots by acting like a sort of fibre mesh that hardens around the blood.

Some examples of these types of medications include:

  • reteplase
  • alteplase
  • streptokinase

You may also be given an additional medication called a glycoprotein IIb/IIIa inhibitor if it is thought you have an increased risk of experiencing another heart attack at some point in the near future.

Glycoprotein IIb/IIIa inhibitors don't break up blood clots, but they prevent blood clots from getting bigger. They're an effective method of stopping your symptoms getting worse.

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Coronary artery bypass graft

A coronary angioplasty may not be technically possible sometimes if the anatomy of your arteries is different from normal. This may be the case if there are too many narrow sections in your arteries or if there are lots of branches coming off your arteries that are also blocked.

In such circumstances, an alternative surgical operation, known as a coronary artery bypass graft (CABG), may be considered. A CABG involves taking a blood vessel from another part of your body, usually your chest or leg, to use as a graft.

The graft bypasses any hardened or narrowed arteries in the heart. A surgeon will attach the new blood vessel to the aorta and the other to the coronary artery beyond the narrowed area or blockage.

Treating NSTEMI or unstable angina

If the results of your ECG show you have a "less serious" type of heart attack (known as a non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina), then blood-thinning medication, including aspirin and other medications, is usually recommended.

In some cases, further treatment with coronary angioplasty or coronary artery bypass graft may be recommended in cases of NSTEMI or unstable angina, after initial treatment with these medications.

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