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Heart attack    See images

Overview | Symptoms | Treatment | Prevention

Alternative names:

Myocardial infarction; MI; Acute MI

Treatment

A heart attack is a medical emergency! Hospitalization is usually required for 1 to 14 days. Treatment may include intensive care and involve emergency surgery. ECG monitoring is started immediately, because life-threatening dysrhythmias are the leading cause of death in the first few hours after a heart attack.

The goal of treatment is to reduce the demands on the heart so that it can heal, and prevent and treat complications. Activity may be restricted initially, then gradually increased.

An intravenous catheter will be inserted to administer emergency medications and fluids. Various monitoring devices may be neccessary. A urinary catheter may be inserted to closely monitor fluid status.

Oxygen is usually given, even if blood oxygen levels are normal. This makes oxygen readily available to the tissues of the body and reduces the workload of the heart.

Diet may or may not be restricted. Diet restrictions often include low salt intake, no caffeine, and low fat.

MEDICATIONS
Morphine is the analgesic most often given for pain. Nitrates such as nitroglycerin are given for pain and to reduce the oxygen requirements of the heart. Beta-blockers (metoprolol and atenolol) reduce the workload of the heart. Digitalis improves the heart's pumping action. Calcium channel blockers reduce oxygen requirements in the heart muscle. Anti-arrhythmics and diuretics may also be prescribed.

Clot-dissolving (thrombolytic) therapy is usually initiated within 6 hours of when chest pain begins. The initial therapy will include an IV infusion of clot-dissolving medication (streptokinase or tissue plasminogen activator) immediately followed by IV infusion of heparin. Heparin therapy will last for 48 to 72 hours. Additionally, oral aspirin and warfarin may be prescribed to prevent further development of clots.

Thrombolytic therapy is not appropriate for people who have had:

• A major surgery, organ biopsy, or major trauma within the past 6 weeks
• Recent neurosurgery
• Head trauma within the past month
• History of GI (gastrointestinal) bleed
• Intracranial tumor
• Stroke within the past 6 months
• The person is currently pregnant

Possible complications of thrombolytic therapy include bleeding and hemorrhage.

SURGERY
Emergency angioplasty may be required to open blocked coronary arteries. Emergency coronary artery bypass surgery (CABG) may be required in some cases.

Prognosis

The expected outcome varies with the amount and location of damaged tissue. The outcome is worse if there is damage to the electrical conduction system (the impulses that guide heart contraction).

Approximately 1/3 of cases are fatal. If the person is alive 2 hours after an attack, the probable outcome for survival is good, but may include complications. Uncomplicated cases may recover fully. Heart attacks are not necessarily disabling. Usually, the person can gradually resume normal activity and lifestyle, including sexual activity.

Complications

• Arrhythmias such as ventricular tachycardia, ventricular fibrillation, heart blocks
• Congestive heart failure
• Cardiogenic shock
• Extension of the amount of affected heart tissue
• Pericarditis
• Complications of treatment (For example, treatment with thrombolytic agents increases the risk of bleeding during treatment.)

Call Your Health Care Provider If:

Go to the emergency room or call the local emergency number (such as 911) if crushing chest pain or other symptoms suggestive of heart attack occur.

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