What Other Therapy Should Be Given During An Acute Heart Attack?
In addition to acting quickly to open up the occluded vessel and restore blood flow to your heart muscle, several other measures should be taken in treating you during an acute MI. These include:
Aspirin
Taking an aspirin (one-half to a whole uncoated adult aspirin, chewed or crushed) as soon as possible whenever an MI (or any form of acute coronary syndrome) is suspected can significantly improve outcomes. Aspirin works by decreasing the "stickiness" of the blood platelets, and thus retarding the growth of the blood clot that is causing the MI.
Heparin
Giving intravenous heparin or another blood thinner during the first 24 hours of acute heart attack probably reduces long-term mortality. The anticoagulant drugs, of which heparin is one, help to prevent the formation of a new blood clot.
Beta blockers
Beta blockers, drugs that block the affect of adrenaline, significantly improve the survival of patients with MIs, and they should be given to all patients unless there is a strong reason not to (such as lung disease, severe heart failure, or very slow heart rates). These drugs are usually initiated the day after the heart attack.
ACE Inhibitors
Angiotensin converting enzyme (ACE) inhibitors have been shown to significantly improve the outcome of patients who have very large heart attacks or signs of heart failure. These patients should be started ACE inhibitors during the first 24 hours after a heart attack. ACE inhibitors may also be beneficial in patients with less severe heart attacks.
Statins
Therapy with statins should be started in all patients with an MI prior to hospital discharge, and probably as early as possible after the onset of the heart attack. Statins appear to improve survival after an MI regardless of cholesterol levels, probably by reducing inflammation or stabilizing coronary artery plaques in some other way.
After the First Critical 24 Hours
The first 24 hours is critical. Getting medical help as rapidly as possible is essential to preventing a cardiac arrest, preserving your heart muscle, and preventing further blood clots from forming in your coronary arteries.But even after you have successfully negotiated that first critical day, there is still a lot of work to do. A heart attack is not simply an isolated event that, once endured, can then be forgotten. Truly surviving a heart attack requires an ongoing effort on your part, and on the part of your doctor.
Sources:
Antman, EM, Hand, M, Armstrong, PW, et al. 2007 focused update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2008; 51:XXX.
Cannon, CP, Hand, MH, Bahr, R, et al. Critical pathways for management of patients with acute coronary syndromes: an assessment by the National Heart Attack Alert Program. Am Heart J 2002; 143:777.
