Emergency treatment for a heart attack
There are two immediate aims to the initial treatment for a heart attack:
- To relieve pain and shock
- To restore blood flow and minimise the amount of heart muscle damage (this is called ‘reperfusion’)
What treatment you receive will depend on the type of heart attack you have had.
Emergency treatment is as follows:
- Treatment to relieve pain and shock
- Antiplatelet therapy aspirin
- Emergency reperfusion treatment. Early reperfusion minimises the extent of heart muscle damage and preserves the pumping function of your heart.
Fast medical attention and evaluation of your individual situation by ambulance and / or medical staff and your geographical access to treatment centres will determine the course of action best for you.
Treatment for pain and shock
This can include:
- Injections of strong pain relieving drugs such as morphine. This also helps to relax your breathing and ease anxiety.
- Oxygen therapy: to help with your breathing and help your body to get enough oxygen.
- Drugs to stop sickness and nausea (anti-emetics).
Antiplatelets are drugs that thin the blood and prevent clotting. This starts the process of getting rid of the clot that is blocking a coronary artery as quickly as possible. This is given regardless of what type of heart attack you have had, i.e. in both STEMI and NSTEMI .
- An initial dose of 300mg aspirin either in the ambulance or as soon as you get to hospital.
- You may receive further antiplatelet therapy depending on the results of your initial tests.
- Emergency treatment to restore blood flow (reperfusion) minimises the extent of heart muscle damage and preserves the pumping action of your heart.
- Reperfusion can be achieved in different ways depending on what type of heart attack you have had.
A STEMI can be treated by either:
- Percutaneous Coronary Intervention (PCI): Primary PCI is a procedure which treats blockages within your coronary arteries and restores blood flow to your heart. During an angiogram a thin catheter is inserted, under local anaesthetic, into a main artery in your upper leg or lower arm and then passed gently into your coronary arteries (the arteries which supply your heart muscle with its own blood supply). The clot / blockage is located and removed.
- Thrombolysis: involves an infusion of ‘clot busting drugs’ which are given directly into your vein. These drugs (usually tissue plasminogen activator (tPA) or alteplase) dissolve the clot(s) within your coronary artery and restore blood flow to your heart. Treatment with thrombolysis is most effective when it is given as soon as possible. For this reason it may be given by paramedics in some areas, or shortly after arrival in hospital.This treatment is not suitable for everyone as there is a risk of bleeding.
Both treatments will have the best results when given as soon as possible.
- It is recommended that a STEMI should be treated immediately with PCI at the treatment centre with the least travel time. However, if PCI cannot be delivered within 120 minutes of ECG diagnosis, people with STEMI should receive immediate thrombolysis.
- PCI may be performed if thrombolysis has been given but blood flow is not completely restored.This is called Rescue PCI. This is most effective within 6 - 12 hours of symptoms. This allows time to travel to a centre where PCI can be performed.
- Once initial tests have confirmed your diagnosis it is likely that you will have an angiogram. This is an x-ray examination of the heart which is used to assess damage to your coronary arteries. PCI can then be performed if necessary to reduce the risk of further cardiac events.
- You may also be treated with further antiplatelet therapy.