Heart Attack Emergency Care

A heart attack, or myocardial infarction, occurs when one or more regions of the heart muscle experience a severe or prolonged lack of oxygen caused by blocked blood flow to the heart muscle.

The blockage is often a result of atherosclerosis – a buildup of plaque composed of fat deposits, cholesterol and other substances. Plaque ruptures, and eventually a blood clot forms. The actual cause of a heart attack is a blood clot that forms within the plaque-obstructed area.

If the blood and oxygen supply is cut off severely or for a long period of time, muscle cells of the heart suffer damage and die. The result is dysfunction of the muscle of the heart in the area affected by the lack of oxygen. 

The goal of treatment for a heart attack is to relieve pain, preserve the heart muscle function and prevent death.

Procedures for treating an ST-elevation myocardial infarction 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.
• 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.
• Fibrinolytic therapy is the intravenous infusion of a medication which dissolves the blood clot, thus restoring blood flow. This therapy is used when timely access to angioplasty or stenting is not possible.

Medications that may be used for the treatment of heart attacks include:

• Antithrombin/antiplatelet therapy, which is used to prevent further blood clotting.
• Cardiac medication such as beta-blockers and Ace-inhibitors (or aldosterone receptor antagonists), which promote blood flow to the heart, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure.
• Cholesterol-lowering medications to lower lipids (fats) in the blood, particularly Low Density Lipid (LDL) cholesterol. 

Once the condition has been treated and the patient is released, we recommend a referral to cardiac rehabilitation, which can improve recovery, reduce the need for repeat hospitalizations and even save lives.