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Treatment of heart attack / myocardial infarction

What can you / you do yourself?

A heart attack is basically a threatening heart attack. If you are not getting proper treatment within the first few hours, there will be a heart attack - cell death in a part of the heart muscle - which causes heart a permanent injury. If you think you have a heart attack, immediately seek help. Do not ignore chest pain or discomfort. Time is a crucial factor. Emergency room, or call the clinic site, and they can define the condition as a heart attack if they send an ambulance if your drive or not to drive someone else's.

If you have salicylate available (eg Dispril, Aspirin, Aspirin, Albyl-E) should take such a tablet (160-300 mg). Salicylates will limit further clot formation and thus could contribute to any blood flow is maintained in the clot-filled artery. By chewing salicylate going faster drug into your system than if you swallow the tablet whole. If you have angina and have received nitroglycerin, you should take the tablets as recommended by your doctor.

What is done by consciousness?

If you find someone unconscious after a suspected heart attack, call for help. If you have training in first aid, you must start with mouth-to-mouth breathing and cardiac compressions. This helps to provide some oxygen to the body and brain. If you can not be first, those serving phone could give you advice on what to do.

In the first minutes of a heart attack may cause cardiac arrhythmias (ventricular fibrillation). This unstable heart rhythm and ineffective heartbeat, and heart beats without pump power. Without immediate treatment, ventricular fibrillation lead to sudden death. The availability of an automatic defibrillator that shocked the heart back to normal rhythm, the acute treatment may be required before the patient reaches the hospital. Some public and private places are such defibrillators, and most ambulances have such equipment. The defibrillator is easy to operate.

When the patient have arrived at the hospital and it is clear that there is a heart attack, it will immediately start treatment with medicines, and it is made clear to any minor or major surgery. Type of treatment depends on the severity of the condition and extent of myocardial injury.

General treatment

Medical treatment usually begins immediately, until a definite diagnosis is available. Acute treatment, which begins in the home and continues during transport to the hospital, consists of the following:

  • Oxygen Supply
  • Nitroglycerin under the tongue
  • Painkillers (Morphine)
  • Aspirin (Albyl / Tylenol)

Two main treatments used to limit the damage to the heart muscle. It is thrombolysis and PCI, balloon expansion of the blocked coronary artery. Which of the two treatments chosen depends on the availability of cardiac catheterization. Balloon therapy (PCI) is recommended today as the standard treatment for most patients can reach a center that offers this treatment within 3 hours. If there is a long pathway given thrombolysis locally, and optionally the patient is transported then into a large hospital with the possibility of the PCI treatment.

Thrombolysis - clot medicine

These are medications that can dissolve blood clots that have formed. The earlier these drugs are given, the better the chances of getting fixed up the clot and open the blocked artery. It can prevent further damage of the heart muscle. If it's been more than 12 hours since the chest pain started, these medicines to little avail. Treatment should be started until at least 6 hours. Bleeding is a possible risk with this treatment, the most serious complication is cerebral hemorrhage (stroke). For this reason the treatment is irrelevant for 15-20% of patients.

Such treatment can be started outside the hospital, but it depends on the local procedures for cooperation between the hospital / ambulance / general practitioners in your area.

Balloon Treatment - Angioplasty

PCI / Angioplasty

Acute performed radiographic imaging of the coronary arteries ( coronary angiography ) and coronary blocking ( angioplasty, PCI - percutaneous coronary intervention) is a treatment that is available at the larger hospitals. This is the most direct method to unblock a coronary artery.

Such a procedure starts with cardiac catheterization and radiographic imaging. A long, thin plastic tube (a catheter) is inserted through the artery in the groin or the arm, until the heart and into the coronary arteries. Contrast material is injected and taking pictures (see video ).

If the investigation confirms that there is a blockage of a coronary artery, extended procedure called coronary balloon angioplasty. At the tip of the catheter is inserted, there is a small elongated balloon which is threaded over a hair-thin lead wire. The catheter is inserted into the narrow coronary artery. When the balloon is in place in the blocked portion of the coronary artery, filled balloon. The balloon pushes aside the plaque and blood clot that blocks the artery and allows blood flow. The balloon is then discharged and removed together with the catheter. (Possibly also made stenting - see below)


A stent is a small, round and rectangular metal grid that can be inserted into the coronary artery after balloon angioplasty is performed. After the catheter and balloon are removed, the stent standing again and keep the artery open (a kind of reinforcement of the vessel wall). A stent protects better than angioplasty alone against the artery from narrowing again.

The gain of PCI or angioplasty is attenuated by a relatively high incidence of restenosis (artery becomes narrow again) and worsening of the condition, leading to new angina symptoms and the need for new interventions. The introduction of stents that release chemotherapy locally, has led to far fewer rest oozing after PCI. But the use of these stents may be associated with risk of late forming blood clots in the stent.


Sometimes plaques (deposits) in the coronary arteries for rigid and large, or calcified, that they can be treated by balloon angioplasty. In these cases, plaques sometimes removed mechanically.

Other drugs

If you have a heart attack or heart attack, you will almost certainly get some or all of the following medicines at the hospital. Some medicines will continue when you leave home:

Nitroglycerin given directly into the bloodstream has been shown to improve blood flow to the heart muscle by causing coronary arteries to dilate (dilated), thereby increasing blood flow. The treatment is usually given continuously for 24-48 hours.

Beta blockers are medicines that reduce heart rate and blood pressure. This reduces the heart's workload and the need for oxygen. Beta-blockers may also help prevent irregular - and sometimes fatal - heart rhythms and future heart attack.

Angiotensin-converting enzyme inhibitor (ACE inhibitor) can prevent repeated heart attacks and other problems if administered early during a heart attack. They are especially beneficial for people with diabetes and in patients with impaired cardiac (heart failure).


Sometimes reveals cardiac catheterization extensive coronary disease. In such cases it will be necessary to coronary bypass surgery . Usually performed this procedure if more coronary arteries are narrowed or blocked. This is especially recommended when the left main coronary artery with significant blockages.

A bypass operation is usually open-heart surgery, which means that the chest is opened. During the procedure transplanting heart surgeons a piece of a vein from another part of the body and uses it to bring blood past the narrow portions of the coronary arteries.

The procedure requires that you are connected to a heart-lung machine that performs cardiac work during surgery. Although this sounds dangerous, considered this form of surgery that is very safe and has a low incidence of complications. Sometimes surgeons perform surgery without heart-lung machine. The heart continues to beat it during surgery. This type of surgery has fewer complications than standard procedure, but is not always feasible.

Minimally invasive coronary-artery bypass may be performed if only the front part of the right coronary artery which requires bypass. The procedure is performed as through a small keyhole opening in the chest wall rather than the creation of a large opening in the chest wall.

Preventive treatment

If you have had a heart attack or if you have additional risk factors generally recommended several measures to prevent new heart attacks, thereby preventing heart damage or even death.

Daily use of salicylic acid, a salicylate-tablet Albyl-E 75 mg or 160 mg is recommended. Salicylates increase the risk of bleeding in some people. Please ask your doctor about treatment is advisable for you.

If you smoke, stop immediately! This is the most important lifestyle change you can make. After 3 years without smoking your risk for heart disease down to the same level as non-smokers. Your doctor can give you advice on how to quit smoking, for example. through smoking cessation programs, medications, or use of non-plastics.

Lower your cholesterol. By lowering the level of cholesterol in the blood, particularly the level of the "bad" cholesterol (LDL-C), the process stops with cholesterol deposits in the coronary arteries. Total cholesterol should be less than 5 mmol / l, and LDL-cholesterol should be less than 3 mmol / l Some manage to control cholesterol levels to change your diet, lose weight and exercise more - others need medication ( statins ).

Narrow fat intake in the diet. Many of us eat too much fat.

Check your blood pressure. Uncontrolled hypertension is one of the important causes of heart disease.

Ensure good control of any diabetes. Uncontrolled diabetes increases your risk for heart disease, heart and circulatory problems.

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