Heart Attack (Myocardial Infarction)
a heart attack diagnosis is established, the treatment procedure starts
immediately. The primary goal of treatment is to restore the normal blood
flow to the damaged portion of the heart muscle and preserve the ability
to function normal for the rest of the myocardium. In some patients, a
heart attack can cause arrhythmias (irregular heart rhythms), ventricular
fibrillation (uncoordinated contraction of heart muscle in which the heart
quivers uselessly), or sudden cardiac arrest which can lead to brain damage
to the severity of the heart attack and extent of heart tissue damage,
the treatment procedure also involves medication and/or invasive medical
Medication. The medication prescribed after a heart attack is effective
in breaking up blot clots, preventing new blood clots from forming, stabilizing
the plaque, and preventing the death of new myocardial cells.
- Anticoagulants. Anticoagulants decrease the blood's ability
to coagulate preventing new blood clots from forming or preventing blot
clots from becoming too large in size (which can lead to complications).
The most common anticoagulants prescribed are: Fragmin (Dalteparin),
Orgaran (Danaparoid), Lovenox (Enoxaparin), Innohep (Tinzaparin), or
- Antiplatelet agents. Antiplatelet agents prevent new blood
clots from forming and helps maintain the blood flow through a narrow
artery. Some of the antiplatelet agents prescribed include: Aspirin,
Ticlopidine, Clopidogel, or Dipyridamole. Aspirin is the most prescribed
antiplatelet agent in patients with heart attack. If the aspirin is
taken during the heart attack and continues to be administrated days
after, it decreases the risk of dying by up to 25 percent.
- Thrombolytics. Thrombolytics, also called clot-busters, dissolve
the blood clot that is obstructing a narrow artery. When the thrombolytic
drug is administrated early (within the first hours following a heart
attack), the patient's survival chance increases and the extent of damaged
myocardial tissue decreases. This type of drug is not prescribed in
all cases of heart attack due to its risk of excessive bleeding (which
increases the risk of stroke). Its used is based on the electrocardiogram
results. Thrombolytics prescribed to patients that suffered a heart
attack include: Activase (alteplase-tissue-type plasminogen activator),
Eminase (Anistreplase), Retavase (Reteplase), or Streptase (Streptokinase).
- Beta blockers. Beta blockers limit the heart workload by decreasing
the heart rate, relaxing the heart muscle, decreasing the blood pressure,
reducing the heart beat, and decreasing the overall myocardial demand
for oxygen. Administrated during and after a heart attack, beta blockers
significantly decrease the risk of recurrent heart attacks and death.
Some of the beta blockers prescribed include: Sectral (Acebutolol),
Tenormin (Atenolol), Kerlone (Betaxolol), Zebeta (Bisoprolol), or Cartrol
- Vasodilators. Vasodilators relax the blood vessels allowing
an increased oxygen-rich blood to flow within them and reduce the heart
workload. It is also used to treat chest pain. The most common vasodilators
prescribed are: Nitroglycerin, Isordil (Isosorbide dinitrate), Natrecor
(Nesiritide), Nitrates, or Minoxidil.
- IIb/IIIa Inhibitors. IIb/IIIa inhibitors is a group of drugs
that prevent platelets from sticking together and forming blood clots,
and can dissolve existing blood clots. The most common drugs prescribed
include: Integrelin (Eptifibatide), Aggrastat (Tirofinban), or ReoPro
- Angiotensin converting enzyme inhibitors. Angiotensin converting
enzyme inhibitors help the heart to heal and improve the heart functioning.
This group of drugs is recommended within the first 24 hours after the
onset of heart attack symptoms and should be taken between 4 to 6 weeks.
Although most patients tolerate this medication well, a small number
of patients experience side effects such as: chronic nonproductive cough,
sudden swelling of the lips, face, and cheeks. Some of the angiotensin
converting enxyme inhibitors prescribed include: Lotensin (Benazepril),
Capoten (Captopril), Vasotec (Enalapril), or Monopril (Fosinopril).
II. Invasive cardiac procedures.
- Coronary angioplasty. Coronary angioplasty, also known
as percutaneous transluminal coronary angioplasty, balloon angioplasty,
or coronary artery balloon dilatation is a catheter-based procedure
used to increase the blood flow through an obstruct artery.
The procedure is performed under sedation or local anesthesia,
and requests the use of a dye agent (iodine-based dye) which
makes the arteries and the blockage visible on a special monitor.
During this procedure, a special catheter with a balloon tip
is inserted through the femoral artery (in the leg) or brachial
artery (in the arm) into the blocked coronary artery. Once placed
into the obstruction site, the balloon is inflated - causing
the artery to open. In certain cases, the doctor may insert
a metal mesh stent (to stretch open the artery) coated with
medication to assure a normal blood flow to the heart muscle
for a longer period of time. Mostly safe, coronary angioplasty
can cause several complications, such as (1) allergic reactions
to the dye agent (hives, rash, swelling, anaphylactic shock),
(2) arrhythmia, (3) bleeding or infection to the insertion site,
(4) kidney failure, (5) the artery ruptures, or (6) stroke.
Article by Kona Vishnu, MS