Thanks to improved treatment, more people survive heart attacks than ever before. And though heart disease and stroke remain leading killers of Americans, a full array of treatment options has revolutionized therapy during those first critical hours after the pain strikes.
What’s at the heart of this medical success story? Better medicines; computer-assisted diagnoses; pinpoint imaging; and coronary care units with highly trained doctors, nurses and technicians. (Even the concept of coronary care units is somewhat new—they came about in the late ‘60s and early ‘70s.)
When a heart attack victim is admitted, the emergency room rushes to stabilize the patient to prevent further heart damage. During this lifesaving work, the patient may receive:
- intravenous blood-thinning drugs called thrombolytic agents to dissolve blockages or clots that caused the attack
- electrocardiogram (ECG) monitoring around the clock to watch the heart’s electrical activity and tell doctors the extent of tissue damage
- oxygen and nitroglycerin to make the blood oxygen-rich and widen the arteries to improve blood flow
- narcotics like morphine to deaden pain in the chest cavity
- beta and channel blockers that lower the heart rate and lessen the heart’s demand for oxygen
- anticoagulants to keep new clots from forming near the damaged area
One of the most successful new diagnostic approaches is bedside blood testing that looks for heart attack markers. As soon as the patient is admitted, his or her blood is immediately analyzed for specific proteins that are released during an attack. Results take three to four hours, allowing physicians to then target their therapy based on what the test shows.
Once stabilized, the patient is then placed in the hands of the hospital’s coronary care unit (CCU). There, a highly trained medical team keeps watch over the heart attack victim’s vital signs, including his or her hemodynamics—heart pressure, blood flow, circulation and blood oxygen level.
The CCU also is equipped with emergency resuscitation equipment such as defibrillators to deliver electrical shocks that restore heartbeat if the patient has another attack or an arrhythmia—sudden, rapid fluttering of the heart muscle.
If the attack was especially severe, the patient might undergo emergency treatment within hours of being admitted.
One of several options may be indicated:
- angioplasty, in which a catheter with a balloon tip is guided into a coronary artery and inflated to remove a blockage
- coronary bypass, in which surgeons take a healthy blood vessel from the patient and graft it onto the diseased coronary artery to “detour” blood into the heart
Lastly, a temporary pacemaker wire might be necessary if doctors believe a patient’s heartbeat could become too slow during recuperation. The wire is slid through a vein until it reaches the right ventricle of the heart. The other end is connected to a battery-powered pacemaker that stimulates the heart with electrical impulses when it’s beating too slowly. The unit is usually not needed after the patient recovers.
Modern heart attack treatment is nothing like therapy of even 30 years ago. As more advances make their way into hospitals and doctors’ offices, the level of care will rise even higher, leading to better survival rates and longer, healthier lives.