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Heart Attack: Emergency Treatment

UPMC Content 2

A heart attack, or myocardial (my-oh-CAR-dee-ol) infarction(in-FARK-shin) (MI), occurs when blood is blocked from flowing to the heart. When this happens, heart muscle cells don’t get the oxygen they need. This damages the heart, and cells begin to die. The damage can happen within minutes. But it can be lessened if the patient seeks emergency treatment right away.

Heart attack warning signs

There are a number of warning signs that you (or someone you know) may be having a heart attack:

  • Chest pain or discomfort
  • Pain in the upper body such as the neck, jaw, upper back, or arms
  • A squeezing feeling or tightness in the chest
  • Difficulty breathing
  • Sweating
  • Nausea or vomiting
  • Dizziness or lightheadedness

Call for help

If you have any of these symptoms, call 911 or your local ambulance service immediately for the safest and quickest transportation to the hospital.

Do not drive yourself to the emergency room. Do not have a family member or friend drive you.

Early treatment within the first few hours of a heart attack can save your life. And it can reduce the damage caused by a heart attack. If you know the warning signs of a heart attack, it could save your life someday.

In the emergency department

The hospital emergency department takes special steps when a person arrives with symptoms of a heart attack. First, the patient is taken to an exam room. Emergency department staff members check the person carefully. This is called a physical assessment.

The patient is connected to a heart monitor (also called an electrocardiogram or EKG). This procedure is painless. The EKG allows the staff to constantly watch the heart’s activity.

The patient may have an IV (intravenous) line put in. The IV is inserted into a vein in the patient’s arm. This allows the staff to give medicines and to take blood samples. Oxygen may be given through a tube in the nose. This helps make sure that the heart and the body get enough.

In the emergency department, the patient is not allowed to eat or drink until a proper diagnosis can be made. He or she must stay in bed to rest the heart as much as possible. In some hospitals, a special team of doctors and nurses arrives to give the best possible care once the patient is diagnosed with a heart attack.

Emergency diagnostic tests

Staff perform tests to learn what caused the heart attack and how bad it is. These tests are called diagnostic tests.

A 12-lead EKG is done to look at the electrical activity inside the heart. This EKG helps identify which areas of the heart may be damaged from the heart attack.

Blood may be checked for special substances called enzymes (EN-zimes). When heart damage occurs, the body releases enzymes. So enzyme blood tests are done every few hours for several days. These tests can help to show when the heart damage has stopped.

In some cases, cardiac catheterization (cath-eh-ter-ih-ZAY-shun) is needed. This procedure is done in a special room called the cardiac catheterization lab. The procedure allows the doctor to see pictures of the heart and blood vessels. The pictures show the amount of blockage in the vessels that supply blood to the heart muscle. These vessels are called coronary arteries. During the procedure, a thin, straw-like tube called a stent may be placed in the coronary arteries. The stent restores blood flow to the heart.

An echocardiogram or “echo,” may be done to determine how well the heart muscle is pumping. The test also can show how much the heart muscle is damaged.

Emergency medicines

At the emergency department, patients are given medicines that can reduce the damage caused by a heart attack.

Some medicines help stop blood clots from forming. They also keep existing clots from getting larger. These drugs include aspirin, heparin, and other antiplatelet drugs. These drugs are called anti-coagulants (an-tee-ko-AG-you-lentz). If a blood clot grows, it can block blood heart doesn’t get enough oxygen and more damage can occur.

Some drugs are known as clot buster therapy or thrombolytic (throm-boh- LIH-tik) therapy. These drugs are given to dissolve clots that have already formed. They work to reduce the amount of heart muscle damage. But these drugs work only if given within 1 to 2 hours from the start of a heart attack. This is why it is so vital to get immediate emergency care after the start of symptoms.

Nitrates include the drug nitroglycerine (NI-tro-GLISS-er-in). These medicines relax the coronary arteries and allow more oxygen to reach the heart muscle. Nitrates also can reduce chest pain.

Other drugs can be given to widen the blood vessels, decrease the work load of the heart, and reduce pain and anxiety. The health care team decides which drugs will work best for each patient.

After the emergency department

Emergency department staff work to diagnose the heart attack and bring the condition under control (stabilize). Once stabilized, the patient will be taken to another area in the hospital called a coronary care unit.

Sometimes, the patient is taken to a special hospital area called a step-down unit. These units have special equipment and expertly trained doctors and nurses who will provide the best up-to-date care available.

The health care team will continue to watch the patient’s heart rate and rhythm. This goes on 24 hours a day until heart damage has stopped. At that point, the patient’s care changes to education about the recovery process. 

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