A heart attack is a medical emergency! Hospitalization is required and, possibly, intensive care. Continuous ECG monitoring is started immediately, because life-threatening arrhythmias are the leading cause of death in the first few hours of a heart attack.

The goals of treatment are to stop the progression of the heart attack, to reduce the demands on the heart so that it can heal, and to prevent complications.

Medications and fluids will be inserted directly into a vein using an intravenous (IV) line. Various monitoring devices may be necessary. A urinary catheter may be inserted to closely monitor fluid status.

Oxygen is usually given, even if blood oxygen levels are normal. This makes oxygen readily available to the tissues of the body and reduces the workload of the heart.

PAIN CONTROL MEDICATIONS

Intravenous nitroglycerin or other medicines are given for pain and to reduce the oxygen requirements of the heart. Morphine and similar medicines are potent pain killers that may also be given for a heart attack.

BLOOD THINNING MEDICATIONS

If the ECG recorded during chest pain shows a change called "ST-segment elevation," clot-dissolving (thrombolytic) therapy may be initiated within 6 hours of when chest pain began. This initial therapy will be administered as an IV infusion of streptokinase or tissue plasminogen activator, and will be followed by an IV infusion of heparin. Heparin therapy will last for 48 to 72 hours. Additionally, warfarin,taken orally, may be prescribed to prevent further development of clots.

Thrombolytic therapy is not appropriate for people who have had:

• A major surgery, organ biopsy, or major trauma within the past 6 weeks
• Recent neurosurgery
• Head trauma within the past month
• History of GI (gastrointestinal) bleed
• Brain tumor
• Stroke within the past 6 months
• Current severely elevated high blood pressure

Thrombolytic therapy can be complicated by significant bleeding.

A cornerstone of therapy for a heart attack is antiplatelet medication. Such medication can prevent the collection of platelets at a site of injury in a blood vessel wall -- like a crack in an atherosclerotic plaque. Platelets collecting and accumulating is the initial event that leads to clot formation. One antiplatelet agent widely used is aspirin. Two other important antiplatelet medications are ticlopidine (Ticlid) and clopidogrel (Plavix).

OTHER MEDICATIONS

• Beta-blockers (like metoprolol, atenolol, and propranolol) are used to reduce the workload of the heart.
• ACE Inhibitors (like ramipril, lisinopril, enalapril, or captopril) to prevent heart failure.

SURGERY AND OTHER PROCEDURES

Emergency coronary angioplasty may be required to open blocked coronary arteries. This procedure may be used instead of thrombolytic therapy, or in cases where thrombolytics should not be used. Often the re-opening of the coronary artery after angioplasty is ensured by implantation of a small device called a stent. Emergency coronary artery bypass surgery (CABG) may be required in some cases.

The expected outcome varies with the amount and location of damaged tissue. The outcome is worse if there is damage to the electrical conduction system (the impulses that guide heart contraction).

Approximately one-third of cases are fatal. If the person is alive 2 hours after an attack, the probable outcome for survival is good, but may include complications.

Uncomplicated cases may recover fully; heart attacks are not necessarily disabling. Usually the person can gradually resume normal activity and lifestyle, including sexual activity.

• Arrhythmias such as ventricular tachycardia, ventricular fibrillation, heart blocks
• Congestive heart failure
• Cardiogenic shock
• Infarct extension: extension of the amount of affected heart tissue
• Pericarditis (infection around the lining of the heart)
• Pulmonary embolism (blood clot in the lungs)
• Complications of treatment (For example, thrombolytic agents increases the risk of bleeding.)