What're the treatments available to cure heart attack?
The primary goal of treatment is to quickly open the blocked artery and restore blood flow to the heart muscle, a process called reperfusion. Once the artery is open, damage to heart muscle ceases, and the patient becomes pain free. By minimizing the extent of heart muscle damage, early reperfusion preserves the pumping function of the heart. Optimal benefit is obtained if reperfusion can be established within the first 4-6 hours of a heart attack. Delay in establishing
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reperfusion can result in more widespread damage to heart muscle and a greater reduction in the ability of the heart to pump blood. Patients with hearts that are unable to pump sufficient blood develop heart failure, decreased ability to exercise, and abnormal heart rhythms. Thus, the amount of healthy heart muscle remaining after a heart attack is the most important determinant of the future quality of life and longevity.
The heart may develop irregular heart rhythms (arrhythmias) or stop beating (sudden cardiac arrest) during a heart attack. When the heart is unable to pump blood throughout the body, brain damage and death can occur within minutes. Emergency medical personnel can quickly assess the situation and may perform an electrocardiogram (ECG) to measure electrical activity in the heart. If the patient is in cardiac arrest, or is experiencing an abnormal heart rhythm, a device called a defibrillator may be used to "shock" the heart into a normal rhythm.
Emergency medical personnel also can administer medications and begin treatments immediately that can help dissolve a blood clot and open a blocked coronary artery, restoring normal blood flow to the heart. If these therapies are initiated within 1 hour of the onset of symptoms, less irreparable damage may occur. Even before emergency personnel arrive, cardiopulmonary resuscitation (CPR) can be performed if the patient has no pulse and a capable bystander is present. Automated external defibrillators designed for CPR are available in some public places (e.g., airports, shopping malls, large office buildings). Defibrillators also are available without a prescription for home use.
Drugs. Taking an aspirin during a heart attack and each day following a heart attack can decrease the risk of dying from the condition by almost 25%. Blood clots primarily are composed of platelets (microscopic particles that circulate in the bloodstream) that "stick" to ruptured plaques and to each other. Aspirin makes platelets less "sticky," decreasing the risk for further blood clot formation. Beta-blockers slow the heart rate and decrease the strength of the heart's contractions, reducing strain on the heart and its oxygen requirement. Nitroglycerin is a chemical that opens up (dilates) arteries and veins and increases blood flow to the heart. During heart attack, nitroglycerin can be placed under the tongue, where it quickly dissolves and is absorbed into the bloodstream. Nitroglycerin also can be administered via continuous intravenous (IV) infusion; applied to the skin in cream or patch form, where it is slowly absorbed; or administered as short- or long-acting nitrate pills. Isosorbide dinitrate (Isordil? usually is taken 3 times a day and isosorbide mononitrate (Ismo? Imdur? is taken either twice (Ismo) or once daily (Imdur). IIb/IIIa Inhibitors help to prevent platelets from sticking together and forming blood clots. They also help dissolve existing blood clots. Studies show that treatment with IIb/IIIa inhibitors can reduce the risk for recurrent heart attack or death.
Coronary angioplasty, or balloon angioplasty. In this procedure, a fine tube, or catheter, is threaded through an artery into the narrowed heart vessel. The catheter has a tiny balloon at its tip which is inflated and deflated to open and stretch the artery. This is done to improve blood flow, after which the balloon and tube are removed. Coronary angioplasty is performed in a catheterization laboratory (cath lab), under sedation and a local anesthetic. An iodine-based dye or other contrast agent is injected to make the arteries and blockage(s) visible on a monitor. Physicians use a monitor as a guide during the procedure. During coronary angioplasty, the coronary arteries are accessed through a small incision made in the femoral artery, located in the groin, or the brachial artery, located in the arm. In most cases, the femoral artery is used. A pencil-sized plastic sheath is inserted through the artery and flexible catheters are passed through the sheath to the blocked coronary artery. Then, a device such as an ultra-thin wire, tiny balloon, or a small metal spring-like device called a stent, is used to stretch open the blocked artery.
Stents. Stents are often inserted during angioplasty to help keep the artery open. A stent may also be used without angioplasty. Basically, a stent is a wire mesh tube that's permanently inserted into an artery to help keep it from closing up again. Even with a stent, however, an artery can reclose, requiring either another angioplasty or a bypass. NHLBI says this is especially common for people with diabetes or unstable angina. The new re-narrowing is called in-stent restenosis. AHA says the use of stents, coated with drugs to help keep the vessel from closing, can help to reduce this risk. Brachytherapy can also be used, according to FDA. It is a procedure in which radioactive material is placed into the body. After initial opening of the in-stent restenosis blockage with a balloon catheter (PTCA), a brachytherapy device is temporarily placed at the site of the in-stent restenosis. FDA says the radiation treatment prevents an exaggerated healing response at the lesion site and a recurrence of a significant blockage.
Bypass surgery. In this procedure, a piece of vein is taken from the leg, or a piece of an artery is taken from the chest or wrist, and then attached to the heart artery above and below the narrowed area, thus creating a "bypass" around the blockage. In many cases, besides fixing the artery that is blocked, the surgeon will fix additional arteries on the heart that are starting to look blocked. The number of arteries repaired becomes the name of the procedure. For example, if the surgeon repairs three of the arteries, it is called a triple bypass. If four arteries are repaired, it's a quadruple bypass. NHLBI says bypass can be the preferred procedure for some patients and is also appropriate when angioplasty hasn't been successful, or when the blockage can't be reached by angioplasty. Sometimes, more than one bypass operation is needed. A bypass also can close again. This happens in more than 10 percent of bypass surgeries, usually after 10 or more years. |
