Treatment of a Heart Attack

Treatment for a heart attack

Understandably, treatment for those diagnosed with heart attack can be complex. But this section on heart attack treatments will help you talk with your doctors and healthcare providers.

As you learn about your treatment plan, don’t be afraid to ask questions. Be sure to voice any concerns you may have.

Common heart attack types and treatments

The type of heart attack (also called myocardial infarction, or MI) you experienced determines the treatments that your medical team will recommend. A heart attack occurs when a blockage in one or more coronary arteries reduces or stops blood flow to the heart, which starves part of the heart muscle of oxygen.

The blockage might be complete or partial:

• A complete blockage of a coronary artery means you suffered a “STEMI” heart attack or ST-elevation myocardial infarction.
• A partial blockage is an “NSTEMI” heart attack or a non-ST-elevation myocardial infarction

Treatments differ for a STEMI versus NSTEMI heart attack, although there can be some overlap.

Hospitals commonly use techniques to restore blood flow to part of the heart muscle damaged during a heart attack:

• You might receive clot-dissolving drugs (thrombolysis), balloon angioplasty (PCI), surgery or a combination of treatments.
• About 36 percent of hospitals in the U.S. are equipped to use a procedure called percutaneous coronary intervention (PCI), a mechanical means of treating heart attack. 

At a hospital equipped to administer PCI, you would likely be sent to a department that specializes in cardiac catheterization, sometimes called a “cath lab.” There, a diagnostic angiogram can examine blood flow to your heart and reveal how well your heart is pumping. Depending on the results of that procedure, you may be routed to one of three treatments: medical therapy only, PCI or coronary artery bypass grafting (CABG).

A hospital that not equipped to perform PCI might transfer you to one that is. Or, your medical team may decide to administer drugs known as fibrinolytic agents to restore blood flow. You might be given an angiography (an imaging technique used to see inside your arteries, veins and heart chambers), possibly followed by an invasive procedure called revascularization to restore blood circulation in your heart.

If the hospital determines you had an NSTEMI heart attack, doctors typically use one of two treatment strategies. Both may involve a test called cardiac catheterization to examine the inside of your heart:

• The ischemia-guided strategy uses various drugs (antiplatelet agents and anticoagulants) to inhibit blood clot formation.
• The early invasive strategy will start with the use of various drugs (antiplatelet agents and anticoagulants) to inhibit blood clot formation, but might also proceed to a medical therapy, a PCI with stenting or coronary artery bypass grafting (CABG), followed by certain types of post-hospital care.

Your doctor and other members of your healthcare team can explain the approach to your heart attack treatment. They can answer any specific questions you might have.

Common heart attack treatments

You’ll find many common heart attack treatments listed here. For more detailed explanations of these treatments, see our page devoted to cardiac procedures.

• Angioplasty: Special tubing with an attached deflated balloon is threaded up to the coronary arteries.
• Angioplasty, Laser: Similar to angioplasty except that the catheter has a laser tip that opens the blocked artery.
• Artificial heart valve surgery: Replaces an abnormal or diseased heart valve with a healthy one.
• Atherectomy: Similar to angioplasty except that the catheter has a rotating shaver on its tip to cut away plaque from the artery.
• Bypass surgery: Treats blocked heart arteries by creating new passages for blood to flow to your heart muscle.
• Cardiomyoplasty: An experimental procedure in which skeletal muscles are taken from a patient’s back or abdomen.
• Heart transplant: Removes a diseased heart and replaces it with a donated healthy human heart.
• Minimally invasive heart surgery: An alternative to standard bypass surgery.
• Radiofrequency ablation: A catheter with an electrode at its tip is guided through the veins to the heart muscle to destroy carefully selected heart muscle cells in a very small area.
• Stent procedure: A stent is a wire mesh tube used to prop open an artery during angioplasty.
• Transmyocardial revascularization (TMR): A laser is used to drill a series of holes from the outside of the heart into the heart’s pumping chamber.

In addition to the above treatments, you might hear about implantable medical devices being used to treat certain heart attacks.

Types of medications

Heart attack treatment involves a variety of drugs. The list below provides a quick overview of the common types. You can also learn about cardiac medications in more detail.

Your doctor will recommend the best combination of heart attack medications for your situation.

• Anticoagulant: Used to treat certain blood vessel, heart and lung conditions.
• Antiplatelet agent: Keeps blood clots from forming by preventing blood platelets from sticking together.
• Angiotensin-converting enzyme (ACE) inhibitor: Expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows blood to flow more easily and makes the heart’s work easier or more efficient.
• Angiotensin II receptor blocker: Rather than lowering levels of angiotensin II (as ACE inhibitors do) angiotensin II receptor blockers prevent this chemical from having any effects on the heart and blood vessels. This keeps blood pressure from rising.
• Angiotensin receptor neprilysin inhibitor: Neprilysin is an enzyme that breaks down natural substances in the body that open narrowed arteries. By inhibiting neprilysin, those natural substances can have their normal effect. That improves artery opening and blood flow, reduces sodium (salt) retention and decreases strain on the heart.
• Beta blocker: Decreases the heart rate and cardiac output, which lowers blood pressure and makes the heart beat more slowly, with less force.
• Combined alpha and beta blocker: Combined alpha and beta blockers are used as an IV drip for those patients experiencing a hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the patient is at risk for heart failure.
• Calcium channel blocker: Interrupts the movement of calcium into the cells of the heart and blood vessels. May decrease the heart’s pumping strength and relax the blood vessels.
• Cholesterol-lowering medications: Various medications can lower blood cholesterol levels, but statins are the best first course of action. When statins prove ineffective, or if a patient experiences serious side effects from statin therapy, other drugs may be recommended.
• Digitalis preparation: Increases the force of the heart’s contractions, which can be beneficial in heart failure and for irregular heartbeats.
• Diuretics: Cause the body to rid itself of excess fluids and sodium through urination. Help to relieve the heart’s workload. Diuretics also decrease the buildup of fluid in the lungs and other parts of the body, such as the ankles and legs. Different diuretics remove fluid at varied rates and through different methods.
• Vasodilator: Relaxes blood vessels and increases the supply of blood and oxygen to the heart while reducing its workload. Available as pills to be swallowed, chewable tablets and as a topical application (cream).

Dual Antiplatelet Therapy (DAPT)

Some patients who have heart attacks, that have stents placed in their coronary arteries, or undergo coronary artery bypass graft surgery (CABG) are treated with two types of antiplatelet agents at the same time to prevent blood clotting. This is called dual antiplatelet therapy (DAPT).

One antiplatelet agent is aspirin. Almost everyone with coronary artery disease, including those who have had a heart attack, stent, or CABG are treated with aspirin for the rest of their lives. A second type of antiplatelet agent, called a P2Y₁₂ inhibitor, is usually prescribed for months or years in addition to the aspirin therapy.

The type of medication and the duration of your treatment will vary based on your condition and other risk factors. The risks and benefits of DAPT should be discussed with your health care provider.

If you had a heart attack and a coronary artery stent placed, or you are being treated with medical therapy (no stent, clot buster or surgery), in addition to aspirin, you should also be on a P2Y₁₂ inhibitor for 6-12 months. In some cases, it may be advisable to be on DAPT longer. This will need to be discussed with your healthcare provider. The three P2Y₁₂ inhibitors currently available that could be prescribed are clopidogrel, prasugrel, and ticagrelor. Studies have shown that two of these drugs (ticagrelor, prasugrel) are “stronger” than clopidogrel, and are a little better at decreasing the complications of blood clots. These two stronger agents, however, slightly increase bleeding. One of these drugs (prasugrel) should not be used by patients who have had a stroke or a transient ischemic attack (TIA). You will be prescribed the drug that is best for you, based on your risk of blood clots and bleeding. For example, according to the FDA(link opens in new window), clopidogrel does decrease the risk of stroke and MI, but does not change the risk of death for specific patients. The choice of what type of medication, cost of the medication and duration of treatment will be determined in discussions with your health care provider.