Health A-Z

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Harvard Medical School



The treatment of a heart attack depends on how stable the person's condition is and his or her immediate risk of death. Usually, the doctor will give the patient an aspirin and often other medicines that help prevent unwanted blood clotting in the coronary arteries.

The person also will be given oxygen to breathe, pain medication (usually morphine) for chest pain, beta-blockers to reduce the heart's demand for oxygen, nitroglycerin to help blood flow into heart muscle cells, and aspirin to prevent blood clotting. The person may be started on heparin in addition to aspirin for more potent anti-clotting action.

While in the hospital, patients often are given daily beta-blockers, ACE (angiotensin-converting enzyme) inhibitors, which help the heart work more efficiently, primarily by lowering blood pressure, and aspirin. Most heart attack patients also are given a prescription for a cholesterol-lowering medication.

If the diagnosis of heart attack is certain, then the patient will be considered for reperfusion therapy. The goal is to restore blood flow to the injured heart muscle as soon as possible to limit permanent damage.

Reperfusion is best done mechanically. The patient is taken to the cardiac catheterization laboratory in the hospital and a catheter is threaded through a large blood vessel toward the heart. Dye is injected to locate the blockage in the coronary artery.

The next step is percutaneous transluminal coronary angioplasty (PTCA). In PTCA, a different catheter that has a small deflated balloon is threaded past the blockage, and the balloon is inflated to crush the clot and plaque. Most balloon catheters also have a wire mesh, called a stent, over the balloon. After the balloon is inflated to unclog the blocked artery, the stent remains in place to keep the artery open.

In addition to aspirin, a second anti-platelet drug is given. The ones used most commonly are clopidogrel (Plavix, generic versions), prasugrel (Effient) and ticagrelor (Brilinta).

Reperfusion therapy can also be done with clot-dissolving drugs called thrombolytic agents, such as tissue plasminogen activator (tPA). This drug is used if it would take too long to transfer a patient to a hospital where an angioplasty could be performed.

Much of the additional treatment for heart attack depends on whether the patient developed any complications. For example, additional drugs may be needed to treat dangerous cardiac arrhythmias (abnormal heartbeats), low blood pressure, and congestive heart failure.

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