Treatment for Heart Attacks

What is a heart attack?

A heart attack is a serious medical condition. The heart is surrounded by blood vessels, called the coronary arteries. During a heart attack, one or more of these blood vessels becomes narrowed or blocked. This blockage stops blood from getting to the heart, which means the heart is not getting enough of the oxygen and nutrients that it needs to keep pumping. This damages the part of the heart that isn’t getting blood, causing the symptoms and complications of heart attacks.

There are a number of treatments and procedures available to people who get heart attacks, both in the hospital and beyond. Here’s a guide to treating heart attacks, including immediate and long-term treatment, as well as prevention tips.

How to know if you are having a heart attack

A number of symptoms are associated with heart attacks. Most people who have a heart attack will have common symptoms, such as chest pain. However, some people might have symptoms that are less common.

Chest pain is the most common symptom of a heart attack. Usually, the chest pain associated with a heart attack has certain “classic” features:

• Feels like pressure 

• Worsens with activity

• Located in the middle of your chest

• Travels into your arms, neck, or jaw

Some other symptoms may occur along with chest pain. These are also considered classic symptoms:

• Sweating

• Nausea

• Shortness of breath

• Abdominal pain

• Passing out

Some people, especially women or people with diabetes, might not have classic symptoms. They are more likely to have less common symptoms, including:

• Shortness of breath without chest pain

• Stabbing-type chest pain

• Unexplained weakness or fatigue

• Indigestion 

It’s important that you get to a hospital right away if you’re worried you might be having a heart attack. If your symptoms point to a heart attack, you might undergo some tests and studies to confirm what’s going on. These tests can include:

• Electrocardiogram (ECG): This is a tracing of the electrical activity of the heart. It can give clues that you are having a heart attack. In some situations, the ECG might show signs of a severe heart attack that will require an emergent procedure.

• Blood work: This can help diagnose a heart attack. A blood test that looks for troponin, a protein in the blood, can give evidence of damage to the heart. Although you can have a high troponin level for other reasons, it often means that you are having a heart attack. Additional blood work may be done to check for other causes of chest pain.

• Chest X-ray and other imaging studies: These may be done to check for other causes of chest pain, such as an infection in the lungs. 

• Cardiac catheterization: If initial testing shows that you’re having a heart attack, or it indicates that you very likely have a blocked vessel, a cardiologist will probably perform a procedure called cardiac catheterization. In this test, a cardiologist inserts a small wire into a blood vessel in your wrist or groin. They feed the wire up to your heart, where they inject contrast dye into the vessels. An X-ray machine helps them see narrowed or blocked blood vessels in your heart.

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These tests are usually done quickly, so the care team can figure out what’s going on and start treatment as soon as possible. Time is of the essence in a heart attack — the sooner treatment can start, the better. 

Giving first aid for a heart attack

If you encounter someone who you think might be having a heart attack, give first aid and act quickly. Here are some basic steps:

• Call 911 immediately. 

• Try not to move the person, unless they are in immediate danger from the environment around them.

• If they are awake, try giving them aspirin — either a 325 mg tablet or four 81 mg baby aspirin tablets. If you don’t think they can swallow the pills, or if you think there might be something other than a heart attack going on, it’s best to wait for emergency responders to arrive. They can decide whether or not to give aspirin.

• If you’re trained to perform CPR, be ready to start in case the person becomes unresponsive. If there is an AED nearby, and you are trained to use it, get it ready so you can use it quickly if needed.

The most important part is calling for help, so the person having the heart attack can receive medical attention as soon as possible.

Treatment options for heart attacks

Several procedures and medications may be needed if you are having a heart attack. Physicians follow clinical practice guidelines that are based on the current scientific evidence, and your symptoms and test results will determine your treatment. Treatment may also be affected by which providers and treatments are available at your hospital. Here’s a breakdown of possible heart attack treatments, starting with the most immediate. 

One of the following three treatments may be performed to address a blockage that is found or is suspected to be in the coronary arteries.

Angioplasty (cardiac stent)

Because a heart attack is due to a blocked blood vessel in the heart, a common treatment for heart attacks is a cardiac stent. This is a small metal object that acts like a brace to open a blocked blood vessel, to keep blood flowing toward the heart. 

Stents are placed during cardiac catheterization. If your cardiologist finds a blockage that is causing a heart attack, they will use the wire to place a stent through the blockage to open up the blood vessel.

Bypass surgery

Coronary artery bypass grafting (CABG) is a major surgery that people with more serious heart disease might need. A surgeon will take a blood vessel (graft) from your chest or your legs and use it to redirect (bypass) blood from other blood vessels to the parts of the heart that need it. 

Bypass surgery is done if the blockage causing the heart attack doesn’t open with a stent or can’t be fixed with a stent. Usually, you’ll get a cardiac catheterization before CABG. If that doesn’t work, CABG is often the next step.

Fibrinolytics

In some situations, you might need medications that break up the blockages in your coronary arteries. If you need a catheterization but aren’t near a hospital where one can be done, you may need medication that will break up any blood clots causing a blockage. Examples of these medicines are tenecteplase and tPA, which are given through an IV. There is a risk of bleeding when getting these medications.

Heart attack medications

It’s important to address the blockage that is causing the heart attack, but additional treatments will be recommended for other reasons. These medications improve pain, prevent blockages in arteries from getting worse, and reduce the amount of work that the heart has to do.

Oxygen

Because your heart needs oxygen to function, you might need extra (“supplemental”) oxygen if you are having a heart attack. Supplemental oxygen is given through a tube into your nose or a mask over your nose and mouth.

Morphine

Treating pain is important for people who are having a heart attack. Morphine is one of the first medicines that most providers will use to treat heart attack pain. 

Nitroglycerin

Nitroglycerin is a medication that can reduce pain. It can be given: 

• As a pill that dissolves under your tongue

• As a paste

• As an oral spray

• Through an IV 

Antiplatelet therapies

Blood-thinning medications

Beta blockers

Calcium channel blockers

Long-term medications after heart attack treatment

Some medications may be recommended for long-term use after you’ve had a heart attack. Studies have shown that these medications can improve overall outcomes and decrease your risk for having another heart attack in the future. These medications may include some of the treatments listed above, as well as some of the ones listed below.

Cholesterol management

Because high cholesterol contributes to blocked arteries, lowering cholesterol is important for people who’ve had a heart attack.

You may have heard of a class of medications called “statins,” which lower cholesterol. The most recommended medicine after a heart attack is atorvastatin (Lipitor), because it more effectively lowers cholesterol than do other statin medicines.

Common side effects of atorvastatin are muscle aches, joint aches, and diarrhea.

ACE inhibitors and angiotensin receptor blockers

Recovery after heart attack 

If you had a heart attack, you might be overwhelmed, or even scared. You’ve already been through a lot, but it can help to start focusing on recovering from your heart attack. 

There are some steps you can take after a heart attack to protect your heart and prevent more heart attacks afterward.

Exercise

Exercise is important after a heart attack. Many people will participate in cardiac rehabilitation, which is a supervised exercise program. Check with your provider about when you should exercise and what exercises you should do, because it’s important to protect your heart as you get started. 

Here are some general guidelines for when to start activity after a heart attack:

• You can begin doing light activities, like daily walking, almost right away.

• You can start aerobic exercise in 1 to 2 weeks.

• It’s a good idea to wait 2 to 4 weeks before beginning resistance exercises.

Managing risk factors

Because some medical conditions put you at higher risk of having a heart attack, it’s important to keep these under control as much as possible. Be sure to speak with your healthcare provider about this if you’re unsure or have questions. Examples are:

• High blood pressure

• High cholesterol

• Diabetes

If you smoke, quitting is really important because smoking puts you at risk of more heart attacks in the future.

Eating a healthy diet is also important. The Mediterranean and DASH (dietary approaches to stop hypertension) diets are often recommended to people who have had heart attacks. This is because they include more healthy fats, vegetables, and fruits. They often limit things like salt, sugar, and processed meats, which are known to contribute to heart attack risk factors like high blood pressure.

Heart-healthy diets tend to include the following:

• Fruits and vegetables

• Whole grains

• Low-fat dairy

• Lean meats, like chicken and turkey

• Beans

• Nuts

Heart-healthy diets usually limit these:

• Sweets and sugary beverages

• Red meat

• Processed foods

• Salt 

You can speed your recovery from a heart attack and help prevent another one by living a heart-healthy lifestyle. This includes exercising, eating a healthy diet, and avoiding smoking. This also means seeing your healthcare providers regularly and taking your medications as prescribed. If you are having trouble with your medications for any reason — such as cost or side effects — be sure to reach out to your provider. 

Preventing heart attacks

Preventing heart attacks is similar to how you would care for yourself after a heart attack. Living a generally healthy lifestyle and getting treatment for your medical conditions that put you at risk for heart attacks can help prevent them from happening in the first place. Here are some general tips:

• Exercise daily

• Keep a healthy weight

• Avoid smoking

• Get checked for diabetes, high cholesterol, and high blood pressure

Why trust our experts?

Written by:

Michael Dreis, MD

Dr. Dreis is an emergency medicine physician currently practicing in Milwaukee, Wisconsin. He went to medical school at the University of Wisconsin – Madison and completed his residency at Henry Ford Hospital in Detroit, Michigan.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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