If you suspect either yourself, or someone you know, is having a heart attack, dial 999 immediately. Do not wait.
Most heart attacks can be successfully treated if immediate medical help is provided. The sooner the treatment, the more effective it will be, and the greater the chance of survival.
Treatment during a heart attack
Cardio-pulmonary resuscitation (CPR)
If someone is not breathing, coughing, moving, or responding to stimulation (being touched or spoken to), immediate lifesaving treatment with cardio-pulmonary resuscitation (CPR) should be started. CPR consists of giving 30 chest compressions to massage the heart for every two mouth-to-mouth resuscitation breaths.
If your heart has stopped (cardiac arrest), the medical team at the scene, or in hospital, will try to restart it using a device called a defibrillator. This sends an electric shock across your chest to kick-start your heart. The heart rhythm may become temporarily irregular as it recovers, so this treatment is best given when the heart is being continuously monitored on an electrocardiograph (ECG) in an ambulance, or in hospital.
Aspirin
If you are having a heart attack, you will normally be given a one-off 300mg dose of aspirin. This helps to prevent the blood clot in your coronary artery from getting bigger. Ideally, it should be chewed, or taken dissolved in water, to ensure that it gets into your bloodstream as quickly as possible.
Thrombolytics
Also known as 'clot-busters', thrombolytics dissolve the clot in your coronary artery, allowing blood to flow back to the damaged heart muscle. Commonly prescribed thrombolytics include alteplase and streptokinase.
During a heart attack, thrombolytics are given by injection as soon as possible, ideally within one hour of symptoms starting. The part of the heart muscle starved of blood does not die immediately. If blood flow is restored within a few hours, much of the heart muscle that would have been damaged will survive.
Morphine
Morphine is a strong type of painkilling medication. A dose of this medicine may be injected into your bloodstream to help ease pain and discomfort, and to reduce anxiety.
Treatment following a heart attack
Following a heart attack, you may need to take a number of different medicines. They will help to reduce the risk of a further heart attack occurring. You may need to take them indefinitely.
Anti-platelets
Anti-platelets help to reduce the 'stickiness' of platelets (tiny particles in blood that help it to clot). When a large number of platelets stick to an atheroma or plaque (fatty deposit) inside an artery, they can form a thrombosis (clot). If this happens in a coronary artery, it causes a heart attack.
Low dose aspirin is the preferred anti-platelet following a heart attack. You will normally be prescribed a 75mg dose to take once a day.
If you have a stomach ulcer, or asthma, you may not be able to take aspirin. Options if you have a stomach ulcer include taking an additional medicine to 'protect the stomach'. And, options if you have asthma include taking a different anti-platelet medicine such as clopidogrel.
Beta-blockers
Beta-blockers (such as metoprolol, propranolol, timolol, and atenolol) help to protect the heart after a heart attack. They make the heart beat slower and with less force in order to lessen the work it has to do. Beta-blockers also stabilise the heart's electrical activity.
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-converting-enzyme inhibitors (ACE) inhibitors open up your blood vessels and lower blood pressure, which help to ease the burden on your heart. They also help to protect your heart from further damage.
ACE inhibitors such as lisinopril, perindopril and ramipril are started at a low dose, which is slowly increased over a period of two to four weeks. Before you start taking an ACE inhibitor, you will normally have a blood test to check your kidneys are functioning normally. Seven to ten days after your first dose, your kidneys will be tested again. This is because ACE inhibitors can affect the kidneys of a small number of people who take them.
Statins
Statins help to lower your blood cholesterol level by preventing cholesterol from being made in your liver. Generally, the higher your blood cholesterol level, the greater your risk of developing plaques (fatty deposits) in your arteries. The aim is to reduce your total blood cholesterol level to less than 4mmol/l, or by 25% of the original blood level, whichever gives the greatest reduction. Commonly prescribed statins include atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin.
Surgery
After having a heart attack, if your heart has been seriously damaged, you may require surgery to treat it. Two of the most common surgical procedures are outlined below.
Angioplasty
Angioplasty is a type of surgery which opens up a coronary artery. It is usually carried out after you recover from your attack. However, in some specialist units, an angioplasty may be performed as an emergency treatment for people having a very serious heart attack.
A tiny wire with a sausage-shaped balloon at the end is put into a large artery in your groin, or arm. It is then passed through your blood vessels up to your heart and into the narrowed section of a coronary artery using X-ray guidance. The balloon is then inflated inside the narrowed part of the artery to widen it. A stent (a flexible metal mesh) is usually inserted into the artery to help keep it open.
Coronary artery bypass graft (CABG)
A coronary artery bypass graft (CABG) is a form of surgery which allows a blocked blood vessel to be bypassed with healthy blood vessel segments (grafts) taken from other parts of the body. Segments of vein from your legs, or chest, are used to create a new channel through which the blood can be directed past the blocked part of your artery. More blood can then get past into your heart muscle. However, not everyone with angina is suitable for this surgery as it depends on where the narrowed arteries are.
Carers
If you are looking after someone who is recovering from a heart attack and they need you to help them with their activities, Carers Direct can help you. On Carers Direct you can find out all about how to get help with caring for the person you look after, your legal and employment rights, and getting benefits on Carers Direct.
