Heart attack - Treatment 

Treating a heart attack 

Vinnie Jones: Hard and Fast - hands-only CPR

Watch Vinnie Jones perform hands-only CPR to the beat of Stayin' Alive. CPR is not as hard as you may think. Just call 999 and then push Hard and Fast. This video was produced by the British Heart Foundation

Cardiopulmonary resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is a first aid technique that can be used if you think that someone’s heart has stopped beating as the result of a heart attack (cardiac arrest).

Someone may have had a cardiac arrest if:

  • they appear to not be breathing
  • they are not moving
  • they do not respond to any stimulation, such as being touched or spoken to

CPR involves combining two techniques:

  • chest compressions
  • rescue breathing

Chest compression

To carry out a chest compression, place the heel of your hand at the centre of the person’s chest, in between their nipples. Place your other hand on top of your first hand and interlock your fingers. Using your body weight (not just your arms), press straight down (4-5cm) onto their chest.

Rescue breathing

To carry out rescue breathing, tilt the person’s head back and lift their chin up to open their airways. Pinch their nostrils closed and breathe into their mouth for one second. If their chest rises, give another breath. If their chest does not rise, tilt their head back and lift their chin again, before giving the second breath.

If you have received training in how to give CPR and you feel confident about performing the manoeuvre:

  • give 30 chest compressions
  • followed by two rescue breaths
  • before repeating the cycle

Aim to do the chest compressions at a rate of 100 compressions a minute.

If you have not been trained in CPR, do not attempt to perform rescue breathing because it is possible to damage the person’s airways if it is not performed correctly. Instead, focus on giving 100 chest compressions a minute.

The above advice only applies to adults. For information about how to perform CPR in children, see Birth to Five: how to resuscitate a child.

 

Your treatment plan

Your treatment plan will depend on the type of heart attack you have had. For example, if you have had an ST segment elevation myocardial infarction (STEMI), there are two treatment options:

  • a combination of medication to dissolve the blood clot and restore the flow of blood to the heart (this is known as thrombolysis)
  • surgery to widen the coronary artery, which is usually done using a technique called coronary angioplasty

If you have had a non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina, thrombolysis is usually recommended as the first treatment option.

If your symptoms do not improve, a coronary angioplasty can be carried out. These treatment options are discussed in more detail below.

STEMI

As STEMI is the most serious type of heart attack, it is important that it is treated quickly. Therefore, once the diagnosis has been confirmed, an immediate decision has to be made as to whether you are treated with surgery or thrombolysis.

Research has shown that surgery is the most effective treatment for STEMIs. However, a coronary angioplasty is a very complex type of surgery that requires specialist staff and equipment, and not all hospitals have the facilities needed to perform the surgery. However, by 2012, the Department of Health hopes to extend angioplasty services across England.

In most cases, surgery would only be the preferred option if it can be carried out within 90 minutes of you being admitted to hospital.

Thrombolysis is usually the preferred option if the facilities for surgery are not available and it would take longer than 90 minutes to transfer you to a hospital where surgery is available. This is because it may be too risky to delay treatment any longer.

Coronary angioplasty

During coronary angioplasty, a tiny wire with a sausage-shaped balloon at the end is put into a large artery in your groin or arm. The wire is passed through your blood vessels and up to your heart, using X-rays to guide it, before being moved into the narrowed section of your coronary artery.

Once in position, the balloon is inflated inside the narrowed part of the artery to open it wide. A stent (flexible metal mesh) is usually inserted into the artery to help keep it open afterwards.

CABG

Sometimes, a coronary angioplasty may not be technically possible if the anatomy of your arteries is different from normal. This may be the case if there are too many narrow sections in your arteries or if there are lots of branches coming off your arteries that are also blocked.

In such circumstances, an alternative surgical procedure, known as a coronary artery bypass graft (CABG), may be considered. CABG involves taking a blood vessel from another part of your body, usually your chest or leg, to use as a graft.

The graft replaces any hardened or narrowed arteries in the heart. A surgeon will attach the new blood vessel to the coronary artery above and below the narrowed area or blockage.

Thrombolysis

Thrombolysis involves giving you injections of a type of medication called thrombolytics. Thrombolytics target and destroy a substance called fibrin. Fibrin is a tough protein that makes up blood clots by acting like a sort of fibre mesh that hardens around the blood.

Thrombolytic medications that are used in the treatment of heart attacks include alteplase and streptokinase.

You may also be given additional blood-thinning medication, such as aspirin or heparin, to prevent further blood clots from developing.

Morphine

Morphine is a painkiller that is usually given to relieve the symptoms of chest pains and to reduce feelings of stress and anxiety.

NSTEMI and unstable angina

In cases of NSTEMI and unstable angina, medication is the first option to dissolve the blood clot and thin the blood to prevent further clotting.

You may also be given an additional medication called glycoprotein IIb/IIIa inhibitors if it is thought that you have an increased risk of experiencing another more serious heart attack.

Glycoprotein IIb/IIIa inhibitors do not break up blood clots in the same way as alteplase and streptokinase, but they prevent blood clots from getting bigger. They are, therefore, an effective method of stopping your symptoms getting worse.

Depending on how serious your symptoms are, how well you respond to treatment and your general state of health, further surgery may be recommended to widen your carotid artery. This will usually be done using a coronary angioplasty.


  • show glossary terms

Glossary

Cholesterol
Cholesterol is a fatty substance made by the body that is found in blood and tissue. It is used to make bile acid, hormones and vitamin D.
Platelet
Platelets are cells in the blood that control bleeding by plugging the broken blood vessel and helping the blood to clot.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Arteries
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Heart attack
A heart attack happens when there is a blockage in one of the arteries in the heart.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Angina
Angina is chest pain caused by a reduced flow of blood to the heart, typically resulting from heart disease.
Shock
Shock is a short-term state of body weakness that usually happens after an accident or injury. It is caused when there is an insufficient supply of oxygen.
Vein
Veins are blood vessels that carry blood from the rest of the body back to the heart.
Stomach
The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.
Blood test
During a blood test, a sample of blood is taken from a vein using a needle so it can be examined in a laboratory.
Heart
The heart is a muscular organ that pumps blood around the body.
Blood vessel
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.
Kidney
Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.
Dose
Dose is a measured quantity of a medicine to be taken at any one time.
ECG
An ECG (electrocardiogram) is a test that measures electrical activity in the heart and is used to identify heart problems. 
Ulcer
An ulcer is a sore break in the skin or on the inside lining of the body.
Coronary artery bypass
A heart (coronary) bypass is surgery to redirect the flow of blood around a clogged artery by creating a new pathway for the blood to travel in.
Coronary angioplasty
Coronary angioplasty is surgery to open up arteries in the heart that have been blocked or narrowed by fatty deposits.
Bypass
A bypass is when the flow of blood or other fluid is redirected, permanently because of a blockage in the body or temporarily during an operation.
Anxiety
Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.

Last reviewed: 17/03/2010

Next review due: 17/03/2012

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