There are two main treatment options for people with the most serious form of heart attack; a ST segment elevation myocardial infarction (STEMI):
- 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
Angioplasty or thrombolysis?
If the results of your electrocardiograph (ECG) indicate that you have had a STEMI then an angioplasty is normally recommended as the first-line treatment.
(See diagnosing heart attacks for more information about ECG results).
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. So you will need to be taken urgently, by ambulance, to one of the specialist centres (Heart Attack Centres) that now serve most regions of the UK.
If you do have a STEMI but it is likely that you would have to wait longer than 150 minutes for a coronary angioplasty then you may be treated with thrombolysis as an alternative.
If the results of your ECG show you have a ‘less serious’ type of heart attack (which is known as a non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina), then blood-thinning medication including aspirin and other medications is usually recommended.
In some cases, further treatment with coronary angioplasty or coronary artery bypass graft (see below for more information) may be recommended in cases of NSTEMI or unstable angina, after initial treatment with these medications.
Coronary angioplasty
During coronary angioplasty, a tiny tube known as a catheter, with a sausage-shaped balloon at the end, is put into a large artery in your groin or arm. The catheter is passed through your blood vessels and up to your heart, over a fine guidewire, 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.
Read more about coronary angioplasties.
Thrombolysis
Thrombolysis involves giving you injections of a type of medication called a thrombolytic.
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 used in the treatment of heart attacks include reteplase, alteplase and streptokinase.
You may also be given a combination of additional blood-thinning medication, such as low-dose aspirin, heparin, fondaparinux, enoxaparin, clopidogrel, prasugrel or ticagrelor to prevent further clots from developing.
(If you are allergic to aspirin, alternatives such as clopidogrel, prasugrel or ticagrelor may be used without it).
You may also be given an additional medication called a glycoprotein IIb/IIIa inhibitor if it is thought you have an increased risk of experiencing another heart attack at some point in the near future.
Glycoprotein IIb/IIIa inhibitors do not break up blood clots in the same way as thrombolytics, but they prevent blood clots from getting bigger. They are, therefore, an effective method of stopping your symptoms getting worse.
Coronary artery bypass graft
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.
