Treatment of a Heart Attack

Updated:Jan 11,2018

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This is an introduction to the common treatments you may experience following diagnosis as a heart attack patient. Heart attack treatment is obviously a complex process, but this basic primer will help you talk with your doctors and other healthcare providers about your own needs and questions.

What We Will Cover

  • Typical types of heart attack and treatments
  • Types of drugs

Common Heart Attack Types & Treatments
The type of heart attack (also called myocardial infarction, or MI) you experienced determines the treatments your medical team will choose.  A heart attack occurs when a blockage in one or more coronary arteries reduces or stops blood flow to the heart, which starves part of the heart muscle of oxygen.

The blockage might be complete or partial.

  • A complete blockage of a coronary artery means you suffered a ‘STEMI’ heart attack — which stands for ST-elevation myocardial infarction.
  • A partial blockage would be an ‘NSTEMI’ heart attack — a non-ST-elevation myocardial infarction.

IMPORTANT: Always dial 911 if you think you might be having a heart attack. The EMS crew in your ambulance will route you to the right hospital based on your location.

Treatments differ for a STEMI versus NSTEMI heart attack, although there can be some overlap. Hospitals commonly use techniques to restore blood flow to part of the heart muscle damaged during a heart attack.

  • You might receive clot-dissolving drugs (thrombolysis), balloon angioplasty, surgery, or a combination of treatments.
  • About 36% of hospitals in the U.S. are equipped to use a procedure called percutaneous coronary intervention (PCI), a mechanical means of treating heart attack.  

At a hospital that uses PCI, you would likely be sent to the department that specializes in cardiac catheterization (usually called a cath lab) for a diagnostic angiogram to examine blood flow to your heart and test how well the heart is pumping. Depending on the results of that procedure, you may be routed to one of three treatments: medical therapy only; PCI; or coronary artery bypass grafting (CABG).

A hospital that does not use PCI might transfer you to one that does. Or, it may decide to administer drugs known as fibrinolytic agents to restore blood flow. You might be given an angiography (an imaging technique used to see inside your arteries, veins and heart chambers), possibly followed by an invasive procedure called revascularization to restore blood circulation in your heart.

If the hospital determines you had an NSTEMI heart attack, doctors typically use one of two treatment strategies. One is called an ‘ischemia-guided strategy’, the other an ‘early invasive strategy’. Both may involve a test called cardiac catheterization to examine the inside of your heart.

  • The ischemia-guided strategy uses various drugs (antiplatelet agents and anticoagulants) to inhibit blood clot formation.
  • The early invasive strategy will start with the use of various drugs (antiplatelet agents and anticoagulants) to inhibit blood clot formation, but might also proceed to a medical therapy, a PCI with stenting, or coronary artery bypass grafting (CABG), followed by certain types of posthospital care.

If that all sounds complicated, you’re right — it is! We don’t want to subject you to information overload. But we do want to give you an overview that helps you have an informed discussion with your doctors. They can explain in appropriate detail what treatments they’re using for your particular condition, and answer any specific questions you might have.

Here is a list of many common heart attack treatments. For more detailed descriptions and explanations of these treatments, see our Cardiac Procedures page.

  • Angioplasty: Special tubing with an attached deflated balloon is threaded up to the coronary arteries.
  • Angioplasty, Laser: Similar to angioplasty except that the catheter has a laser tip that opens the blocked artery.
  • Artificial Heart Valve Surgery: Replaces an abnormal or diseased heart valve with a healthy one.
  • Atherectomy: Similar to angioplasty except that the catheter has a rotating shaver on its tip to cut away plaque from the artery.
  • Bypass Surgery: Treats blocked heart arteries by creating new passages for blood to flow to your heart muscle.
  • Cardiomyoplasty: An experimental procedure in which skeletal muscles are taken from a patient's back or abdomen.
  • Heart Transplant: Removes a diseased heart and replaces it with a donated healthy human heart.
  • Minimally Invasive Heart Surgery: An alternative to standard bypass surgery.
  • Radiofrequency Ablation: A catheter with an electrode at its tip is guided through the veins to the heart muscle to destroy carefully selected heart muscle cells in a very small area.
  • Stent Procedure: A stent is a wire mesh tube used to prop open an artery during angioplasty.
  • Transmyocardial Revascularization (TMR): A laser is used to drill a series of holes from the outside of the heart into the heart's pumping chamber.

In addition to the above treatments, you might hear about implantable medical devices being used to treat certain heart attacks.We devote a page to these devices here.

Types of Drugs
Heart attack treatment involves a variety of drugs. The list below provides a quick overview of the common types. See more details on our cardiac medications page. Your doctor will decide the best treatment combination for your situation.

  • Anticoagulant: Used to treat certain blood vessel, heart and lung conditions.
  • Antiplatelet agent: Keeps blood clots from forming by preventing blood platelets from sticking together.
  • Angiotensin-converting enzyme (ACE) inhibitor: Expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows blood to flow more easily and makes the heart's work easier or more efficient.
  • Angiotensin II receptor blocker: Rather than lowering levels of angiotensin II (as ACE inhibitors do) angiotensin II receptor blockers prevent this chemical from having any effects on the heart and blood vessels. This keeps blood pressure from rising.
  • Angiotensin receptor neprilysin inhibitor: Neprilysin is an enzyme that breaks down natural substances in the body that open narrowed arteries. By limiting the effect of neprilysin, it increases the effects of these substances and improves artery opening and blood flow, reduces sodium (salt) retention, and decreases strain on the heart.
  • Beta blocker: Decreases the heart rate and cardiac output, which lowers blood pressure and makes the heart beat more slowly and with less force.
  • Combined alpha and beta blocker: Combined alpha and beta-blockers are used as an IV drip for those patients experiencing a hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the patient is at risk for heart failure.
  • Calcium channel blocker: Interrupts the movement of calcium into the cells of the heart and blood vessels. May decrease the heart's pumping strength and relax blood vessels.
  • Cholesterol-lowering medication: Various medications can lower blood cholesterol levels, but drug other than statins should only be used for patients in whom statins are not effective enough or who have serious side effects due to statin therapy.
  • Digitalis preparation: Increases the force of the heart's contractions, which can be beneficial in heart failure and for irregular heartbeats.
  • Diuretic: Causes the body to rid itself of excess fluids and sodium through urination. Helps to relieve the heart's workload. Also decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles and legs. Different diuretics remove fluid at varied rates and through different methods.
  • Vasodilator: Relaxes blood vessels and increases the supply of blood and oxygen to the heart while reducing its workload. Can come in pills to be swallowed, chewable tablets and as a topical application (cream).

Dual Antiplatelet Therapy (DAPT)
Patients who have had heart attacks, patients who are treated with stents in their coronary arteries, and some patients who undergo coronary artery bypass graft surgery (CABG) are treated at the same time with two types of antiplatelet agents to prevent blood clotting. This is called dual antiplatelet therapy (DAPT).

One antiplatelet agent is aspirin. Almost everyone with coronary artery disease, including those who have had a heart attack, stent, or CABG are treated with aspirin for the rest of their lives. A second type of antiplatelet agent, called a P2Y12 inhibitor, is usually prescribed for months or years in addition to the aspirin therapy.

The type of medication and the duration of your treatment will vary based on a discussion with your healthcare provider weighing the risks of potential bleeding complications.

If you had a heart attack and a coronary artery stent placed, or you are being medically managed for your heart attack (specifically non-ST elevation myocardial infarction (NSTEMI), you should also be on a P2Y12 inhibitor for approximately 6-12 months. In some cases, it may be advisable to be on DAPT for a longer duration.  This will need to be discussed with your healthcare provider. There are three P2Y12 inhibitors that doctors prescribe, which are clopidogrel, prasugrel, and ticagrelor.  Studies have shown that two of these drugs (ticagrelor, prasugrel) are “stronger” than clopidogrel, and are a little better at decreasing the complications of blood clots. These two stronger agents, however, slightly increase bleeding. One of these drugs (prasugrel) should not be used by patients who have had a stroke or a transient ischemic attack (TIA). Which one these medications your doctor prescribes will be based on what he or she feels is best for you, based on your risk of blood clots and bleeding. For example, according to the FDA, clopidogrel does decrease the risk of stroke and MI, but does not change the risk of death for specific patients. Ultimately, the type of medication and duration of treatment will be determined in conjunction with your healthcare provider.

This content was last reviewed March 2017.


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