Heart Attack

Treatment

Mayo Clinic uses a multidisciplinary approach to treat heart attack. Typically, patients progress through four phases of treatment. Each includes several members of the health care team.

• Diagnosis: Emergency department - fast diagnosis, preparation for treatment and rapid transfer to the cardiac catheterization laboratory. (Emergency department physicians and nurses)

• Treatment: Cardiac catheterization laboratory - cardiac angiogram and opening of arteries with balloon dilation and/or stent placement. (Interventional cardiologists, electrophysiologists)

• Recovery: Coronary Care Unit (CCU) - monitoring, evaluation and formulation of comprehensive, long-term rehabilitation plan. (Preventive cardiologists, nurses, social workers, physical therapists, occupational therapists and spiritual leaders)

• Rehabilitation: Cardiovascular rehabilitation program - implementation of rehabilitation and cardiac health plan, long-term follow-up. (Preventive cardiologists, exercise physiologists, dietitians, nicotine-dependence counselors)

During a Heart Attack

After diagnosis, heart attack patients at Mayo Clinic are rapidly transferred to the cardiac catheterization laboratory. After locating the blockage with a catheter (coronary angiogram,) interventional cardiologists have two options for opening the artery:

• Coronary angioplasty - Using a catheter that has been threaded to the heart through an artery in the patient's leg, the interventional cardiologist inserts a small balloon at the site of the blockage. The balloon is then expanded to push the vessel wall out. In some cases, a small wire tube (stent) is placed in the artery to keep it from closing again. Some patients are fitted with drug-coated stents, which are lined with a time-release medication to keep the artery open and healthy. Read more about heart catherterization.

• Coronary artery bypass surgery - When catheter-based interventions cannot be performed or angioplasty fails to open the blocked vessel, bypass surgery can create a detour for the blood to bypass the blockage. A short piece of blood vessel is taken from another location in the body (usually a leg vein) and is connected to the aorta on one end and, on the other, to the heart artery downstream of a blockage. Blood is rerouted through this "bypass" to nourish the heart. If more than one artery is blocked, each can be bypassed.

• Most heart attacks, at Mayo Clinic, are treated with cardiac catheterization and coronary angioplasty to open the blocked artery, and medications are sometimes also used to improve survival of heart muscle cells. Types of medications used include:

  • Antiplatelet agents and anticoagulants thin the blood and reduce the formation of blood clots in the arteries.

  • Beta-blockers make the heart's job easier by slowing its rhythm and decreasing blood pressure.

  • Pain relievers and nitroglycerin are administered to reduce pain and relieve discomfort during a heart attack.

• Thrombolytic Drugs - Thrombolytic drugs are potent medications which dissolve the blood clot in the coronary artery can also be used to treat acute heart attacks. These are most often used either in patient who present very early in the course of the attack or when they present to a hospital without expertise in angioplasty for acute heart attacks.

After a Heart Attack

Coronary Care Unit
After initial heart attack treatment in the cardiac catheterization laboratory, patients at Mayo Clinic are transferred to the Coronary Care Unit (CCU) for monitoring and evaluation. Here, medications may be prescribed to assist in the healing process and for long-term prevention of another heart attack. These medications may include cholesterol-lowering medications, angiotensin converting enzyme inhibitors (ACE inhibitors), beta-blockers and calcium channel blockers. The patient's preventive cardiologist will determine which medications are appropriate.

In addition, the preventive cardiologist will begin to formulate a personalized long-term rehabilitation plan, which is set up through the cardiovascular rehabilitation program.

Cardiovascular rehabilitation program
A heart attack patient's comprehensive rehabilitation plan may include:

• Blood pressure management. Blood pressure is a key indicator of heart health, and medications and/or lifestyle changes can help to maintain a healthy level.

• Lipid Management. Correction of high blood lipids especially cholesterol is an important part of a comprehensive rehabilitation plan.

• Blood Sugar Management. Long term management of elevate blood sugar or diabetes is a major piece of the comprehensive rehabilitation plan after a heart attack.

• Tobacco cessation. Tobacco use increases risk of heart problems dramatically. Mayo Clinic's state-of-the-art tobacco cessation program is one of the most successful of its kind, and tobacco cessation counselors can help patients quit.

• Exercise prescription. Having a specific exercise prescription is important for patients immediately after a heart attack. The plan should have safeguards so that patients don't overdo exercise at first, and also should include long-term recommendations for daily exercise to improve the heart's function and performance.

• Diet prescription. Recovery from a heart attack is easier and faster when certain foods are avoided, such as salt, "bad" fats like saturated or trans fats, and cholesterol. Likewise, other foods are typically recommended for a quick recovery and long-term health, such as "good" fats like monounsaturated or polyunsatruated fats, and foods containing antioxidants.

• Stress management. Stress reduction helps lower blood pressure and the work required of the heart.