What is the first line treatment for a patient with a myocardial infarction?
Understandably, treatment for those diagnosed with heart attack can be complex. But this section on heart attack treatments will help you talk with your doctors and healthcare providers. Show As you learn about your treatment plan, don’t be afraid to ask questions. Be sure to voice any concerns you may have. Common heart attack types and treatmentsThe type of heart attack (also called myocardial infarction, or MI) you experienced determines the treatments that your medical team will recommend. 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:
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:
At a hospital equipped to administer PCI, you would likely be sent to a department that specializes in cardiac catheterization, sometimes called a “cath lab.” There, a diagnostic angiogram can examine blood flow to your heart and reveal how well your 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 not equipped to perform PCI might transfer you to one that is. Or, your medical team 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. Both may involve a test called cardiac catheterization to examine the inside of your heart:
Your doctor and other members of your healthcare team can explain the approach to your heart attack treatment. They can answer any specific questions you might have. Common heart attack treatmentsYou’ll find many common heart attack treatments listed here. For more detailed explanations of these treatments, see our page devoted to cardiac procedures.
In addition to the above treatments, you might hear about implantable medical devices being used to treat certain heart attacks. Types of medicationsHeart attack treatment involves a variety of drugs. The list below provides a quick overview of the common types. You can also learn about cardiac medications in more detail. Your doctor will recommend the best combination of heart attack medications for your situation.
Dual Antiplatelet Therapy (DAPT)Some patients who have heart attacks, that have stents placed in their coronary arteries, or undergo coronary artery bypass graft surgery (CABG) are treated with two types of antiplatelet agents at the same time 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 your condition and other risk factors. The risks and benefits of DAPT should be discussed with your health care provider. If you had a heart attack and a coronary artery stent placed, or you are being treated with medical therapy (no stent, clot buster or surgery), in addition to aspirin, you should also be on a P2Y12 inhibitor for 6-12 months. In some cases, it may be advisable to be on DAPT longer. This will need to be discussed with your healthcare provider. The three P2Y12 inhibitors currently available that could be prescribed 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). You will be prescribed the drug that is best for you, based on your risk of blood clots and bleeding. For example, according to the FDA(link opens in new window), clopidogrel does decrease the risk of stroke and MI, but does not change the risk of death for specific patients. The choice of what type of medication, cost of the medication and duration of treatment will be determined in discussions with your health care provider. Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff. What is the first treatment for myocardial infarction?Although the immediate priority in managing acute myocardial infarction is thrombolysis and reperfusion of the myocardium, a variety of other drug therapies such as heparin, β-adrenoceptor blockers, magnesium and insulin might also be considered in the early hours.
What treatment is indicated in the first 12 hours of myocardial infarction?Alteplase, reteplase and streptokinase need to be given within 12 hours of symptom onset, ideally within one hour. Tenecteplase should be given as early as possible and usually within six hours of symptom onset. Bleeding complications are the main risks associated with thrombolysis.
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