Heart Attack Treatment (cont.)
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
In this Article
- What is a heart attack?
- How is a heart attack treated?
- Antiplatelet agents
- Glycoprotein IIb/IIIa inhibitors
- Clot-dissolving drugs
- Coronary angiography and percutaneous transluminal coronary angioplasty (PTCA)
- Coronary artery stents
- Angiotensin converting enzyme (ACE) inhibitors
- Beta blockers
- Coronary artery bypass
- What can a patient expect during recovery from a heart attack?
- How can a second heart attack be prevented?
- Find a local Cardiologist in your town
Oxygen also is commonly administered during the acute phase of a heart attack as are narcotics such as morphine; these agents aid in the reduction of discomfort and actually help minimize the amount of heart damage.
Coronary artery bypass
In some patients, PTCA can be technically difficult or dangerous to perform. In others, PTCA and clot-dissolving medications may fail to achieve reperfusion or maintain open arteries. These patients may be considered for coronary artery bypass grafting surgery. For more information, please see the Coronary Artery Bypass Graft article.
What can a patient expect during recovery from a heart attack?
Heart attack patients are monitored in the hospital for 3 or more days prior to discharge home. Rhythm disturbances, shortness of breath due to heart failure, or recurrent chest pain are reasons for further therapy such as balloon angioplasty or coronary stenting, additional medications, or bypass surgery.
Patients gradually increase their activity under observation. Before discharge, a low-level exercise stress test may be performed to detect important residual narrowing in the coronary arteries, exercise-induced cardiac rhythm abnormalities, and heart muscle failure, and to help guide the doctor in prescribing an activity regimen after hospitalization. An abnormal stress test prior to hospital discharge following a heart attack predicts a high risk for subsequent cardiac events; if the patient has not yet had a coronary angiogram, an abnormal pre-discharge stress test is a strong reason for doing angiography. Since most patients usually receive angiography early, the use of pre-discharge stress testing has declined.
Before resuming full activity or work, several weeks may be needed for the heart muscle to heal. After a small heart attack (little damage to heart muscle), patients usually can resume normal activities after 2 weeks. These activities include returning to work as well as normal sexual activity. A moderate heart attack (moderate damage to heart muscle) requires limited, gradually increasing activity for up to 4 weeks, while a large heart attack (much damage to heart muscle) may result in a recovery period of 6 weeks or longer. These time frames are necessary in order for the dead heart muscle to substantially complete the scarring process. During this healing period, patients should avoid vigorous exertion and heavy lifting (over 20 pounds) or any strenuous activity that causes shortness of breath or undue fatigue.
Cardiac rehabilitation typically begins during hospitalization and continues during the months following a heart attack. Cardiac rehabilitation programs provide a helpful transition to a safe and full return to a normal lifestyle. In addition, cardiac rehabilitation allows the prescription of a long-term exercise program tailored to each patient and helps patients and their families adjust to lifestyle changes and the difficult and conflicting emotions that often follow a heart attack.
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