heart and blood vessel disorders
Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina)
Treatment of Acute Coronary Syndromes
Drugs Reopening or bypassing blocked arteries Lifestyle changes Acute coronary syndromes are medical emergencies. Half of deaths due to a heart attack occur in the first 3 or 4 hours after symptoms begin. The sooner treatment begins, the better the chances of survival. Anyone having symptoms that might indicate an acute coronary syndrome should obtain prompt medical attention. Prompt transportation to a hospital’s emergency department by an ambulance with trained personnel may save the person’s life. Trying to contact the person’s doctor, relatives, friends, or neighbors is a dangerous waste of time. In a person who is having symptoms that might indicate a heart attack, prompt transportation to a hospital’s emergency department by an ambulance with trained personnel may save the person’s life. Trying to contact the person’s doctor, relatives, friends, or neighbors is a dangerous waste of time. People who may be having a heart attack are usually admitted to a hospital that has a cardiac care unit. Heart rhythm, blood pressure, and the amount of oxygen in the blood are closely monitored so that heart damage can be assessed. Nurses in these units are specially trained to care for people with heart problems and to handle heart emergencies. Often, oxygen is given through nasal prongs or a face mask. Providing more oxygen to the heart helps keep heart tissue damage to a minimum. If no Complications of an Acute Coronary Syndrome occur during the first few days, most people can safely leave the hospital within a few more days. If complications such as The most important issue in the early part of treatment of a heart attack is to get to medical attention quickly so doctors can attempt to restore blood flow in the affected artery. People who think they may be having a heart attack should chew anaspirintablet immediately after calling an ambulance. Ifaspirinis not taken at home or given by emergency personnel, it is immediately given at the hospital. This therapy improves the chances of survival by reducing the size of the clot (if present) in the coronary artery. People with an allergy toaspirinmay be givenclopidogrel,ticlopidine, orticagrelorinstead. Some people are given bothaspirinandclopidogrel,ticlopidine, orticagrelor. People are given drugs to prevent the formation of blood clots, to reduce anxiety, and to reduce the size of the heart. People may need to take these drugs for some time after they have recovered from a heart attack. Drugs are used to reduce the heart's workload during and after a heart attack. Because decreasing the heart’s workload also helps limit tissue damage, a beta-blocker is usually given to slow the heart rate. Slowing the rate enables the heart to work less hard and reduces the area of damaged tissue. Most people are also given an anticoagulant drug, such asheparin, to help prevent the formation of additional blood clots. Most people are givennitroglycerin, which relieves pain by reducing the workload of the heart and possibly by dilating arteries. Usually, it is first given under the tongue, then intravenously. Occasionally, whennitroglycerinecannot be used or is ineffective, doctors givemorphineto reduce discomfort and anxiety. Angiotensin-converting enzyme inhibitors can reduce heart enlargement and increase the chance of survival for many people. Therefore, these drugs are usually given in the first few days after a heart attack and prescribed indefinitely. Treatment have long been used to help prevent coronary artery disease, but doctors have recently found that they also have short-term benefit for people with an acute coronary syndrome. Doctors give a statin to people who are not already taking one. More information on the Drug Treatment of Coronary Artery Disease can be found elsewhere in THE MANUAL. The decision on the timing and method of opening a blocked coronary artery depends on the type of acute coronary syndrome and on how quickly the person got to the hospital. There are several ways to open blocked coronary arteries: Percutaneous Coronary Intervention None Clot-dissolving drugs Bypass surgery (coronary artery bypass grafting) Inpeople who have an ST-segment elevation MI,immediately clearing the coronary artery blockage saves heart tissue and improves survival. Doctors try to clear the blockage within 90 minutes after the person arrives at the hospital. Because the sooner the artery is cleared the better the outcome, the method of clearing is probably not as important as the timing. Percutaneous Coronary Intervention None (also called thrombolytic or fibrinolytic drugs—see table Drugs Used to Treat Coronary Artery Disease* ) are given by vein (intravenously) to open the arteries if PCI procedures are not available within the 90-minute time frame. Thrombolytic drugs include streptokinase, Because thrombolytic drugs can cause bleeding, they are not usually given to people who have bleeding in the digestive tract, who have severe high blood pressure, who have recently had a stroke, or who have had surgery during the month before the heart attack. Older people who do not have any of these conditions can be safely given a thrombolytic drug. People who have a non-ST-segment elevation MI or unstable anginado not usually benefit from immediate PCI or thrombolytic drugs. However, doctors usually do PCI within the first day or two of hospitalization. If the person’s symptoms worsen or certain complications develop, doctors may do PCI earlier. Coronary Artery Bypass Grafting None Because physical exertion, emotional distress, and excitement stress the heart and make it work harder, a person who has just had a heart attack should stay in bed for a short while and stay in a quiet room for a few days. Visitors are usually limited to family members and close friends. Watching television may be permitted if the programs do not cause stress. Smoking, a major risk factor for coronary artery disease, is prohibited in hospitals. Moreover, an acute coronary syndrome is a compelling reason to Smoking Cessation . Stool softeners and gentle laxatives may be used to prevent constipation, so that the person does not have to strain. If the person cannot pass urine or if the doctors and nurses need to keep track of the precise amount of urine produced, a urinary catheter is used. For severe nervousness (which can stress the heart), a mild antianxiety drug (for example, a benzodiazepine such aslorazepam) may be prescribed. To deal with mild depression and denial of illness, which are common after acute coronary syndromes, people are encouraged to talk about their feelings with doctors, nurses, social workers, and their family members and friends. Some people require an antidepressant. After about 2 to 4 days in the hospital, people who have had an uncomplicated heart attack and successful PCI are usually discharged. Other people may require a longer stay. , a beta-blocker, an angiotensin-converting enzyme (ACE) inhibitor, and a Lipid-lowering drugs (most often, a statin) are usually prescribed. 