Heart attack - Treating a heart attack

The treatment options for a heart attack depend on whether you have had an ST segment elevation myocardial infarction (STEMI), or another type of heart attack.

A STEMI is the most serious form of heart attack and requires emergency assessment and treatment. It is important that you are treated quickly to minimise damage to your heart.

If you have symptoms of a heart attack and an electrocardiogram (ECG) shows you have a STEMI, you will be assessed for treatment to unblock the coronary arteries.

The treatment used will depend on when your symptoms started and how soon you can access treatment.

If your symptoms started within the past 12 hours – you will usually be offered primary percutaneous coronary intervention (PCI).
If your symptoms started within the past 12 hours but you cannot access PCI quickly – you will be offered medication to break down blood clots.
If your symptoms started more than 12 hours ago – you may be offered a different procedure, especially if symptoms have improved. The best course of treatment will be decided after an angiogram and may include medication, PCI or bypass surgery.

Primary percutaneous coronary intervention (PCI)

PCI is the term for emergency treatment of STEMI, using surgery to widen the coronary artery (coronary angioplasty).

Coronary angiography is usually offered first to assess your suitability for PCI.

You may also be given blood-thinning medication such as aspirin, heparin, ticagrelor or bivalirudin to prevent further clots from developing. Some of these medications may be continued for several months after PCI.

Coronary angioplasty

A coronary angioplasty is a very complex type of surgery that requires specialist staff and equipment, and not all hospitals have the facilities needed to perform the surgery. This means you will need to be taken urgently, by ambulance, to one of the specialist centres (Heart Attack Centres) that now serve most of the UK's regions.

During coronary angioplasty, a tiny tube known as a catheter, with a sausage-shaped balloon at the end, is put into a large artery in your groin or arm. The catheter is passed through your blood vessels and up to your heart, over a fine guidewire, using X-rays to guide it, before being moved into the narrowed section of your coronary artery.

Once in position, the balloon is inflated inside the narrowed part of the artery to open it wide. A stent (flexible metal mesh) is usually inserted into the artery to help keep it open afterwards.

Medication to break down blood clots

Medications used to break down blood clots, known as thrombolytics or fibrinolytics, are usually given by injection.

Thrombolytics, or fibrinolytics, target and destroy a substance called fibrin. Fibrin is a tough protein that makes up blood clots by acting like a sort of fibre mesh that hardens around the blood.

Some examples of these types of medications include:

You may also be given an additional medication called a glycoprotein IIb/IIIa inhibitor if it is thought you have an increased risk of experiencing another heart attack at some point in the near future.

Glycoprotein IIb/IIIa inhibitors do not break up blood clots, but they prevent blood clots from getting bigger. They are, therefore, an effective method of stopping your symptoms getting worse.

Coronary artery bypass graft

A coronary angioplasty may not be technically possible sometimes if the anatomy of your arteries is different from normal. This may be the case if there are too many narrow sections in your arteries or if there are lots of branches coming off your arteries that are also blocked.

In such circumstances, an alternative surgical procedure, known as a coronary artery bypass graft (CABG), may be considered. A CABG involves taking a blood vessel from another part of your body, usually your chest or leg, to use as a graft.

The graft bypasses any hardened or narrowed arteries in the heart. A surgeon will attach the new blood vessel to the aorta and the other to the coronary artery above and below the narrowed area or blockage.

Angina: Angina is chest pain caused by a reduced flow of blood to the heart, typically resulting from heart disease.
Arteries: Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood: Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Cholesterol: Cholesterol is a fatty substance made by the body found in blood and tissue. It is used to make bile acid, hormones and vitamin D.
Heart attack: A heart attack happens when there is a blockage in one of the arteries in the heart.
Liver: The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Platelet: Platelets are cells in the blood that control bleeding by plugging broken blood vessels and helping the blood to clot.
Pain: Pain is an unpleasant physical or emotional feeling your body produces as a warning sign it has been damaged.
Shock: Shock is a short-term state of body weakness usually after an accident or injury. It is caused when there is an insufficient supply of oxygen.
Stomach: The sac-like organ of the digestive system. It helps digest food by churning and mixing it with acids to break it down.
Vein: Veins are blood vessels that carry blood from the rest of the body back to the heart.
X-ray: An X-ray is a painless way of producing pictures of inside the body using radiation.