What treatment will I be given when I leave hospital following my heart attack?
Some medication is prescribed as a matter of course because you will have a better chance of survival and complications can be prevented. Medication includes aspirin, clopidogrel, statins, betablockers and ACE inhibitors.
Not all medicines suit everyone and not everyone needs them, but you should be aware if you are taking them and, if not, why not. For some reason, not all people are given the medication that they need: only one-third of those people who should be on beta-blockers are prescribed them. Because you have a 25% better chance of survival if you are given beta-blockers, it is important to know why you haven’t been given them. Ask your doctor why are you are not on them if you have not been prescribed these tablets.
Other tablets may be prescribed for specific problems, for example water pills (diuretics) to reduce fluid retention and help breathing, and special medication to regulate your heart rhythm if it has been upset by the heart attack.
Just as it is vitally important to know what you are being treated with, it is equally important not to discontinue any treatment without checking with the doctor first. Simply stopping medication is a dangerous policy, as you could suddenly get a rebound effect and risk another heart attack occurring. If you have side effects, tell your doctor so that your medication can be changed to another type. If you had a heart attack whilst taking medication for another condition, such as high blood pressure or high cholesterol, it is essential to check whether treatments for these are still needed – they usually will be.
My husband has angina and I am worried that he may not survive a heart attack. What can I do if he has one suddenly – and what should I tell his friends to do?
Quick action is needed by you or his friends, as the muscle will stop working permanently if left without oxygen for 6 hours. The quicker you act, the better the chances of survival: getting help within 1 hour is better than within 2. He will have the very best chances of survival if you get help within the first 4 hours following the start of pain.
There are medications that can be used to break down the clot and open up the artery again. These are known as ‘clot buster drugs’ and the medical term for breaking down the clot is thrombolysis (pronounced ‘throm-bo-lie-siss’). Aspirin helps break down clots as do streptokinase or tissue plasminogen activators (TPAs).
As these medications thin the blood, they are not used when there is a risk of bleeding elsewhere, for example if someone has a stomach ulcer or has recently had surgery. If you think your husband has had a heart attack, and he is able, get him to crunch a 300 mg aspirin into small pieces and swallow it before the trip to hospital. Some pieces will be absorbed quickly through the lining of the mouth.
Clot buster drugs slightly increase the chances of a stroke, but this is offset by a major reduction (40%) in his chances of death from a heart attack. Streptokinase is less expensive than TPA, but TPA is more effective within 4 hours of a heart attack and the more frequently used. If he is given streptokinase, his body becomes sensitive to its effects, so it cannot be used again for at least 12 months, but TPA can be used as many times as is needed. People treated with these medications are given a card to carry with them for future reference. Clot busters are not always successful but do work for 7 out of 10 people with heart attacks.
Is there an alternative to ‘clot buster’ drugs for heart attacks?
Apart from letting nature take its course, percutaneous transluminal coronary angioplasty (PTCA) is the only alternative. This is a means of unblocking arteries with a balloon and squashing the narrowings out of the way. PTCA can be performed if clot busters fail or the pain returns after the clot busters have been tried, if there is a reason why such medications cannot be used safely, or if you are admitted to a unit where angioplasty is routinely available.
Angioplasty with a stent inserted is the most successful way of opening the blocked artery and limiting heart muscle damage and is now advocated as the preferred treatment if available (day or night).
We were so grateful that my brother did not die from his heart attack. Why do some but not others die from a heart attack?
Sometimes the attack is just too big for all the modern treatment to cope with, sometimes the treatment just doesn’t work and some – times it’s left too late. No matter how clever we are, there is always going to be a bad luck factor. However, advances have increased the chances of surviving from 76 to 93% over the last 10 years.
