Heart attack

Initial treatments for heart attacks

The initial treatment of a heart attack at the time of these interviews (2004 and 2011) included pain relief, thrombolysis (clot busting) and other blood thinning drugs (e.g. aspirin), given by ambulance staff or at the hospital. Many of these treatments are still given in the same way.

On the way to the hospital, ambulance staff may give people oxygen if they have a low level of oxygen in their blood. To relieve pain they may give morphine intravenously (through a vein) and glyceryl trinitrate (GTN) as a tablet under the tongue or as a spray and an aspirin to chew to thin the blood.

Some people we talked to said that they found it very reassuring being in the ambulance and receiving treatment. One woman said that ambulance staff did an ECG while in the ambulance, which was immediately transmitted electronically to the coronary care unit, and enabled her to receive treatment immediately on arrival at hospital (see 'DIagnosing a heart attack').
 
One woman described the series of tests she had done, in the ambulance, and over the next few days while she was in hospital to assess the amount of damage caused by the heart attack and a few months later to establish whether she would need further treatment for narrowing of her coronary arteries.
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People we talked to found it reassuring being in the ambulance and receiving treatment even before they arrived in hospital enabling healthcare staff to plan treatment before the person arrived at the hospital.

Primary angioplasty: Is one of the first choices of treatment for most heart attacks. It is a procedure in which the clot causing the heart attack is disrupted with a balloon catheter. This is the same procedure as a coronary angioplasty but called a primary angioplasty if given as an emergency. Where possible it is usually done within a two hours of admission (see ‘What is a heart attack' for more information). An increasing number of hospitals in the UK now have the facilities to do primary angioplasty and the government wants to have this facility available throughout the UK. But thrombolysis (clot busting by a drug) is still widely used as a first line of treatment.
Because primary angioplasty requires a stand-by team of cardiologists to be available at all times, heart attack patients may now find themselves transferred as rapidly as possible to a centre some distance from home. But the advantage of immediate removal of the clot is that it can spare heart muscle damage and promote fuller and more rapid recovery from the attack.
Before and after primary angioplasty, a range of injected drugs may be used to improve the success of the procedure and prevent further clotting. If a metal mesh (called a stent) is used to keep the artery open after the procedure, an anti-clotting drug usually clopidogrel is prescribed for a year afterwards.
 
People who have had a heart attack need to be treated within two hours to make primary angioplasty effective and to avoid further damage to the heart muscle. [Department of health - Treatment of Heart Attack National Guidance 2008]
 
Other treatments:
Other people we interviewed s describe the interventions they received when they got to hospital. Where diagnosis was not straightforward, it took a little longer for initial treatments to be given.

Thrombolytic (clot buster) drugs help to dissolve the clot that is blocking the artery and are usually given immediately upon arrival in hospital. But in some parts of the country, people get them before they reach hospital, to speed up treatment. Ideally the injection should be given as soon as possible after the onset of symptoms of the heart attack. If the injection is delayed beyond six hours, the benefit is less and beyond 12 hours there is little or no benefit.

Thrombolysis was a very effective treatment for people who received the drug early enough after their symptoms began. One man described how the doctor explained the risks and the benefits of thrombolysis, so that he could give informed consent to it being used. Another woman chose not to have this treatment. One man was given warfarin to thin the blood instead of thrombolysis, because staff thought that his heart attack had occurred a few days previously.

After initial diagnosis and treatment, people were cared for in the hospital's coronary care unit (CCU), where further tests and decisions about treatment were made (see 'The coronary care unit'). Sometimes, people are transferred to another hospital for specialist treatment and care.

Last reviewed June 2017.

Last updated June 2017.

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