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November 25, 2009
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Heart Attack Treatment

Medical Authors and Editors: Dennis Lee, MD and Daniel Kulick, MD, FACC, FSCAI
Revising Medical Editor: Jay Marks, MD

What is a heart attack?

A heart attack (also known as a myocardial infarction) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the heart muscle causes chest pain and pressure. If blood flow is not restored within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for six to eight hours at which time the heart attack usually is "complete." The dead heart muscle is replaced by scar tissue.

Approximately one million Americans suffer a heart attack each year. Four hundred thousand of them die as a result of their heart attack.

Click here to view interactive photos of hearts that have suffered a heart attack.

How is a heart attack treated?

Treatment of heart attacks include:

  • Anti-platelet medications to prevent formation of blood clots in the arteries
  • Anti-coagulant medications to prevent growth of blood clots in the arteries
  • Coronary angiography with either percutaneous transluminal coronary angioplasty (PTCA) with or without stenting to open blocked coronary arteries
  • Clot-dissolving medications to open blocked arteries
  • Supplemental oxygen to increase the supply of oxygen to the heart's muscle
  • Medications to decrease the need for oxygen by the heart's muscle
  • Medications to prevent abnormal heart rhythms

The primary goal of treatment is to quickly open the blocked artery and restore blood flow to the heart muscle, a process called reperfusion. Once the artery is open, damage to heart muscle ceases, and the patient becomes pain free. By minimizing the extent of heart muscle damage, early reperfusion preserves the pumping function of the heart. Optimal benefit is obtained if reperfusion can be established within the first four to six hours of a heart attack. Delay in establishing reperfusion can result in more widespread damage to heart muscle and a greater reduction in the ability of the heart to pump blood. Patients with hearts that are unable to pump sufficient blood develop heart failure, decreased ability to exercise, and abnormal heart rhythms. Thus, the amount of healthy heart muscle remaining after a heart attack is the most important determinant of the future quality of life and longevity.



Next: Anti-platelet agents »

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Heart Attack Treatment

Folic acid, B vitamins, and homocysteine

Homocysteine is metabolized (chemically transformed) into methionine and cysteine with the help of the B vitamins; folic acid, B12, and B6 (pyridoxine). Therefore, insufficient amounts of these B vitamins in the body can theoretically hamper the metabolic breakdown of homocysteine, and hence increase its blood levels. High levels of homocysteine in the blood (hyperhomocysteinemia) can damage the inner surface of blood vessels, promote blood clotting, and accelerate atherosclerosis.

The current state of knowledge regarding folic acid, homocysteine, and heart attacks is as follows:

  • The level of blood folate is an important determinant of the blood homocysteine level. Low blood folate levels are associated with high blood levels of homocysteine.
  • Low blood folate is common among individuals who do not take multivitamins, but unusual among those who do.
  • The...

Read the Vitamins & Exercise: Heart Attack Prevention Series article »










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