Advances in Heart Attack Treatment

By Kenneth Adams, MD, FACC

There have been many advances over the years that help us treat patients who experience heart attack. In this article, I want to describe what happens when a heart attack occurs so you will understand how these new treatments work. Then, I want to tell you a personal story to help explain how important these advances in treatment are to all of us.

What Happens When a Heart Attack Occurs?
When someone has a heart attack it means that the heart muscle is injured. A plaque in one of the coronary arteries that feeds the heart muscle has cracked, split or ruptured exposing a gel or matrix. The body then thinks that it must repair the artery and the only way it knows how to do that is to form a blood clot. The blood clot or thrombus totally blocks the artery so no blood flow gets to that part of the heart. That’s why we used to refer to a heart attack as a coronary thrombosis. The longer that blood clot is present, the greater the amount of injury to the heart.

What Method is the Best Treatment for Heart Attacks?
In 1979, I was assigned to the Intensive Care Unit during the first month of my medical internship. One of my distinct memories is taking care of a patient who came in with a major heart attack (MI for Myocardial Infarction). His heart attack involved the front of the heart where there is a major amount of heart muscle. Most likely, the artery feeding the front of his heart was blocked with blood clot—the coronary thrombosis. I didn’t have much to offer for treatment that was really going to help him. I gave him pain killers and some nitroglycerin paste. I stayed at his bedside as he became more comfortable but I knew the outcome was not going to be good—either sustaining major heart damage or not making it at all.

Today, we have clot busters called thrombolytics to dissolve the blood clot in the artery. These clotbusters have come a long way.  Originally, they had to be injected directly into the artery but later they could be given intravenously so they could be given much more quickly. Then, angioplasty and stents became available, and the debate began as to which method—clotbusters or angioplasty and stents—would be the best treatment for heart attacks. Of course, most hospitals have thrombolytics or clotbusters available but not every hospital has a catheterization lab for angioplasty or stents.  Early on, angioplasty and clotbusters were running neck and neck in terms of success. Giving clotbusters could be done so quickly versus the time and manpower it would take to get a patient to the cardiac cath lab for treatment.

Current Research Sheds New Light
A recent Danish study compared angioplasty to thrombolytic (clotbuster) treatment for heart attacks even if patients had to be transferred to get this done. Angioplasty was a superior treatment whether it was done on site or if the patient had to be transferred as long as the transfer took two hours or less. Cardiology organizations and community hospitals are now, more than ever, grappling with the question of whether they should have the capability to perform angioplasty on site for heart attack treatment. Keep in mind that clotbuster treatment is still very good in many circumstances. 

What Should You Do If You Think You Are Having A Heart Attack? 
First and foremost go to the nearest emergency room as quickly as possible. As soon as you are there, a diagnosis can be made and treatment options discussed. Remember, the sooner treatment can be started, the better the outcome. There are so many treatment options available to you now compared with just a short time ago.  Please let us do the best that we possibly can for you.