Heart Attack Treatment: Medication, Lifestyle Changes, and More
A heart attack occurs when blood flow to the heart is severely restricted or blocked. The treatment your doctor recommends for a heart attack will depend on the level of blockage in your coronary arteries (blood vessels that supply blood to the heart) and the extent of damage to your heart muscle.
Your doctor may put you on medications, recommend surgery, or suggest lifestyle changes to help you recover from a heart attack and prevent future issues.
Speak with your doctor before starting any treatments to discuss which options are best for you.
During or after a heart attack, your doctor may start you on one or more medications to break up blood clots, prevent future clots, or keep a partial blockage from getting worse.
“Anyone with a prior allergy to these medications or bleeding complications should be sure to bring up these elements of their medical history to their treating doctor,” says Leila Haghighat, MD, a cardiologist with University of California San Francisco's department of medicine.
Thrombolytics
If diagnostic tests show that one or more of your coronary arteries is blocked, your doctor may start you on a thrombolytic, or “clot-busting,” drug.
These medications work to quickly dissolve any blood clot that may be causing the blockage. They’re given as an intravenous (IV) infusion through a tube.
Thrombolytics are most effective at limiting damage when given as soon as possible, ideally within 30 minutes of the start of your chest pain or other heart attack symptoms. Thrombolytics are used less commonly than in the past because of the broad availability of cardiac catheterization to perform coronary angiograms and place coronary stents, which is often the most effective treatment for a heart attack.
Medications in this class include:
alteplase (Acitvase)
anistreplase (Eminase)
reteplase (Retavase)
tenecteplase (TNKase)
urokinase (Abbokinase)
Anticoagulants
These drugs are known as blood thinners and reduce your blood’s ability to clot. They may prevent existing clots from growing larger and causing more serious problems.
Medications in this class include:
Heparin This is the most common anticoagulant used after heart attacks. It is given by IV or subcutaneous (under the skin) injection. Unfractioned heparin (UFH) is stronger and acts faster than low-molecular weight heparin (LMWH). UFH use requires close monitoring, as its effects vary by person, while LMWH may last longer and be more predictable. The synthetic medication fondaparinux also may be an option to prevent rather than treat blood clots.
Direct Thrombin Inhibitors These alternatives to heparin attach to the enzyme thrombin to prevent clotting. They include argatroban, bivalirudin, and desirudin.
Antiplatelet Drugs
Aspirin is commonly suggested for people experiencing a heart attack or symptoms of it. It stops blood clots from forming by preventing platelets from sticking together.
Once you’re at the hospital, emergency room doctors may give you antiplatelet drugs called P2Y12 inhibitors, which also help prevent new clots and the growth of existing clots.
Glycoprotein IIb/IIIa inhibitors may also be used if you cannot tolerate P2Y12 inhibitors, or if you received a percutaneous coronary intervention (PCI), also known as an angioplasty, which is a procedure to open a blocked coronary artery. Medications in this class include:
eptifibatide (Integrilin)
tirofiban (Aggrastat)
Beta-Blockers
These drugs help lower blood pressure and reduce your heart rate. They can relieve chest pain and discomfort, limit heart muscle damage, and reduce your risk of another heart attack.
Medications in this class include:
acebutolol
atenolol (Tenormin)
bisoprolol (Zebeta)
carvedilol (Coreg, Coreg CR)
metoprolol (Lopressor, Toprol XL)
nadolol (Corgard)
nebivolol (Bystolic)
propranolol (Hemangeol, Inderal LA, Innopran XL)
ACE Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors also reduce the strain on your heart, potentially limiting damage to the organ. They work by stopping production of an enzyme that constricts blood vessels.
They are popular medications, but they come with some risks.
“ACE inhibitors lower blood pressure but can also have a dangerous side effect called angioedema, where swelling of the face, lips, and tongue can develop,” Dr. Brown says.
Medications in this class include:
benazepril (Lotensin)
captopril (Capoten)
enalapril (Vasotec)
fosinopril (Monopril)
lisinopril (Zestril)
moexipril (Univasc)
perindopril (Aceon, Coversyl, Coversum)
quinapril (Accupril)
ramipril (Altace)
trandolapril
Aldosterone Antagonists
Your doctor may prescribe aldosterone antagonists, which force your kidneys to remove more salt and water to help lower your blood pressure. They may cause more frequent urination.
Medications in this class include:
eplerenone (Inspra)
finerenone (Kerendia)
spironolactone (Aldactone, CaroSpir)
Statins
These drugs lower the levels of triglycerides and low-density cholesterol (LDL) in your blood, potentially reducing your risk of a future heart attack or stroke.
“Statin medications are generally safe but can cause muscle aches in some patients and can very rarely affect the liver,” Brown says.
Medications in this class include:
atorvastatin (Lipitor)
fluvastatin (Lescol)
pravastatin (Pravachol)
rosuvastatin (Crestor)
simvastatin (Zocor)
Depending on the extent and location of blockages in your coronary arteries, your doctor may recommend surgery or other procedures to restore and maintain blood flow to your heart.
Angioplasty and Stent Placement
Angioplasty, also known as PCI, is a procedure to open a narrowed or blocked coronary artery. This procedure is usually performed after you receive a coronary angiography, a test in which a dye is injected through a catheter into your coronary arteries to pinpoint any blockages.
In this procedure, your doctor will insert a plastic tube through a small incision in your groin or arm and guide it through your artery to the site of the blockage.
A small balloon is then inflated from the tube to open the blockage. A mesh tube called a stent may be left in the area to keep your artery open.
Heart Bypass Surgery
Also known as coronary artery bypass grafting (CABG) or open heart surgery, this procedure creates a new route for blood and oxygen to reach your heart.
Your doctors will take part of a blood vessel (often a piece of vein from your upper leg) and use it to make a detour, or bypass, around your blocked artery.
Most people are placed on a heart-lung bypass machine, or cardiopulmonary bypass (CPB) pump, during this surgery.This machine does the work that your heart would normally do while doctors operate on your heart.
Heart bypass surgeries typically last four to six hours.
Pacemaker
A heart attack can temporarily or permanently disrupt the electrical activity in your heart that’s responsible for a normal heartbeat. You may require a pacemaker during your hospital stay if your heartbeat is irregular or too slow. This battery-powered device sends electrical impulses to help your heart beat normally.
If your doctor determines that you’ve sustained permanent damage to your heart’s electrical conduction system, you may require a long-term pacemaker.
William Fearon, MD, professor of cardiovascular medicine at Stanford Health Care in California, says it’s important to ask your doctor how often you need to have your pacemaker monitored for issues and battery replacement, as well as any activity restrictions. When traveling, it’s also wise to let airport security know you have a pacemaker, he says.
There are a number of changes you can make to your daily life to lessen your risk of having another heart attack.
One popular study followed men ages 45 to 79 for more than a decade and noted common behaviors among those who did not have a heart attack. The five key lifestyle factors attributed to preventing a future heart attack include:
Cutting Out Smoking This includes cigarettes, vaping, and marijuana use, Brown says. Ceasing use of nicotine may reduce your risk of a future heart attack by as much as 36 percent, making it one of the more effective lifestyle adjustments.
Consuming a Healthy Diet A balanced diet includes fruits, vegetables, whole grains, nuts, legumes, fish, and low-fat dairy. “Avoid saturated fats, which can be found in red meat, cheese, and butter,” Dr. Haghighat says.
Moderating Alcohol Use Consider reducing alcohol consumption to one drink a day for women or one to two drinks for men. “Alcohol should ideally not be consumed,” Brown says.
Exercising Research shows that walking or biking at least 40 minutes a day, plus an hour of additional exercise each week, can be effective in preventing future heart attacks. “Many patients can begin aerobic exercise like walking, running, biking, elliptical, or swimming on their own once cleared by their physician,” Dr. Fearon says.
Maintaining a Healthy Body Weight Obesity is a risk factor for heart issues. The more extra weight you carry, the higher your risk may be.
The time immediately after a heart attack is crucial, as nearly 25 percent of patients find themselves admitted to a hospital within 90 days of a previous heart attack. It can also be stressful and confusing, with new treatments, doctors, and routines to consider.
Recovering from a heart attack often requires help. Your healthcare provider may recommend you to a medically supervised cardiac rehabilitation program at your hospital or a specialty heart center. Research has shown that participation in a cardiac rehabilitation program may reduce the risk of heart-related death by as much as 47 percent.
In addition to monitoring your exercise and helping to speed your recovery, these programs may teach you more about heart disease, risk factors, and ways to monitor your own safety.
Depending on the severity of your heart attack, you may be able to drive within one to four weeks. Ask your physician about when you can return to work.
Can you have sex after a heart attack? Yes, but it is also wise to discuss this with your healthcare provider. If you did not have open-heart surgery, you can probably resume sexual activity two to four weeks after your heart attack. If you did have surgery, you may want to wait as long as six months, to allow your breastbone time to heal fully.
Sexual dysfunction, including erectile dysfunction, may be a side effect of heart disease or the medication you are taking. It’s common, so speak with your partner and your physician about ways to address it.
“Anger, hostility, anxiety, and other psychological challenges are common in patients following a heart attack, and cardiac rehabilitation programs are designed to assist patients with these challenges,” Brown says. “This really should be a priority for all patients after a heart attack.”
Ask your physician or cardiologist for a referral to a cardiac rehabilitation program if you have not received one.
In many cases, you may receive medication to treat chest pain during or after a heart attack. These pain relievers may include:
Nitroglycerin By relaxing blood vessels and reducing workload on your heart, nitroglycerin can be used to reduce chest pain quickly. It is available by pill or spray and may act as quickly as one to five minutes after administration.
Morphine Although this has been used to for persistent, severe pain that does not subside with nitroglycerin, research has shown that it could lead to complications, addiction, or increased risk of death.
As with all drugs, ask your doctor about what pain medication is the right choice for you, especially if you are also taking other medications.
The most effective treatment after a heart attack depends on the severity of your heart attack, potential complications, and your related health issues.
A number of medication options can help reduce or prevent blood clotting or blockages during or after a heart attack. Surgery may be necessary to restore blood flow, and you may need a pacemaker to maintain a normal heart rhythm.
Stopping smoking may be the most effective lifestyle change you can make to reduce your risk of heart attack.
Other effective changes for preventing future heart attacks and related health issues include eating a healthy diet, reducing alcohol consumption, exercising, keeping your weight in check, and participating in cardiac rehabilitation therapy..
