Surviving a Heart Attack
Initially, arrhythmias are a major concern. Opening blocked arteries, minimizing damage to heart muscle, and preventing future heart attacks are important issues in the near and long term after a heart attack.
In the initial minutes after a heart attack and for several days afterwards, the heart is at risk of arrhythmias. These life-threatening heart rhythms include ventricular tachycardia and ventricular fibrillation. As long as the bloocked -- or occluded -- coronary artery causing your heart attack remains blocked, arrhythmias can occur. It is critical that you call 911 immediately when heart attack symptoms develop. The ambulance crew will contact the emergency room while en route to update them of your status. Emergency room doctors will then be ready to treat these rhythms and open the occluded artery with either angioplasty or thrombolytics when you arrive.
Opening a blocked artery needs to be done as soon as possible during an acute myocardial infarction (MI). The two main ways to do this are angioplasty with stenting and thrombolytic medication. The pros and cons of immediate stenting versus thrombolytic drugs are discussed here. The key is to get the artery open one way or the other, and to do it fast.
Some people take a wait-and-see approach about symptoms of a heart attack, hoping symptoms will resolve. This delay may make it too late to salvage dying heart muscle. Again, if you think you are having a heart attack, call 911 without delay. Not doing so places you at great risk of disability and death.
Once the coronary artery is open, the job is just beginning. Damaged heart muscle needs help to recover. Medications to heal the heart can also prevent remodeling, a process in which heart muscle becomes less effective and weak. Doctors must assess the risk of a second heart attack and take steps to reduce these odds. Further angioplasty and stenting may be necessary. Modifying risk factors takes on even greater importance after a heart attack. You and your doctor will aggressively lower blood pressure and cholesterol. Additionally, health risks such as obesity and diabetes must be controlled. Smoking must be stopped. Medications to improve survival such as aspirin, statins, beta-blockers, and ACE inhibitors need to be started and dosed appropriately. Within several weeks, the heart's squeezing function needs to be evaluated. The ejection fraction (EF) is a percentage that represents the heart's ability to squeeze blood. Normally, this number is above 50%. If it falls below 30%, you may require a defibrillator -- also known as Automatic Implantable Cardioverter Defibrillator or AICD -- to prevent dangerous rhythms.
The above represents a checklist of important post-heart attack issues to discuss with your doctor. The list is only a starting point. Regular follow-up with a cardiologist should be part of any heart attack.