The Doctor's Orders: Emergency Care of a Myocardial Infarction
Doctors order the medications and procedures listed below for patients with a suspected heart attack (myocardial infarction). The list includes general category names instead of specific drugs. This is because most categories have many drugs on the market and keep growing. Doctors choose the appropriate categories and the specific drug in each category based on patient’s needs, clinical guidelines, and professional experience.
Oxygen
How: Nose-plugs or face-mask if a heart attack is suspected, rarely a breathing machine (respirator) is required
Why: Increases the amount of oxygen in the blood, slowing injury to heart muscle
When: Shortly after arrival in the emergency room and lasting for six or more hours
Aspirin
How: Pills
Why: Prevent blood clotting inside coronary arteries
When: Shortly after arrival in the emergency room
Caution: If you are allergic to aspirin or have had a bleeding ulcer tell the emergency room staff immediately.
Plavix (clopidogrel)
How: Pills
Why: Prevent blood clotting inside coronary arteries
When: Shortly after arrival in the emergency room
Anticoagulant
How: Intravenous of subcutaneous (under the skin)
Why: Prevent blood clotting inside the coronary arteries
When: Shortly after arrival in the emergency room
GP IIb/IIIa Inhibitor
How: Intravenous
Why: Prevent blood clotting inside coronary arteries
When: Shortly after arrival in the emergency room
Nitroglycerine
How: Dissolving tablets under the tongue (one tablet every five minutes for three doses) or via an intravenous line
Why: Dilates the coronary arteries improving blood flow to heart muscle
When: Shortly after arrival in the emergency room and for 48 hours afterwards in some cases
Caution: Nitroglycerine can be very dangerous due to low blood pressure if you took other medications such as Viagra, Cialis, or Levitra for erectile dysfunction within 24 to 48 hours. Always tell the emergency room staff if you are taking these or any other medications.
Beta Blockers
How: Pills or intravenous
Why: Decrease blood pressure and the hearts workload
When: Pills will be started within the first 24 hours, intravenous medication may be given shortly after arrival in the emergency room
Caution: Beta blockers can be dangerous if you have a medical condition such as slow heart rhythm or asthma. Always tell the emergency room staff all your medical history.
Morphine
How: Intravenous
Why: Decreases anxiety and dilates coronary arteries improving blood flow to heart muscle
When: Shortly after arrival in the emergency room
Calcium Channel Blockers
How: Pills
Why: In addition to beta blockers and nitrates, calcium channel blockers improve blood flow to heat muscle. Usually used as a third-line agent after beta-blockers and nitrates.
When: Within the first several days
ACE Inhibitors
How: Pills
Why: Decrease the hearts workload
When: Within the first 24 hours
Proton Pump Inhibitors
How: Pills
Why: Protect the stomach from aspirin, especially if you have stomach ulcers or bleeding
When: Within the first 24 hours
Coronary Angiography
How: Intra-arterial procedure done in the catheterization laboratory
Why: Diagnose the location and severity of coronary blockage and allow for a balloon and stent procedure
When: Emergently for an STEMI and urgently (within 24 - 48 hours) for a non-STEMI and unstable angina
Intra-Aortic Balloon Pump
How: Inserted through an artery in the leg into the aorta
Why: Decreases heart injury when medications are not working well enough, maintains blood pressure and heart function
When: Emergency procedure meant to temporarily improve heart function and blood pressure