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The heart may develop irregular heart rhythms (arrhythmias) or stop beating (sudden cardiac arrest) during a heart attack. When the heart is unable to pump blood throughout the body, brain damage and death can occur within minutes.

Emergency medical personnel can quickly assess the situation and may perform an electrocardiogram (ECG) to measure electrical activity in the heart. If the patient is in cardiac arrest, or is experiencing an abnormal heart rhythm, a device called a defibrillator may be used to “shock” the heart into a normal rhythm.

Emergency medical personnel also can administer medications and begin treatments immediately that can help dissolve a blood clot and open a blocked coronary artery, restoring normal blood flow to the heart. If these therapies are initiated within 1 hour of the onset of symptoms, less irreparable damage may occur.

Even before emergency personnel arrive, cardiopulmonary resuscitation (CPR) can be performed if the patient has no pulse and a capable bystander is present. CPR is a combination of rescue breathing and chest compressions. Automated external defibrillators designed for CPR are available in some public places (e.g., airports, shopping malls, large office buildings). Defibrillators also are available without a prescription for home use.

Most communities have an emergency cardiovascular care system that can respond quickly. This prompt care dramatically reduces heart damage. In fact, most heart attack survivors can return to their usual work or activities.

Therapies to restore blood flow or reperfusion (rep”er-FU’zhun) should be initiated promptly by calling 9-1-1 and getting transportation via ambulance to an emergency room. Reperfusion therapies include the use of drugs to dissolve clots (thrombolysis), balloon angioplasty (PCI [formerly called PTCA]) or surgery. The sooner medical attention is obtained, the sooner blood flow can be restored to the heart muscle and decrease disability after a heart attack.

Thrombolysis:Thrombolysis (throm”bo-LI’sis) involves injecting a clot-dissolving agent, such as streptokinase, urokinase or tPA (tissue plasminogen activator), to dissolve a clot in a coronary artery and restore blood flow. For best effect, these drugs must be used within a few (usually three) hours of a heart attack.

Percutaneous Coronary Intervention:Percutaneous coronary intervention (PCI) is another important treatment for heart attack. PCI is often the first treatment of choice for a type of heart attack known as ST-elevation myocardial infarction (STEMI), which occurs when one of the coronary arteries is completely blocked. The goal of both thrombolysis and PCI is to prevent the death of heart muscle cells by restoring coronary blood flow to the heart.

Surgical Revascularization:Surgical Revascularization, also called coronary artery bypass graft surgery (CABG), may be required to improve the blood supply to the heart muscle when several coronary arteries have significant blockages that hinder blood flow.

The glycoprotein IIb/IIIa inhibitors such as abciximab (Reopro) and eptifibatide (Integrilin) prevent aggregation of platelets by inhibiting the glycoprotein receptors on the platelets. They are the most potent anti-platelet agents, approximately 9 times more potent than aspirin, and three times more potent than the thienopyridines. The glycoprotein IIb/IIIa inhibitors are also the most expensive anti-platelet agents. The currently FDA-approved glycoprotein IIb/IIIa inhibitors have to be given intravenously. They usually are given along with aspirin and heparin. They are quick acting; their maximal anti-platelet effects are achieved within minutes of infusion. These inhibitors have become important in the treatment of patients with heart attacks, patients with unstable angina, and patients undergoing PTCA with or without stenting. Numerous studies have shown that glycoprotein IIb/IIIa inhibitors:

1.Decrease the size of the blood clot blocking the coronary arteries, thus improving blood flow, limiting damage to heart muscle, and improving survival among patients with heart attacks

2.Decrease the incidence of heart attacks and improve survival among patients with unstable angina

3.Prevent the formation of blood clots inside coronary stents and in coronary arteries unblocked by PTCA, thus decreasing the incidence of heart attacks and improving survival, specifically, when given intravenously at the time of PTCA and stenting and followed by oral aspirin and clopidogrel

The major risk of glycoprotein IIb/IIIa inhibitors is bleeding. Therefore, patients on heparin, aspirin, and glycoprotein IIb/IIIa inhibitors have to be monitored closely for bleeding. Recent studies have demonstrated equal efficacy of abciximab and eptifibatide. Eptifibatide is shorter acting than abciximab. In the event of major bleeding, the anti-platelet effect of eptifibatide can be reversed within hours of stopping the intravenous infusion, while the anti-platelet effect of abciximab will last much longer. Sometimes, transfusions of platelets are necessary to treat major bleeding due to abciximab.

An uncommon side effect of glycoprotein IIb/IIIa inhibitors is the development of low platelet counts (thrombocytopenia). Thrombocytopenia can increase the risk for bleeding and, in rare instances, may actually cause blood to clot. Thus, patients receiving glycoprotein IIb/IIIa inhibitors should have their platelet counts monitored closely.

Another, newer treatment is called cardiocerebral resuscitation. This involves applying uninterrupted chest compressions for about two minutes, then using either a defibrillator or performing standard CPR. If, after using the defibrillator or performing CPR for several minutes, the patient’s heart is still not beating, the process is repeated. Sometimes, the drug epinephrine is also used when performing cardiocerebral resuscitation. This drug constricts the blood vessels.

Another immediate treatment that can be done is mild therapeutic hypothermia. This involves lowering the patient’s body temperature to less than 93.2 degrees Fahrenheit while he or she is in cardiac arrest. This should be done as soon as the patient is resuscitated, and his or her body temperature should be kept at this lower degree for up to 24 hours. This can be done by using ice packs, fans, and special cooling blankets.

While all of these treatments are an option for those who are suffering from a heart attack, it is important to remember that none of them work well unless they’re administered right away. Time is the main enemy of anyone dealing with a heart attack. The faster they can be taken to an emergency room or passed off to trained medical professionals, the better. Otherwise, the risk of permanent damage will only increase the longer they have to wait for treatment.

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