Treating a Heart Attack in the First Few Hours
Of course, in the first few hours after a heart attack, the intensive care team is not just waiting around for the test results: your treatment starts from the moment you enter the unit. It has two immediate aims - to remove any pain and shock, and to minimize the amount of heart muscle damage.
The first is achieved by giving pain relief and sedation. For most people that means injections of morphine or some similar narcotic drug. That has the double advantage of easing anxieties and calming the heart and circulation.
The second aim is achieved by doing everything possible to get rid of any clot that may be blocking a coronary artery. This was, of course, the purpose of the aspirin tablet given before the admission to hospital. It will be followed, either in the emergency ambulance or as soon as you enter the unit, by injections of 'thrombolytic' (clot-dissolving) agents. Heparin or warfarin, 'anticoagulant' drugs that prevent further clots from forming, will probably be added.
If this combination of treatments is given to full heart attack victims in the first six hours of their attack, they have a much better chance of survival than if their admission to hospital is delayed, or if they are kept at home.
For most MI victims, this acute period is the vital one. Once they have survived the first day, the road to full recovery is steady and uneventful. They are asked to get out of bed within a few days, and the vast majority go home within seven to ten days.
For a small number of MI patients, however, the ICU is a real life-saver. For them, the heart attack may have damaged not only the heart muscle, but the complex network of nerve cells that coordinate the heart beat. This can lead to arrhythmias, in which the heart can suddenly lose its regular, steady rhythm, and burst into runs of beats that are slower, faster, or much more irregular than normal.
This abnormal form of heart beat may simply be an inconvenience - the palpitations felt by some people after drinking too much coffee is an example. After an MI, however, it can be life-threatening. This is why every patient admitted because of a heart attack spends the first few days 'wired up' to an ECG monitor, which will sound an alarm at the first evidence of an arrhythmia.
The peak time for such arrhythmias is the first 48 hours after the attack. Sometimes it is the recovery of the heart muscle, when the blood supply starts to return to it after an artery is unblocked, that stimulates the arrhythmia. The ICU staff are very well aware of this danger period of 'reperfusion'. They are prepared for it with an armoury of 'antiarrhythmic' drugs.
They are also trained to use the defibrillator, an electrical machine used to stimulate the 'fibrillating', or shivering heart back into a normal rhythm. This shivering rhythm is the most dangerous of all the arrhythmias, in that, untreated, it always leads to death.
Arrhythmias have to be reversed within minutes, and sometimes within seconds, if lives are to be saved. For this reason alone, if I were to have a coronary, I would opt for ICU admission, at least for the first week.
Home is only comfortable and reassuring if you don't need professional help immediately to hand. It is impossible to predict, from the severity of the initial attack, who will develop an arrhythmia. It can be stimulated by even the most minor MI, so that there is really no case for keeping anyone with a proven heart attack at home.
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