Guidelines on Heart Attacks
To take a heart attack - a myocardial infarction - first. If you suspect a heart attack, then it is vital to take a whole aspirin tablet immediately. Chew it, then swallow it. There is good evidence that it will work quickly to limit the size and severity of the clot in your coronary artery and limit the damage to your heart muscle. Do it even if you are taking aspirin every day. That's because there's evidence that the heart attack may have started in response to a flood of new platelets flushing out from the bone marrow - and they will not be affected by an aspirin taken an hour or more before. Only a fresh aspirin tablet will deal with them, and stop their clumping together, or to an artery wall, to form a clot.
So it is a good idea to carry an aspirin around with you, just in case. One tablet in a wallet or a handbag is enough. You don't need to have water with it - indeed it is a good idea to chew it, because that will get it into your bloodstream faster. From then on you should take half an aspirin a day for the rest of your life.
The guidelines also make it clear that if you are having a heart attack, the paramedic or doctor who first attends you should give a 'thrombolytic' (streptokinase and/or heparin, or tissue plasminogen activator (tPA) and/or herapin) as soon as possible. This should be combined with a betablocker drug given into a vein to start with, then followed by a betablocker tablet for several years. You should also be given an ACE inhibitor within 24 hours, and continue with it for about a month if you are at a relatively low risk of dying, and for several months if you have any signs of heart failure (the two main ones are breathlessness and ankle swelling). Nitrates are useful to ease symptoms in the early stages after heart attack.
These may seem complicated treatment, but RCTs have proved that all of these treatment steps significantly lower death rates after heart attacks.
If you reach hospital within four hours of the onset of the chest pain, and have the typical ECG changes of poor oxygen flow to the heart muscle (ischemia), then your chances of survival are greatly improved by having an immediate balloon angioplasty (percutaneous transcoronary angioplasty, or PTCA). If this is done within 90 minutes of reaching hospital by an experienced team in a centre that is regularly performing PTCAs, it will prevent much, and perhaps even "all, of the irreversible damage to the heart.
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