Heart Attacks and Hospitals

What to expect at the hospital

If you are unfortunate enough to require hospital treatment due to a heart attack, things happen so fast you may not realise what is happening. At some later stage you may start to ask questions about what happened to you!

A heart attack is treated as an emergency because of the severe pain and the risk to life if the heart stops pumping effectively (cardiac arrest).

The first priority is treatment to relieve the pain. Ambulance staff may give the patient oxygen or a mixture of nitrous oxide and oxygen (Entonox) through a mouthpiece to help relieve the chest pain. They may also give an aspirin to chew. This helps to improve the anti clotting effect of the ‘thrombolysis’ treatment, which is given later. If the pain is still severe, painkillers will be administered either by the ambulance staff or on admittance to hospital.

Thrombolysis is a treatment that helps to dissolve the clot that is blocking the artery. It involves injecting a thrombolytic drug such as streptokinase into the bloodstream. Ideally the injection should be given as soon as possible – within one hour of getting the symptoms of the heart attack if possible, and at the latest within six hours. Thrombolysis can be administered later, but it is less effective as time goes by. That is why it is important to get to hospital as soon as possible. In some parts of the country, thrombolysis is given to people before they reach hospital, to help speed up treatment.

If a streptokinase injection is given, the patient is given a card to carry, because they should not be given another dose. If the patient has a further heart attack, a different thrombolytic drug is given.

Once in hospital, pain relief is a priority. Oxygen is administered, if the patient is breathless or in shock. If the patient is diabetic they may also receive an insulin-glucose infusion.

A person who has suffered a heart attack will probably be cared for in the coronary care unit of a hospital – the CCU. The patient will have an electrocardiogram (ECG) to assess heart rhythm and to help diagnose the heart attack. A heart monitor is attached so that the nurses can check for any disturbances in heart rhythm. Blood tests will be carried out to find out how the heart has been affected. If necessary further painkillers will be administered through a vein in the arm. This amount can be increased or decreased until the chest pain had eased.

Other tests may be carried out to find out how severe the heart attack was and to help decide on the best form of treatment. These tests may include:

A chest x-ray
An electrocardiogram
An exercise ECG
A radionuclide test
An MRI scan, or
Coronary angionplasty

When the doctor is confident that the patient is making good progress, he or she will make arrangements for the patient to transfer to a general ward, and will suggest that the patients gradually start moving around again.

Care and treatment at hospital

After a heart attack, drugs are administered for four main reasons

To prevent a further heart attack (for example, aspirin, anticoagulants, beta blockers or anti-arrhythmic drugs)
To relieve breathlessness and heart failure (for example diuretics or ACE inhibitors)
To control risk factors such as high cholesterol levels (for example, statins or other cholesterol-lowering drugs)
To treat angina (for example, nitrates, calcium antagonists or beta blockers)

If tests show that one or more coronary arteries are severely narrowed and that drug treatment is not likely to be successful, you may be advised to have:

Coronary angioplasty with stents, or
Coronary bypass surgery

Before discharge from hospital, doctors and other health care professionals will assess the patient’s needs, and discuss and agree a written individual plan for meeting these needs for rehabilitation.

What happens to the heart after a heart attack?
After a heart attack the body will replace the area of the heart muscle that was damaged with scar tissue. This takes from a few days to a few weeks. Within two or three months, the hearts of many heart attack victims are working just as well as they were before their heart attack. However, sometimes a heart attack can cause more severe damage to the heart, with the result that the pumping action of the heart is not as good as it was before. This can lead to breathlessness, tiredness and swollen ankles. Also some people continue to experience angina (heaviness or tightness in the chest when they exercise) because there is still narrowing of the coronary arteries. If you have any of these symptoms, tell your doctor.

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Heart Attacks and Hospitals

Care and treatment at hospital

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