Which drug should be administered as the initial management for a patient with chest pain consistent with a myocardial infarction?

Diagnosis

Ideally, a health care provider should screen you during regular checkups for risk factors that can lead to a heart attack.

A heart attack is often diagnosed in an emergency setting. If you've had or are having a heart attack, care providers will take immediate steps to treat your condition. If you're able to answer questions, you may be asked about your symptoms and medical history.

Diagnosis of a heart attack includes checking blood pressure, pulse and temperature. Tests are done to see how the heart is beating and to check overall heart health.

Tests

Tests to diagnose a heart attack include:

• Electrocardiogram (ECG or EKG). This first test done to diagnose a heart attack records electrical signals as they travel through the heart. Sticky patches (electrodes) are attached to the chest and sometimes the arms and legs. Signals are recorded as waves displayed on a monitor or printed on paper. An ECG can show if you are having or have had a heart attack.
• Blood tests. Certain heart proteins slowly leak into the blood after heart damage from a heart attack. Blood tests can be done to check for these proteins (cardiac markers).
• Chest X-ray. A chest X-ray shows the condition and size of the heart and lungs.
• Echocardiogram. Sound waves (ultrasound) create images of the moving heart. This test can show how blood moves through the heart and heart valves. An echocardiogram can help identify whether an area of your heart has been damaged.
• Coronary catheterization (angiogram). A long, thin tube (catheter) is inserted into an artery, usually in the leg, and guided to the heart. Dye flows through the catheter to help the arteries show up more clearly on images made during the test.
• Cardiac CT or MRI. These tests create images of the heart and chest. Cardiac CT scans use X-rays. Cardiac MRI uses a magnetic field and radio waves to create images of your heart. For both tests, you usually lie on a table that slides inside a long tubelike machine. Each test can be used to diagnose heart problems. They can help show the severity of heart damage.

Treatment

Each minute after a heart attack, more heart tissue is damaged or dies. Urgent treatment is needed to fix blood flow and restore oxygen levels. Oxygen is given immediately. Specific heart attack treatment depends on whether there's a partial or complete blockage of blood flow.

Medications

Medications to treat a heart attack might include:

• Aspirin. Aspirin reduces blood clotting. It helps keep blood moving through a narrowed artery. If you called 911 or your local emergency number, you may be told to chew aspirin. Emergency medical providers may give you aspirin immediately.
• Clot busters (thrombolytics or fibrinolytics). These drugs help break up any blood clots that are blocking blood flow to the heart. The earlier a thrombolytic drug is given after a heart attack, the less the heart is damaged and the greater the chance of survival.
• Other blood-thinning medications. A medicine called heparin may be given by IV or injection. Heparin makes the blood less sticky and less likely to form clots.
• Nitroglycerin. This medication widens the blood vessels. It helps improve blood flow to the heart. Nitroglycerin is used to treat sudden chest pain (angina). It's given as a pill under the tongue, as a pill to swallow or as an injection.
• Morphine. This medicine is given to relieve chest pain that doesn't go away with nitroglycerin.
• Beta blockers. These medications slow the heartbeat and decrease blood pressure. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks. They are given to most people who are having a heart attack.
• ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart.
• Statins. These drugs help lower unhealthy cholesterol levels. Too much bad (low-density lipoprotein, or LDL) cholesterol can clog arteries.

Surgical and other procedures

If you've had a heart attack, a surgery or procedure may be done to open a blocked artery. Surgeries and procedures to treat a heart attack include:

• Coronary angioplasty and stenting. This procedure is done to open clogged heart arteries. It may also be called percutaneous coronary intervention (PCI). If you've had a heart attack, this procedure is often done during a procedure to find blockages (cardiac catheterization).

  During angioplasty, a heart doctor (cardiologist) guides a thin, flexible tube (catheter) to the narrowed part of the heart artery. A tiny balloon is inflated to help widen the blocked artery and improve blood flow.

  A small wire mesh tube (stent) may be placed in the artery during angioplasty. The stent helps keep the artery open. It lowers the risk of the artery narrowing again. Some stents are coated with a medication that helps keep the arteries open.

• Coronary artery bypass surgery (CABG). This is open-heart surgery. A surgeon takes a healthy blood vessel from another part of the body to create a new path for blood in the heart. The blood then goes around the blocked or narrowed coronary artery. CABG may be done as an emergency surgery at the time of a heart attack. Sometimes it's done a few days later, after the heart has recovered a bit.

Cardiac rehabilitation

Cardiac rehabilitation is a personalized exercise and education program that teaches ways to improve heart health after heart surgery. It focuses on exercise, a heart-healthy diet, stress management and a gradual return to usual activities. Most hospitals offer cardiac rehabilitation starting in the hospital. The program typically continues for a few weeks or months after you return home.

People who attend cardiac rehab after a heart attack generally live longer and are less likely to have another heart attack or complications from the heart attack. If cardiac rehab is not recommended during your hospital stay, ask your provider about it.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

To improve heart health, take the following steps:

• Exercise. Regular exercise helps improve heart health. As a general goal, aim for at least 30 minutes of moderate or vigorous physical activity five or more days a week. If you've had a heart attack or heart surgery, you may have activity restrictions. Ask your health care provider what's best for you.
• Eat a heart-healthy diet. Avoid or limit foods with a lot of saturated fat, trans fats, salt and sugar. Choose whole grains, fruits, vegetables, and lean proteins, such as fish and beans.
• Maintain a healthy weight. Too much weight strains the heart. Being overweight increases the risk of high cholesterol, high blood pressure and diabetes.
• Don't smoke. Quitting smoking is the most important thing you can do to improve heart health. Also, avoid being around secondhand smoke. If you need to quit, ask your provider for help.
• Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
• Get regular health checkups. Some of the major risk factors for a heart attack — high blood cholesterol, high blood pressure and diabetes — don't cause early symptoms.
• Manage blood pressure, cholesterol and blood sugar. Ask your provider how often you need to have your blood pressure, blood sugar and cholesterol levels checked.
• Control stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to ease stress.

Coping and support

Having a heart attack is scary. Talking about your feelings with your care provider, a family member or a friend might help. Or consider talking to a mental health care provider or joining a support group. Support groups let you connect with others who have been through similar events.

If you feel sad, scared or depressed, tell your care provider. Cardiac rehabilitation programs can help prevent or treat depression after a heart attack.

Sex after a heart attack

Some people worry about having sex after a heart attack. Most people can safely return to sexual activity after recovery. But talk to your care provider first. When you can resume sex may depend on your physical comfort, emotional readiness and previous sexual activity.

Some heart medications can affect sexual function. If you're having problems with sexual dysfunction, talk to your care provider.

Preparing for your appointment

A heart attack usually is diagnosed in an emergency setting. However, if you're concerned about your risk of a heart attack, talk to your care provider. A cardiovascular risk assessment can be done to determine your level of risk.

You may be referred to a doctor trained in heart diseases (cardiologist).

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. You might need to avoid food or drink for a while before a cholesterol test, for example.

Make a list of:

• Your symptoms, including any that seem unrelated to heart disease, and when they began
• Family history of heart problems, including heart disease, stroke, high blood pressure, diabetes or early heart attacks
• Important personal information, including recent major stresses or recent life changes
• All medications, vitamins and other supplements you take, including doses
• Questions to ask your provider

Take a friend or relative along, if possible, to help you remember the information you're given.

Some questions to ask your provider about heart attack prevention include:

• What tests do I need to determine my current heart health?
• What foods should I eat or avoid?
• What's an appropriate level of physical activity?
• How often should I be screened for heart disease?
• I have other health conditions. How can I best manage these conditions together?
• Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask you questions, including:

• How severe are your symptoms?
• Are they constant or do they come and go?
• What, if anything, seems to improve your symptoms?
• If you have chest pain, does it improve with rest?
• What, if anything, worsens your symptoms?
• If you have chest pain, does strenuous activity make it worse?
• Have you been diagnosed with high blood pressure, diabetes or high cholesterol?

What you can do in the meantime

It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more active. These are important steps in preventing heart attacks and improving overall health.

What is the drug of choice for myocardial infarction?

Which drug should be given to all patients experiencing chest pain?

What drugs are given after myocardial infarction?

Which drug administered first in patients with heart attack?