ľ¹ÏÖ±²¥

Treatment for people diagnosed with heart attack can be complex. We hope this section on heart attack treatments will help you talk with your health care team about your treatment plan.

Be sure to voice any questions or concerns you may have.

Common heart attack types and treatments

The type of heart attack (also called myocardial infarction, or MI) you had determines the treatments that your medical team will recommend. A heart attack occurs when a blockage in one or more heart (coronary) arteries reduces or stops blood flow to the heart, which starves part of the heart muscle of oxygen.

The blockage might be complete or partial:

• A complete blockage of a coronary artery means you suffered a “STEMI” heart attack or ST-elevation MI.
• A partial blockage is an “NSTEMI” heart attack or a non-ST-elevation MI.

Treatments differ for a STEMI versus NSTEMI heart attack, although there can be some overlap.

Hospitals use techniques to restore blood flow to the part of the heart muscle damaged during your heart attack:

• You might receive clot-dissolving drugs (thrombolysis), balloon angioplasty, surgery or a combination of treatments.
• However, not all hospitals in the U.S. are equipped to use a procedure called percutaneous coronary intervention (PCI), a mechanical means of treating heart attack. 

At a hospital able to perform PCI, you would likely be sent to an area that specializes in cardiac catheterization, sometimes called a “cath lab.” There, a diagnostic angiogram can examine blood flow to your heart and reveal how well your heart is pumping. Depending on the results of that procedure, you may be routed to one of three treatments: medical therapy only, PCI or coronary artery bypass grafting (CABG).

A hospital that is not equipped to perform PCI might transfer you to one that is. Or your medical team may decide to administer drugs to break down a clot and restore blood flow. You might be given an angiogram ‒ an imaging technique used to see inside your arteries, veins and heart chambers. This may be followed by surgery to restore the blood circulation in your heart.

If the health care team determines you had an NSTEMI heart attack, they typically use one of two treatment strategies. Both may involve a procedure called cardiac catheterization to examine the inside of your heart:

• The ischemia-guided strategy uses blood thinners to stop a blood clot from forming.
• The early invasive strategy starts with the use of blood thinners to stop blood clot from forming, but might also proceed to a medical therapy, a PCI with stenting or coronary artery bypass grafting (CABG), followed by certain types of post-hospital care.

Your health care team can explain the approach to your heart attack treatment. They can answer any specific questions you might have.

Common medical procedures following a heart attack

You’ll find many common medical procedures for heart attack listed here. For more detailed explanations of these treatments, see our page devoted to cardiac procedures.

• Angioplasty: Special tubing with an attached deflated balloon is threaded up to the coronary arteries. The balloon is inflated to widen blocked areas where blood flow to the heart muscle has been reduced or cut off.
• Laser angioplasty: Similar to angioplasty except the catheter has a laser tip that opens the blocked artery.
• Heart valve surgery: Repairs an abnormal or diseased heart valve or replaces it with a healthy one.
• Atherectomy: Similar to angioplasty except the catheter has a special tool on its tip to cut away plaque from the artery.
• Bypass surgery: Treats blocked heart arteries by creating new pathways around the clot so blood can flow to your heart muscle.
• Minimally invasive heart surgery: An alternative to standard bypass surgery using small incisions.
• Stent procedure: A stent is a wire mesh tube that is placed during angioplasty to hold open an artery and restore blood flow.
• Transmyocardial revascularization (TMR): A laser is used to drill a series of holes from the outside of the heart into the heart’s pumping chamber.

In addition to the above treatments, you might hear about implantable medical devices being used to treat certain conditions that increase risk of heart attacks.

Types of medications

Heart attack treatment involves a variety of drugs. The following list provides an overview of the common types. You can also learn about cardiac medications in more detail.

Your health care team will recommend the best combination of medications for your situation.

• Anticoagulant: Sometimes called blood thinners, these medicines make it harder for clots to form and also keep existing blood clots from getting larger.
• Antiplatelet agent: Keeps blood clots from forming by preventing blood platelets from sticking together.
• Angiotensin-converting enzyme (ACE) inhibitor: Relaxes blood vessels and allows them to expand while decreasing resistance by lowering levels of angiotensin II. Allows blood to flow more easily and makes the heart’s work easier or more efficient.
• Angiotensin II receptor blocker: These medicines inhibit angiotensin II from having effects on the heart and blood vessels. This keeps blood pressure from rising.
• Angiotensin receptor neprilysin inhibitor: Neprilysin is an enzyme that breaks down natural substances in the body that open narrowed arteries. By inhibiting neprilysin, those natural substances can have their normal effect. That improves artery opening and blood flow, reduces sodium (salt) retention and decreases strain on the heart.
• Beta blocker: Makes the heart beat slower and with less force, which lowers blood pressure.
• Combined alpha and beta blocker: Combined alpha and beta blockers may be used as an IV drip for people in hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the person is at risk for heart failure.
• Calcium channel blocker: Interrupts the movement of calcium into the cells of the heart and blood vessels. May decrease the heart’s pumping strength and relax the blood vessels.
• Cholesterol-lowering medications: Various medications can lower blood cholesterol levels, but statins are the best first course of action. When statins don’t work, or if a person has serious side effects from statin therapy, other drugs may be recommended.
• Vasodilator: Relaxes blood vessels and increases the supply of blood and oxygen to the heart while reducing its workload. Available as pills to be swallowed, chewable tablets and as a topical application (cream).

Dual Antiplatelet Therapy (DAPT)

Some people who have heart attacks, that have stents placed in their coronary arteries, or undergo coronary artery bypass graft surgery (CABG) are treated with two types of antiplatelet agents at the same time to prevent blood clotting. This is called dual antiplatelet therapy (DAPT).

One antiplatelet agent is aspirin. Many people with coronary artery disease, including those who have had a heart attack, stent or CABG are treated with aspirin for the rest of their lives. A second type of antiplatelet agent, called a P2Y₁₂ inhibitor, is usually prescribed for months or years in addition to the aspirin therapy.

The type of medication and the duration of your treatment will vary based on your condition and other risk factors. The risks and benefits of DAPT should be discussed with your health care professional.

If you had a heart attack and a coronary artery stent placed, or you are being treated with medical therapy (no stent, clot buster or surgery), in addition to aspirin, you should speak with your health care professional about taking a P2Y₁₂ inhibitor for 6-12 months. In some cases, it may be advisable to be on DAPT longer. 

You may be prescribed one of the following: clopidogrel, ticlopidine, prasugrel, ticagrelor or cangrelor. You will be prescribed the drug that is best for you, based on your risk of blood clots and bleeding. The choice of what type of medication and duration of treatment will be determined in discussions with your health care professional.