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When you arrive at the emergency room (ER) in an ambulance, you are already on the fast track to treatment. The ER staff will continue to monitor your vital signs and give you oxygen. Doctors will use your symptoms, your personal and family medical history, and diagnostic tests to see if you have are having a heart attack and choose the best treatment.
Heart attack tests
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Electrocardiogram (ECG or EKG) — This test detects and records the electrical activity of the heart. Certain changes in the appearance of the electrical waves on an ECG are strong evidence of a heart attack. An ECG can also show if you're having arrhythmias (abnormal heartbeats), which a heart attack (and other conditions) can cause. If the ECG indicates you have had a heart attack, doctors will immediately start treatment.
More about electrocardiograms »When you have an ECG, you will lie down and a nurse or technician will clean 10 to 12 areas on your chest, arms, and legs. Sticky pads will be attached to your skin and connected to a machine that records the heart's electrical activity as wavy lines on a strip of moving paper. You should lie still during the test, which takes about two minutes.
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Blood Tests — During a heart attack, heart muscle cells die and burst open, letting certain proteins out into the bloodstream. Blood tests can measure the amount of these protein "markers" of heart damage. The tests are often repeated to check for changes over time.
More about blood tests »For these tests, a blood sample will be taken from a vein in your arm or from a pinprick on your finger. The most common heart attack blood tests are:
- Cardiac troponin (say: TROH-poh-nin) — A marker that is released from injured heart muscle. It is not found in the blood of healthy people. This test is given to all patients with chest pain or other heart attack symptoms.
- Creatine Kinase-MB (CKMB) — Another marker that is produced when the heart muscle is damaged. The CKMB test can also tell if treatments to restore blood flow to the heart are working.
- Myoglobin (say: MY-oh-GLOH-bin) — This is the best test to diagnose a heart attack in the very early stages. It may not be accurate if you have an injury or other condition that causes muscle damage.
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Nuclear scan — This test shows areas of the heart that may be damaged because they are not getting enough blood. It also can reveal problems with the heart's pumping action.
More about nuclear scans »To perform this test, a small amount of radioactive dye is injected into a vein, usually in your arm. A camera positioned over the heart records whether the dye is taken up by the heart muscle (healthy areas) or not (damaged areas). The camera also can tell how well the heart is pumping. This test can also be done during exercise to see how your heart pumps when it is working hard.
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Coronary angiography (or arteriography) — A test that can show the exact location of blockages or narrowing in the arteries that supply blood to the heart.
More about coronary angiography »During this test, a long thin tube called a catheter is put into your arteries through a small cut in your groin (upper thigh) or arm. The catheter is guided through your arteries to your heart, and an X-ray dye is released from the tip of the catheter into your bloodstream. As your heart pumps, the dye is filmed to create an angiogram — an X-ray movie of blood flowing through your arteries. If a blockage is found, a procedure called angioplasty may be used to open the artery.
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Chest X-ray — A test that takes X-ray pictures of the organs in your chest, including the heart and lungs. Although a chest X-ray cannot diagnose a heart attack, it may be used to find other causes of your symptoms (such as lung problems).
More about chest X-rays »To perform a chest X-ray, a large glass panel containing X-ray film will be placed behind your back as you sit up in bed, and the moveable arm of an X-ray machine will be pointed toward your chest. The test takes only a few seconds and you will not feel anything.
Heart attack treatments
If tests show you are having a heart attack, doctors will start treatment to open the blocked artery and restore blood flow to the heart. The sooner you are treated, the better your chances of surviving a heart attack and making a full recovery.
The main heart attack treatments are medications and medical procedures.
Medications
The most common type of medications used to treat heart attack are called clot busters (or thrombolytics). Clot busters can stop a heart attack in its tracks by dissolving the blood clots in your arteries, restoring blood flow to the heart. Clot busters work best if they are given within one hour of the start of heart attack symptoms.
You may also receive other medications to increase blood flow to the heart, prevent future problems, and make you more comfortable. These include:
Aspirin and blood thinners to stop blood cells from clumping together and forming new clots
Nitrates (including nitroglycerin) to widen your arteries and increase blood flow to your heart
Beta-blockers to reduce the heart's workload, reduce the risk of another heart attack, and prevent life-threatening heart rhythm problems
Medical procedures
For some women, medical procedures are the best treatment for heart attack. The most common procedures used to treat heart attack are:
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Coronary angioplasty (also called balloon angioplasty) — A procedure that uses a tiny balloon to open blocked arteries and restore blood flow to the heart. A small mesh tube called a stent is usually left in place to make sure the artery stays open.
More about coronary angioplasty »During a coronary angioplasty procedure, you will be awake, but you will be given medication to prevent any pain and help you relax. A long, thin tube called a catheter is put into your arteries through a small cut in your upper thigh (groin) or arm. The catheter is guided through your arteries to your heart. Once it is in place, a small balloon at the tip of the catheter is inflated to push any blockage back against the artery wall, restoring blood flow. In most cases, a stent is left in place to make sure the artery does not close again.
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Coronary artery bypass graft surgery ("bypass surgery") — A surgical procedure that uses a healthy artery or vein from another part of your body to re-route blood around the blockage. You may need surgery if more than one artery is blocked, or if coronary angioplasty did not work to restore blood flow to your heart.
