Heart attack

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Acute MI	Anterior heart arteries	Heart, front view	Heart, section through the middle
Heart attack symptoms	Posterior heart arteries	Post myocardial infarction ECG wave tracings	Progressive build-up of plaque in coronary artery

• Severe high blood pressure
• A major surgery or major trauma within the past 3 weeks
• Internal bleeding within the past 2-4 weeks
• Peptic ulcer disease

This therapy is also very dangerous in women who are currently pregnant, and in people who use blood thinners such as Coumadin.

Use of thrombolytic therapy can be complicated by significant bleeding. Your doctor can help you find the right therapy.

A cornerstone of therapy for a heart attack is antiplatelet medication. Such medication can prevent the collection of platelets at a site of injury in a blood vessel wall -- like a crack in an atherosclerotic plaque. Platelets collecting and accumulating is the initial event that leads to clot formation. One antiplatelet agent widely used is aspirin. Two other important antiplatelet medications are ticlopidine (Ticlid) and clopidogrel (Plavix).

OTHER MEDICATIONS

• Beta-blockers (like metoprolol, atenolol, and propranolol) are used to reduce the workload of the heart and lower blood pressure.
• ACE Inhibitors (like ramipril, lisinopril, enalapril, or captopril) are used to prevent heart failure and lower blood pressure.

SURGERY AND OTHER PROCEDURES

Emergency coronary angioplasty may be required to open blocked coronary arteries. This procedure may be used instead of thrombolytic therapy, or in cases where thrombolytics should not be used. A device called a stent is often inserted into the artery during angioplasty, to help ensure that the newly opened coronary artery remains open after surgery. Emergency coronary artery bypass surgery (CABG) may be required in some cases.

Recent evidence supports the use of angioplasty and stenting as the first-line therapy to reopen a clogged heart artery if this procedure can be performed in a timely manner in an experienced center. If this procedure is not available, the use of thrombolytic therapy is warranted.

For additional information and resources, see heart disease -- resources.

The expected outcome varies with the amount and location of damaged tissue. The outcome is worse if there is damage to the electrical conduction system (the impulses that guide heart contraction).