Heart attack

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.

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.