Best Heart Attack Treatment​ in Hyderabad, India | Advanced Cardiac Care

If the patient receives faster heart attack treatment, the better chances are to survive and alleviate the symptoms. It includes the following:

First aid treatment for heart attack

Heart attack treatment in hospital

• Oxygen therapy
• Anti-platelets or Anti-coagulants
• Vasodilators
• Thrombolysis
• Emergency (Primary) angioplasty

Common treatment for heart attack

• Medical management of myocardial infarction or 
• Surgical management of myocardial infarction 

First aid treatment for myocardial infarction (heart attack)

A heart attack is dangerous and life-threatening. Therefore, immediate treatment for heart attack must be needed to improve the survival and recovery of the patient.

• Contact the nearby emergency services of any hospital right away
• Check if the patient has a pulse and is breathing
• Begin CPR immediately if the patient is not breathing, which includes hard and fast pushing by hands on the patient chest in rapid rhythm with 100-120 compressions a minute to restore the oxygen and blood flow. CPR is the preferred heart attack emergency treatment at home or any place.

It is crucial to give the emergency management of myocardial infarction for the heart attack patient to prevent significant heart damage.

Myocardial infarction (heart attack) treatment in hospital

After the patient arrives at the hospital, if there is suspicion of a heart attack, some treatments may be given to the patient right away, even before the diagnosis is confirmed.

Prompt treatments may involve administering oxygen therapy, anti-platelet drugs to reduce clotting, nitrate vasodilator to alleviate chest pain, and possibly thrombolytics or emergency cardiac interventions such as angioplasty or stent placement to stop the clotting and restore blood flow to the heart. 

Rapid analysis and interventions minimize heart muscle damage and improve the patient's progress.

Myocardial infarction emergency treatment may include as follows:

• Oxygen therapy
• Anti-platelets or Anti-coagulants
• Vasodilators

Oxygen therapy:  It is a treatment that uses oxygen gas for the patient to breathe. The patient may receive oxygen therapy from tubes placed in the nose, a face mask, or a tube positioned in the windpipe (trachea). It will be given when the patient has a condition that causes low blood oxygen levels.

Antiplatelets: These are the preferred drugs for a heart attack patient upon arrival. It avoids further blood clots.

Anticoagulants: Typically, these drugs are not given immediately, as they might need closer monitoring, and their prescription might depend on the specific cause of the heart attack. Blood thinners or anticoagulants prevent blood clots from forming in arteries; an injection of an anticoagulant will be given to the patient for a few days to prevent further blood clotting.

Vasodilators: A nitrate vasodilator may be given to treat and avoid angina, heart failure, heart attack, and hypertension. This vasodilator may widen and relax the blood vessels, which helps to control high blood pressure and alleviate chest pain. In hypertensive acute heart failure, vasodilator therapy is the treatment of choice to decrease the ventricular afterload rapidly.

The first 24-48 hours (one day to 2 days) after a heart attack is when the patient's condition might be most unstable.

During this time, the patient's heart rhythm might be monitored to examine whether there are any issues with how the patient's heart beats. The patient might have been cared in the coronary care unit (CCU- area specializing in treating heart conditions) or a medical admission unit.

Giving treatment for people diagnosed with a heart attack may be complicated. A cardiologist chooses the therapy based on the type of heart attack, how stable the patient's condition is, and the facilities that are available in a hospital.

A heart attack occurs when a deficiency of blood supply to the heart is due to blockage in one or more heart coronary arteries. The blockage might be partial or complete;

• A partial blockage is an "NSTEMI" "heart attack or a non-ST elevation MI
• A complete blockage is a "STEMI" "heart attack or ST elevation MI

ST segment defines the patterns that are visible on an electrocardiogram, which is a display of a person's heartbeat. Although there may be some overlap, treatments may vary for NSTEMI and STEMI heart attacks.

Hospitals use various techniques to restore the blood flow to the part of the myocardium (heart muscle) injured during a heart attack and limit the damage.

Two treatments are preferable to restore the blood flow through the narrowed or blocked coronary artery, such as:

Thrombolysis: It is a treatment used to dissolve any blood clots that block the arteries and is given through a vein in the patient's arm. Side effects of these medicines include sickness, nausea, and bleeding. The patient might receive clot-dissolving drugs (thrombolysis), balloon angioplasty, surgical interventions or surgery, or a combination of treatments.

Patients may be sent to an area called the "cath lab" that specializes in cardiac catheterization, and the cardiac team might decide whether to perform PCI.

It is a diagnostic angiogram, which examines the blood flow to the heart and reveals how well the patient is pumping. Based on the findings of the prior diagnostic procedure, the patient may be routed to one of the following treatments:

• Medical therapy only
• PCI or coronary artery bypass grafting (CABG)

The patient might be given an angiogram (imaging technique) to see within the arteries, veins, and heart chambers, which may be followed by surgery to restore the blood circulation in the heart.

If the diagnostic reports determine that the patient had an NSTEMI heart attack, the cardiology team typically uses one of two treatment strategies. Both may include cardiac catheterization to examine the heart.

• The ischemia-guided strategy uses anticoagulants (blood thinners) to stop blood clot formation.
• The early invasive strategy begins with the use of blood thinners, a PCI with stenting or CABG, followed by post-hospital care. 

Emergency (Primary) angioplasty

• It is the preferred treatment for most patients with STEMI, but only if it may be given soon after the patient begins showing symptoms. In this technique, a tiny wire with a balloon at the end is inserted into a large artery in the arm or groin. Afterward, it is passed up into the blocked portion of the coronary artery with the guidance of a special X-ray. The balloon will be blown up within the blocked section of the artery to open it wide again.
• A stent (metal mesh tube) might be left in the widened section of the artery to keep it open and to support the artery.

Common treatment for myocardial infarction (heart attack)

The common management approaches for myocardial infarction may be classified into two types:

• Medical management of myocardial infarction or 
• Surgical management of myocardial infarction

Medical management of myocardial infarction 

It is also called pharmacological management of myocardial infarction, where this process uses drugs (medicines) to treat the heart attack and to prevent another heart attack.

Myocardial infarction treatment drugs include the following:

• Anti-platelet agents: They reduce the risk of another heart attack. They prevent blood clots by reducing the "stickiness" of the platelets. Platelets are tiny blood cells that clump together to form a blood clot. The dose that is suggested after a heart attack is less than the dose that the patient takes to relieve pain. A cardiologist might give a second anti-platelet medicine, but giving the two combinations of anti-platelet drugs is more effective than just giving one. Most patients will be advised to take combinational anti-platelet therapy for at least six months. A cardiologist may discuss with the patient about how long the drug has to take the treatment. Antiplatelets may cause side effects such as nausea, stomach aches, and vomiting. To prevent these side effects, it is advised to take drugs with food.

• Beta-blockers: If the patient has had a heart attack, a beta-blocker may be recommended to protect the heart muscle, prevent abnormal heart rhythm (arrhythmias) from developing, and reduce the risk of another heart attack. They are contraindicated for asthma people as they can make it worse, but they are indicated for people who have other lung conditions and diseases. They may show side effects such as tiredness, cold hands and feet, dizziness, erectile dysfunction, disturbed sleep, or even nightmares. These side effects may improve over time. It is noted that don't stop the beta-blockers suddenly. If anyone experiences any of these side effects, consult the doctor, as they may reduce the dose or try another beta blocker.

• Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors may help patients lower their blood pressure, reduce the strain on the heart, and decrease the risk of death after a heart attack. They also aid in slowing down the further weakening of the myocardium. They make the blood vessels relax and widen, lowering the blood pressure and reducing the heart's workload. Patients might be ordered to have regular blood tests to check their blood pressure, kidney function, and potassium levels because these drugs may raise the potassium level in a person's blood. Hence, it is advised to reduce eating salt substitutes because these substances contain potassium, too. Up to 15 out of every 100 patients who take an ACE inhibitor may develop a cough. It is suggested to consult a cardiologist if a cough occurs.

• Statins: A cardiologist may suggest statins to lower blood cholesterol levels. If a person has had a heart attack, statin may be offered for the rest of their life even if the patient has normal cholesterol levels because statins may decrease the risk of further heart events. Before prescribing statin, a patient has to be monitored to check the liver function. A lower statin dose may be recommended if the liver is not working as usual. In some cases, it may cause muscle pain or weakness; rarely, this can be due to the swelling or inflammation of the muscles. Hence, it is advised to consult a doctor if the patient experiences unexpected tenderness, muscle pain, or weakness.

• Angiotensin receptor blockers: These drugs work the same way as ACE inhibitors. However, they are less likely to cause a cough compared to ACE inhibitors. The patient may be prescribed an angiotensin receptor blocker instead of an ACE inhibitor rugs if the patient has had a heart attack that was caused by the left of the heart not working correctly or if the patient may be unable to take an ACE inhibitor.

• Insulin: During a heart attack, some patients may have an increased level of blood sugar, even if they do not have diabetes. Insulin injection will be given to the patient to control the blood sugar levels.

• Dual Anti-platelet Therapy (DAPT): Some patients with heart attacks might be placed with stents in their coronary arteries or undergo CABG, which is treated with two types of anti-platelet drugs at the same time to avoid blood clotting. This is called dual anti-platelet therapy (DAPT). Many people with CAD – coronary artery disease, such as patients who have had a heart attack, stent, or CABG, are treated with one platelet drug for the rest of their lives. Usually, a second anti-platelet drug may be given for months or years in addition to the first anti-platelet therapy. The drug type and treatment duration may vary based on the patient's condition and other risk factors. Before suggesting, the cardiac team may discuss this therapy's benefits and risks to the patient. If the patient had a heart attack and a coronary artery stent placed or is being treated with medical therapy in addition to one anti-platelet drug, speaking with the consultant might be required before taking another type of anti-platelet drug for 6-12 months.

Surgical management of myocardial infarction (heart attack)

Myocardial infarction surgery procedures might include the following:

• CABG
• Percutaneous coronary intervention
• Heart valve surgery
• Transmyocardial revascularization

Coronary artery bypass grafting (CABG)

It is also called bypass surgery, a surgical procedure to improve the blood flow to the heart. It may be required when the coronary arteries become blocked or narrowed.

It may be recommended in an emergency to treat a severe heart attack or to lower the risk of a heart attack if the patient has coronary heart disease. In this method, healthy blood vessels from the body's other parts will be connected to blood vessels above and below the blocked artery.

This method will create a new way for blood to flow that bypasses the blocked or narrowed coronary arteries. Usually, the new blood vessels (grafts) are arteries from the chest or arm or veins from the legs.

The number of grafts required may depend on how severe the coronary heart disease is and how many coronary blood vessels are blocked or narrowed.

It usually lasts up to 3 to 6 hours. In traditional "open heart" CABG, the patient's heart is stopped, and a heart-lung bypass machine can work as the artificial heart (Pumps the blood throughout the body).

Percutaneous coronary intervention (PCI)

 It is a minimally invasive treatment to open the clogged or blocked coronary arteries. It is also called coronary angioplasty with stenting or angioplasty.

Types of PCI: The main aim of the PCI is to open up the blocked arteries, but there are various ways that a cardiologist can perform it, which include:

• Balloon angioplasty: An Interventional cardiologist might use the balloon to insert it into the artery and inflate it to remove the plaque
• Laser angioplasty: It is similar to angioplasty, interventional cardiologist may use a laser to insert the end of a catheter and vaporize the plaque to open the blocked artery
• Angioplasty with a stent: A balloon is inserted to open the artery, and a permanent stent (metal coil) will be placed to keep the coronary artery open for a long time.
• Atherectomy: It is similar to angioplasty, except catheter, cardiac team may use a special tool on its tip to cut away the clogged plaque from the artery
• Rotational Atherectomy: A special drill will be used to remove the calcium deposits by inserting it into the artery
• Percutaneous Transluminal Coronary Angioplasty (PTCA): It is also similar to an angioplasty procedure. However, it mainly focuses on using balloon angioplasty to open the narrowed arteries, whereas PCI (coronary angioplasty) involves additional techniques such as stent placement and other interventions besides PTCA.

Heart valve or replacement surgery 

It corrects the problems caused by diseased heart valves. Sometimes, heart attacks may damage the heart valves. Heart valve surgery might be needed in case of significant damage to the heart valves due to a heart attack, which may lead to heart conditions, including stenosis or valve regurgitation.

Heart attacks can sometimes cause damage to the heart muscle or the heart valves. If the heart attack has resulted in significant damage to the heart valves, leading to conditions like severe valve regurgitation or stenosis, heart valve surgery might be necessary. Heart valves work efficiently to aid blood flow in the right direction through the heart. If the person's heart valve becomes diseased or damaged, it may cause symptoms such as chest pain, dizziness, breathing difficulties and palpitations.

This surgery may be performed through open and minimally invasive or vein access to the patient's heart. It includes two types of heart valve surgery:

• Valve repair surgery: It involves fixing the faulty or damaged valve while reserving more tissue for the patient
• Valve replacement surgery: An interventional cardiologist can replace a diseased valve with an artificial one (human, cow, or pig tissue) or a mechanical valve (carbon or metal). The type of procedure may depend on the type of valve problem. An interventional cardiologist may combine valve surgery with other surgeries of the heart, such as bypass surgery, aortic aneurysm surgery, and atrial fibrillation surgery.

Transmyocardial revascularization (TMR)

A surgical procedure uses a laser (special carbon dioxide-CO2) to bore small pinholes or channels through the myocardium and into the heart's left ventricle (lower chamber). These new pinholes or channels improve the flow of oxygen-rich blood to the areas of the heart not being reached by clogged or diseased arteries, reducing chest pain (effects of angina).

Usually, procedures such as coronary artery bypass grafting (CABG surgery), angioplasty, or stenting might be helpful for patients experiencing coronary artery disease. However, these procedures are not safe for patients with advanced heart disease or other health problems. TMR acts as the safest, most effective alternative and is done for prior CABG patients who cannot tolerate another bypass surgery.

It is mainly indicated to treat a blockage or narrowing of the coronary artery when a bypass is not possible.

Before planning heart surgery for a patient with a heart attack, a cardiac surgeon might evaluate multiple factors carefully to ensure the safety and efficacy of the surgery.

• Patient condition: Assessment of the patient's condition, including the medical history, age, gender, overall health condition, and severity of the heart attack, is very important. It helps to determine the suitable treatment option and surgical approach

• Stabilization: Stabilizing the patient's condition is crucial in some cases because the first 24–48 hours after a heart attack is when the patient's condition might be most unstable. It includes medical treatments to alleviate the symptoms, stabilize the hypertension (blood pressure), and address any other prompt medical concern.

• Diagnostic tests: Initially, cardiac team check the location of the blockages, heart function, type of heart attack, and severity of heart attack by performing various diagnostic tests such as ECG, echocardiography, and angiography

• The severity of the heart attack: The severity of the heart attack and the presence of any complications such as heart failure or arrhythmias might be majorly considered by the doctor. Based on those considerations, a cardio surgeon decides when to perform the surgery, such as immediately, in the next few days, or after the patient has stabilized. 

• Type of heart attack: Different treatment or surgical approaches may vary based on the type of heart attack, such as STEMI, NSTEMI, or unstable angina.

• Hospital facilities: Treatment equipment might include assist devices, pacemakers, extracorporeal membrane oxygenation (ECMO), and CPB. A cardiologist may choose the surgical approach according to the presence of facilities in a particular hospital. In some hospitals, angiography equipment might not be available, and the cardiac team may choose another treatment or surgical approach.

Before surgery, the main objectives of preoperative cardiac management are to discover the people with severe heart conditions needing evaluation by a cardiologist, select required tests while avoiding nonessential ones, and rule out the best treatments, whether medication or procedures, to manage any identified heart issues and to keep the patient heart healthy.

Other goals include:

• Restore the blood flow to the heart
• Improve the blood flow to the heart
• Evaluate the severity of the heart attack

✅Minimally invasive heart surgery

It is performed by making one or more tiny chest incisions, but open-heart surgeries use one large incision down the center of the chest. It offers faster recovery less scarring and pain.

It is indicated for a variety of surgeries, such as:

• CABG
• Atrial septal defect closure'
• Cardiac tumour removal
• Valve repairs or replacement
• Ventricular assist device placement

This procedure includes two main types as follows;

• Thoracoscopic surgery
• Robotically assisted heart surgery

Thoracoscopic surgery: A cardiothoracic surgeon makes one or more small incisions in the side of the patient's chest. Afterward, a long tube with a video camera will be inserted through the incisions to view the heart and to operate it.

Robotically assisted heart surgery: A cardiothoracic surgeon makes one or more tiny incisions in the side of the patient chest. In this surgery, a robotic arm will be used to guide through the incisions. The robot shows clear pictures of the heart, and the surgeon controls the robotic arms to perform this procedure, such as repairing the heart, replacing a heart valve, placing a device, or removing tumors.

After the surgery

The patient might be discharged to the home, depending on the type of treatment, the severity of the heart attack, and the patient's condition. Some follow-up information might be received before the patient leaves the hospital, such as:

Cardiac rehabilitation: It is an essential-supervised program designed to improve heart health to recover and prevent another heart attack. It involves emotional support, exercise training, and nutrition details. It may start before the hospital discharges the patient and should continue in the long term.

Usually, it takes at least three months to help the patient regardless of age, gender, and minor or significant heart issues.

It mainly combines the following:

• Emotional support
• Exercise training
• Education of heart health
• Diet and nutrition counselling
• Cardiac risk factor changes

Specialist/hospital cardiac team: Before leaving the hospital, the patient may receive a follow-up appointment with the hospital team, which will last for a few months. This is an excellent opportunity for a patient to discuss concerns and worries with the healthcare team.

The team might check regarding risk factors that the patient may have (such as blood pressure, obesity, etc.) and may take blood tests to monitor the medicines that the patient is taking.

Walking slowly for 50–100 meters may be recommended in the first few weeks, gradually increasing the distance daily.

Stopping the walking might suggest If the patient experiences chest pain or breathing difficulty, and resting may help in this case.

The first few days and weeks at home:

In the first few weeks, the patient may get tired quickly. This is normal and will usually recover as the patient gets better. About ten days after a heart attack, most people find it easy to start doing small, gentle activities. A cardiologist might gradually increase the amount of exercise depending on the patient's heart condition.

Will the heart attack happen again?

Yes, it is possible to get another heart attack after one heart attack. Many patients may worry about having another heart attack. Usually, one heart attack may increase the risk of another heart attack. However, one can decrease this risk by taking the proper medications and following a healthy lifestyle.



Many patients go on to live a better life than before their heart attack by following a healthy lifestyle and making healthier choices.

How does a mini heart attack feel?

A mini heart attack is a term that can used to represent a less severe form of heart attack called NSTEMI- non-ST segment elevation myocardial infarction, which may feel different from a severe heart attack (STEMI).



Mini heart attack symptoms might not be as intense or noticeable as severe heart attacks. Most people might mistake these symptoms for muscle ache, indigestion, gastric reflux, heartburn, or other minor problems, and they may feel physical discomfort or fatigue and chalk it up to poor sleep, overwork, or age-related pain or ache.

What should I do if I get chest pain?

It is recommended to act quickly if one can experience chest pain, especially if it is persistent, severe, radiating to the neck, shoulder, arm, or jaw, and accompanied by other signs and symptoms such as cold sweating, shortness of breath, and dizziness.

• Immediately, avoid exertion and call the emergency services.
• Try to stay calm until emergency help arrives, and avoid taking medicines on your own without the prescription of a healthcare professional.
• Take an antiplatelet drug if it was advised previously by the doctor.
• Do not have anything until the doctor diagnoses because eating something may make it difficult for healthcare professionals to diagnose the cause of chest pain.
  

Will too much activity brings on another myocardial infarction (heart attack)?

Yes, too much activity can strain the heart and may raise the risk of heart attack. However, average and moderate exercise like walking may help the patient's heart strengthen and improve recovery. It is natural to get scared of getting another heart attack or doing excess physical activity. It is important to remember that a sudden increase in physical activity might strain the heart too much. Hence, it is recommended to gradually increase physical activity levels, starting slowly and progressing at a steady pace.

Which side of chest pain is myocardial infarction (heart attack)?

Most heart attacks cause pain or discomfort in the left side or center of the chest that lasts for more than a few minutes to hours or disappears and comes back. Sometimes, the location of chest pain may vary, and it may feel like squeezing, fullness, uncomfortable pressure, or discomfort and sometimes radiate to the shoulder, arm, jaw, neck, or upper abdomen and also manifest on the right side.

If one may experience mild to severe and persistent pain or chest discomfort accompanied by other symptoms such as sweating, shortness of breath, or tiredness, seek prompt medical help regardless of the pain location.

Do you need surgery after a myocardial infarction (heart attack)?

No, not everyone needs surgery after a heart attack because the treatment plan or surgical approach after a heart attack might depend on different factors such as type of heart attack, extent of heart damage, severity of heart attack, location of the blockage, and patient health condition.



Some people might recover with medications, lifestyle changes, and cardiac rehabilitation, whereas others might need surgery, including coronary angioplasty or bypass surgery, to restore the blood flow to the heart. A cardio surgeon may determine the choice based on patient condition and facilities.

Is vomiting a sign of a myocardial infarction (heart attack)?

No, vomiting alone is not a sign of a heart attack because it might happen due to other conditions such as pregnancy in women, food poisoning, gallbladder disease, and infections. Therefore, it is not a definitive sign of a heart attack.



However, sometimes, it may act as a symptom that is linked to heart attack, particularly in women or in some instances. If one experiences vomiting along with heart attack symptoms such as tiredness, shortness of breath, and chest pain, it is advised to seek prompt medical help.