What are the initial steps and medications for managing a heart attack?

From the Guidelines

The initial management of a heart attack requires immediate action, including calling emergency services and chewing a 162 to 325 mg non–enteric-coated aspirin tablet, unless contraindicated, as instructed by emergency medical dispatchers 1. The goal is to rapidly restore blood flow to the affected heart muscle, and every minute counts in preserving heart function and reducing morbidity and mortality. While waiting for help to arrive, patients may also be advised to take 1 nitroglycerin dose promptly if prescribed, and if symptoms are unimproved or worsening 5 minutes after 1 dose, they should be instructed to call 9-1-1 immediately 1. Key steps in managing a heart attack include:

• Calling emergency services immediately if a heart attack is suspected
• Chewing a non–enteric-coated aspirin tablet as instructed by emergency medical dispatchers
• Taking nitroglycerin if prescribed and symptoms persist
• Receiving oxygen, additional nitroglycerin, and morphine for pain relief if needed from emergency responders
• Undergoing rapid restoration of blood flow through procedures like percutaneous coronary intervention (angioplasty with stent placement) or thrombolytic therapy at the hospital. The primary goal is to minimize door-to-balloon time, ideally under 90 minutes, to reduce mortality risk and long-term heart damage 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION Myocardial Infarction Early Treatment During the early phase of definite or suspected acute myocardial infarction, initiate treatment with metoprolol tartrate as soon as possible after the patient’s arrival in the hospital. In hemodynamically stable patients within 24 hours of the onset of symptoms of acute myocardial infarction, give lisinopril tablets 5 mg orally, followed by 5 mg after 24 hours, 10 mg after 48 hours and then 10 mg once daily.

The initial steps for managing a heart attack include:

• Initiating treatment with metoprolol tartrate as soon as possible after the patient's arrival in the hospital, with three bolus injections of 5 mg of metoprolol tartrate injection each, given at approximately 2-minute intervals 2.
• Administering lisinopril tablets 5 mg orally, followed by 5 mg after 24 hours, 10 mg after 48 hours, and then 10 mg once daily in hemodynamically stable patients within 24 hours of the onset of symptoms of acute myocardial infarction 3. Key medications for heart attack management are:
• Metoprolol tartrate to reduce 3-month mortality by 36% in patients with suspected or definite myocardial infarction 2 2.
• Lisinopril tablets to reduce mortality in acute myocardial infarction 3.

From the Research

Initial Steps for Managing a Heart Attack

• The immediate treatment of a heart attack includes taking aspirin to prevent blood from clotting and nitro-glycerin to treat chest pain and oxygen 4
• Identification of heart attack signs and symptoms by victims or bystanders, and taking immediate action by calling emergency services, are crucial to ensure timely receipt of emergency care and thereby improve the chance for survival 5
• Rapid identification and early treatment are supported by research that demonstrates time is a fundamental factor in reducing morbidity and mortality from acute myocardial infarction (AMI) and cardiac arrest 6

Medications for Managing a Heart Attack

• Aspirin tablets are used to prevent blood from clotting 4
• Thrombolytic or clot dissolving drugs such as tissue plasminogen activator, streptokinase or urokinase can be injected into the blood within 3 hours of the onset of a heart attack to dissolve arterial blockage 4
• Painkillers such as morphine or meperidine can be administered to relieve pain 4
• Nitroglycerin and antihypertensive drugs such as beta-blockers, ACE inhibitors or calcium channel blockers may also be used to lower blood pressure and to improve the oxygen demand of the heart 4
• Dual antiplatelet therapy with the use of aspirin plus either clopidogrel, prasugrel, or ticagrelor can be used in the treatment of acute coronary syndromes 7

Diagnostic Tests

• ECG, coronary angiography, and X-ray of the heart and blood vessels can be performed to observe the narrowing of coronary arteries 4