Heart Attack Treatment: Medication, Lifestyle Changes, and More

Your doctor may put you on medications, recommend surgery, or suggest lifestyle changes to help you recover from a heart attack and prevent future issues.

Speak with your doctor before starting any treatments to discuss which options are best for you.

During or after a heart attack, your doctor may start you on one or more medications to break up blood clots, prevent future clots, or keep a partial blockage from getting worse.

“Anyone with a prior allergy to these medications or bleeding complications should be sure to bring up these elements of their medical history to their treating doctor,” says Leila Haghighat, MD, a cardiologist with University of California San Francisco's department of medicine.

Thrombolytics

These medications work to quickly dissolve any blood clot that may be causing the blockage. They’re given as an intravenous (IV) infusion through a tube.

• alteplase (Acitvase)
• anistreplase (Eminase)
• reteplase (Retavase)
• tenecteplase (TNKase)
• urokinase (Abbokinase)

Anticoagulants

These drugs are known as blood thinners and reduce your blood’s ability to clot. They may prevent existing clots from growing larger and causing more serious problems.

• Heparin This is the most common anticoagulant used after heart attacks. It is given by IV or subcutaneous (under the skin) injection. Unfractioned heparin (UFH) is stronger and acts faster than low-molecular weight heparin (LMWH). UFH use requires close monitoring, as its effects vary by person, while LMWH may last longer and be more predictable. The synthetic medication fondaparinux also may be an option to prevent rather than treat blood clots.
• Direct Thrombin Inhibitors These alternatives to heparin attach to the enzyme thrombin to prevent clotting. They include argatroban, bivalirudin, and desirudin.

Antiplatelet Drugs

Aspirin is commonly suggested for people experiencing a heart attack or symptoms of it. It stops blood clots from forming by preventing platelets from sticking together.

• cangrelor (Kengreal)
• clopidogrel (Plavix)
• prasugrel (Effient)
• ticragrelor (Brilinta)

As with many heart attack medications, bleeding could be an issue with antiplatelet drugs, says Todd Brown, MD, professor of medicine in the cardiovascular disease division of the University of Alabama at Birmingham and a board member of the American Association of Cardiovascular and Pulmonary Rehabilitation.

• eptifibatide (Integrilin)
• tirofiban (Aggrastat)

Beta-Blockers

• acebutolol
• atenolol (Tenormin)
• bisoprolol (Zebeta)
• carvedilol (Coreg, Coreg CR)

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• metoprolol (Lopressor, Toprol XL)
• nadolol (Corgard)
• nebivolol (Bystolic)
• propranolol (Hemangeol, Inderal LA, Innopran XL)

ACE Inhibitors

They are popular medications, but they come with some risks.

“ACE inhibitors lower blood pressure but can also have a dangerous side effect called angioedema, where swelling of the face, lips, and tongue can develop,” Dr. Brown says.

• benazepril (Lotensin)
• captopril (Capoten)
• enalapril (Vasotec)
• fosinopril (Monopril)
• lisinopril (Zestril)
• moexipril (Univasc)
• perindopril (Aceon, Coversyl, Coversum)
• quinapril (Accupril)
• ramipril (Altace)
• trandolapril

Aldosterone Antagonists

Medications in this class include:

• eplerenone (Inspra)
• finerenone (Kerendia)
• spironolactone (Aldactone, CaroSpir)

Statins

“Statin medications are generally safe but can cause muscle aches in some patients and can very rarely affect the liver,” Brown says.

• atorvastatin (Lipitor)
• fluvastatin (Lescol)
• pravastatin (Pravachol)
• rosuvastatin (Crestor)
• simvastatin (Zocor)

Depending on the extent and location of blockages in your coronary arteries, your doctor may recommend surgery or other procedures to restore and maintain blood flow to your heart.

Angioplasty and Stent Placement

Angioplasty, also known as PCI, is a procedure to open a narrowed or blocked coronary artery. This procedure is usually performed after you receive a coronary angiography, a test in which a dye is injected through a catheter into your coronary arteries to pinpoint any blockages.

In this procedure, your doctor will insert a plastic tube through a small incision in your groin or arm and guide it through your artery to the site of the blockage.

Heart Bypass Surgery

Also known as coronary artery bypass grafting (CABG) or open heart surgery, this procedure creates a new route for blood and oxygen to reach your heart.

Your doctors will take part of a blood vessel (often a piece of vein from your upper leg) and use it to make a detour, or bypass, around your blocked artery.

Most people are placed on a heart-lung bypass machine, or cardiopulmonary bypass (CPB) pump, during this surgery.This machine does the work that your heart would normally do while doctors operate on your heart.

Pacemaker

If your doctor determines that you’ve sustained permanent damage to your heart’s electrical conduction system, you may require a long-term pacemaker.

William Fearon, MD, professor of cardiovascular medicine at Stanford Health Care in California, says it’s important to ask your doctor how often you need to have your pacemaker monitored for issues and battery replacement, as well as any activity restrictions. When traveling, it’s also wise to let airport security know you have a pacemaker, he says.

There are a number of changes you can make to your daily life to lessen your risk of having another heart attack.

• Cutting Out Smoking This includes cigarettes, vaping, and marijuana use, Brown says. Ceasing use of nicotine may reduce your risk of a future heart attack by as much as 36 percent, making it one of the more effective lifestyle adjustments.

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• Consuming a Healthy Diet A balanced diet includes fruits, vegetables, whole grains, nuts, legumes, fish, and low-fat dairy.

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  “Avoid saturated fats, which can be found in red meat, cheese, and butter,” Dr. Haghighat says.
• Moderating Alcohol Use Consider reducing alcohol consumption to one drink a day for women or one to two drinks for men. “Alcohol should ideally not be consumed,” Brown says.
• Exercising Research shows that walking or biking at least 40 minutes a day, plus an hour of additional exercise each week, can be effective in preventing future heart attacks.

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  “Many patients can begin aerobic exercise like walking, running, biking, elliptical, or swimming on their own once cleared by their physician,” Dr. Fearon says.
• Maintaining a Healthy Body Weight Obesity is a risk factor for heart issues. The more extra weight you carry, the higher your risk may be.

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In addition to monitoring your exercise and helping to speed your recovery, these programs may teach you more about heart disease, risk factors, and ways to monitor your own safety.

“Anger, hostility, anxiety, and other psychological challenges are common in patients following a heart attack, and cardiac rehabilitation programs are designed to assist patients with these challenges,” Brown says. “This really should be a priority for all patients after a heart attack.”

Ask your physician or cardiologist for a referral to a cardiac rehabilitation program if you have not received one.

In many cases, you may receive medication to treat chest pain during or after a heart attack. These pain relievers may include:

• Nitroglycerin By relaxing blood vessels and reducing workload on your heart, nitroglycerin can be used to reduce chest pain quickly. It is available by pill or spray and may act as quickly as one to five minutes after administration.

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• Morphine Although this has been used to for persistent, severe pain that does not subside with nitroglycerin, research has shown that it could lead to complications, addiction, or increased risk of death.

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As with all drugs, ask your doctor about what pain medication is the right choice for you, especially if you are also taking other medications.

• The most effective treatment after a heart attack depends on the severity of your heart attack, potential complications, and your related health issues.
• A number of medication options can help reduce or prevent blood clotting or blockages during or after a heart attack. Surgery may be necessary to restore blood flow, and you may need a pacemaker to maintain a normal heart rhythm.
• Stopping smoking may be the most effective lifestyle change you can make to reduce your risk of heart attack.
• Other effective changes for preventing future heart attacks and related health issues include eating a healthy diet, reducing alcohol consumption, exercising, keeping your weight in check, and participating in cardiac rehabilitation therapy..

Additional reporting by Lindsey Konkel and Quinn Phillips.