MEDICAL THERAPY: TREATMENT OF MYOCARDIAL INFARCTION - WHAT DOES THE ACTUAL TREATMENT INVOLVE ?

During treatment, there are set principles but no set schedule, because no two patients who have suffered heart attacks are alike. They vary in severity and incidence of complications. The treatment must change in accordance with the changing condition of the patient. What may be right one moment may not be so the next; for example, a medication which can and should be given at a blood pressure of say 120/80 may have to be withheld if the pressure falls to say 86/60, and other measures have to be taken to stabilise the blood pressure at a higher level.

The actual treatment is now briefly described. Nitrates and other coronary dilating drugs are given to increase the blood supply to the ischaemic segments of the heart; antiplatelet drugs such as aspirin are given to prevent further thrombosis in the coronary arteries and leg veins. For the same purpose anticoagulant drugs such as heparin are administered. Oxygen is provided to ensure sufficient oxygen concentration in the blood; antiarrhythmic drugs are given to prevent or treat disturbances of the heart rhythm. Suitable treatment is directed towards controlling the fall of blood pressure and prevention of shock or left ventricular failure, if and when these complications arise. Active movement of the legs is encouraged to prevent clotting of blood in the leg veins, even though the patient may otherwise be undergoing complete bed rest. If infections, especially of the lungs, occur, they are treated with antibiotics. Cardiac arrest has to be treated as an extreme emergency by external cardiac massage or by electric cardioversion, if available.

Currently, thrombolytic therapy is gaining popularity, in spite of some concomitant dangers and the high cost. In this treatment certain agents (e.g., streptokinase) are injected into the blood or directly into the affected coronary artery to dissolve the clotted blood, thus opening up the blocked artery and restoring blood supply to the ischaemic segments of the heart muscle. The treatment is likely to be successful if administered within the first four hours or so of the attack. In many centres abroad, this treatment is followed by angioplasty. In some centres, angioplasty is offered as the first line of treatment for myocardial infarction. This approach is debatable. With all the dangers accompanying this procedure, it can hardly be called safe as a first line of treatment for acute myocardial infarction, except perhaps as a desparate measure in desparate cases.

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Cardio & Blood