At the Hospital
If you have a heart attack and are taken to a hospital emergency room, you will be admitted immediately. An emergency room generally has a special area for treating heart patients that is well equipped with monitoring devices, oxygen, intravenous drips and other tools to diagnose and treat a heart attack.
As soon as you arrive at the hospital, you will receive an electrocardiogram (ECG). The results, combined with the patient's symptoms, give doctors a pretty good idea whether a heart attack has occurred. Confirmation of a heart attack, however, must wait several hours for detection of elevated creatine kinase (CK) or troponin in the blood. CK is a heart muscle enzyme that is released into the blood circulation by dying heart muscle cells. Troponin is an enzyme that lives within the heart muscle cells; it appears in the blood stream only if cells are damaged or dying.
Once the electrical leads of the ECG are attached and the test is being run, an intravenous drip usually is started. Through this IV, you can receive medications. Drugs usually administered in the emergency room are designed to eliminate a blood clot in a coronary artery or to ease the heart's work load. These medications may include aspirin, nitrates, beta-blockers and possibly drugs called thrombolytics to dissolve any blood clots that could be restricting blood flow through your heart's arteries.
Blood will be drawn and sent to the laboratory to check your CK or troponin levels, as well as levels of calcium, sodium, potassium and other minerals called electrolytes, which help keep the heart beating. The attending physician may call in a cardiologist to provide consultation or take over the case. If the ECG shows definite evidence of a heart attack, you might be sent directly to the cardiac catheterization laboratory, where physicians will try to re-open a blocked blood vessel that is causing your problems. If your hospital does not have such a laboratory, you might be transferred by ambulance to another, bigger hospital with a catheterization laboratory.
Doctors in the emergency room also look for arrhythmias, the dangerous, unsteady, irregular or excessively rapid or slow beating of the heart. For certain life-threatening arrhythmias a defibrillator may be used to restore steady beating. A defibrillator is a portable machine that delivers a strong electrical impulse to "shock" the heart back into a regular rhythm. Defibrillation is used to interrupt ventricular fibrillation - extremely rapid, ineffectual contractions of the ventricles that result in death if not reversed quickly. To obtain more information about your heart, specifically whether you have atherosclerosis blocking or reducing the inner diameter of your heart's arteries, the doctor also may have you undergo a cardiac catheterization.
The flurry of activity in the emergency room begins to slow when you are stabilized. By then doctors have carried out several tests to establish whether you are having a heart attack. These tests include blood tests as well as radiology scans that show blood flow patterns in the heart. They may have given pain killers intravenously, administered oxygen to ease the load on the heart and started drug therapy to limit damage to heart tissue. These steps help you get through the crisis and keep you alive.
After you are stabilized in the emergency room, you will be transferred to the cardiac care unit (CCU) or to an "intermediate care unit" (also called a "step down unit"). These highly specialized environments are designed to treat patients with heart disease and prevent complications. They are staffed with specialists ranging from cardiac nurses to cardiologists. Doctors and nurses monitor your blood pressure and heart rate as well as the electrical activity of the heart. ECG leads are attached to your chest and a monitor is placed near your bed. Members of the medical staff can glance at a monitor for each patient and tell exactly how you are faring from one moment to the next.
In the CCU or intermediate care unit, patients rest and begin to recover. Drug therapies begun in the emergency room are continued. While in these units, patients sometimes receive oxygen to ease part of the heart's job. Diets during the first 24 hours or more are sometimes limited to clear liquids because digestion increases blood flow to the digestive tract, which makes more work for the heart.
In the old days, bed rest meant just that: rest. Today, doctors know that too much rest actually can cause problems instead of resolving them. Lying down for long periods of time without changing position gives the blood the chance to pool in places it shouldn't. It also encourages muscles to cramp. These complications can be avoided with a little exercise. Even in the CCU, patients are soon expected to participate in very light exercise.
At first, you will be encouraged to sit up in bed for short periods. After that, you'll graduate to sitting in a chair. To keep your arms flexible, you may start a program of easy range-of-motion exercises with a nurse or physical therapist.