At the Hospital
If you suspect you are having a heart attack, you need to call 911 to get an emergency department as quickly as possible. In the emergency department, you will immediately have an IV and an electrocardiogram (ECG).
The results, combined with the patient's symptoms, give doctors a pretty good idea whether a heart attack has occurred. Blood tests will be sent for additional information. However, treatment must begin immediately. You will likely be given nitroglycerin, other pain relievers as needed, an aspirin and other medicines to prevent new blood clots, and a statin drug.
You may go to the catheterization laboratory for an emergent cardiac cath. This procedure allows the heart specialist to detect blockages in one or more of the coronary arteries. If there is a blockage, the doctor will use a balloon to open the artery. The goal is to get blood past the blockage as quickly as possible. This helps limit heart damage from the heart attack. If your hospital does not have such a laboratory, you might be transferred by ambulance to another, bigger hospital with a catheterization laboratory.
If cardiac cath is not indicated, you may receive a clot-busting drug instead. It is given through the IV.
Blood will be drawn and sent to the laboratory. One of the blood tests is a troponin. Troponin is an enzyme that lives within the heart muscle cells; it appears in the blood stream only if cells are damaged or dying. The laboratory will also check levels of calcium, sodium, potassium and other minerals called electrolytes, which help keep the heart beating.
Doctors in the emergency department 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. The flurry of activity in the emergency department begins to slow when you are stabilized. After that, 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.
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 by moving around in the room.
At first, you will be encouraged to sit up in bed for short periods. After that, you'll graduate to sitting in a chair and then start taking short walks.