- [voiceover] The main idea in treating myocardial infarcts
is to limit the damage that happens to your heart,
and to minimize complications that might crop up.
The treatment has to address the clot
that caused the myocardial infarct in the first place.
And it has to restore the balance
between the myocardial oxygen supply and demand.
So there are some treatment aspects
that are common to all of the types
of acute coronary syndromes.
But there's some really important differences
in the approach to patients who present with a STEMI,
or an ST elevation myocardial infarct;
compared to unstable angina and N STEMI,
non-st elevation myocardial infarct.
And we'll talk about those.
Unstable angina and N STEMI's
they're usually treated in the same way.
Whereas STEMI's are treated a little bit differently
because they're more serious.
So what happens?
Well any patient who comes to a hospital
with a suspected heart attack,
with a suspected myocardial infarct,
will first be admitted to an intensive care setting.
They would be under continuous ECG monitoring
for arrhythmias, or abnormal heart rhythms.
Remember the ECG would also give a really good idea
of what type of heart attack they might have had.
They'd be made to lie down in bed
to prevent their heart from working to hard.
Thus, minimizing their heart muscles oxygen demand.
They might be given supplemental oxygen,
if it turned out that they weren't carrying enough
oxygen in their blood stream.
And they might be given morphine
and that's to reduce the amount of chest pain
that they're feeling.
And to also reduce the amount of anxiety
that they might be feeling.
And hopefully by doing that,
by reducing their anxiety they'd reduce their heart rate
and even further reduce the amount of oxygen
that their heart needed.
Really importantly, they'd be given aspirin too.
And the aspirin would reduce the development
of the clot that might be causing their symptoms,
that might be causing their myocardial infarct.
This aspirin is actually one of the most important
interventions in reducing mortality in patients
with all forms of acute coronary syndrome.
Okay, so all that stuff happens right away
on an immediate basis.
Then we have to think about sort of getting rid
of that clot that caused their heart attack.
And allowing blood to flow back into that area
that was deprived of blood.
So getting rid of that clot and allowing blood back
into that part of the heart is called reperfusion.
And that's the next goal.
If a patient comes in and the ECG trace
has determined that they have a STEMI,
an ST elevation myocardial infarct
and they presented to the hospital
within about two hours of the onset of their symptoms.
They might be given a medication to break down their clot,
in a process called thrombolysis, or thrombolysis.
Thrombo refers to the blood clot
and lysis refers to break down.
This is actually what's being referred
to when you hear of clot busters.
Unfortunately, no relation to Ghostbusters.
So if this mediation's given early enough,
there's a really high chance of restoring blood flow
to the damaged part of the heart.
And that actually really reduces the tissue damage
that the heart would experience.
Again, just to reiterate this is only
for patients with STEMI's, not unstable angina or N STEMI's.
And that's because the type of clots
that are being busted up with clot busters,
they're only found in STEMI's and not in N STEMI's.
So everything that we've talked is really part
of the acute management of someone
who presents with an acute coronary syndrome.
So all this stuff will happen in the hospital right away.
Then the patient will be put on medications
at the hospital that they'll then have to continue
for the rest of their life.
And the reason for this is because
taking these medications for the rest of their lives,
this has been shown in clinical trials
to reduce mortality, so that's the rate of death
attributed to having had a previous heart attack.
Among other positive affects, they've also been shown
to reduce the chance of you having another heart attack.
So again, these are medications that you'll start
in hospital after the sort of acute management.
And then you'll need to be on them indefinitely.
So what are these drugs?
Well, there's drugs that try to restore
that oxygen supply and demand balance.
So drugs like beta blockers, beta blockers work
by making the heart beat slower,
so fewer beats per minute.
And it also makes the heart beat with a reduced force.
So over all this reduces the heart's oxygen demand,
because if the muscles not working as hard
it needs less oxygen.
Another group of drugs you might get are nitrates.
Nitrates are vasodilators,
so they open up your blood vessels.
They dilate your blood vessels to improve your blood flow.
You'd also be given more medications
to prevent the development of more clots
that could block off your coronary vessels.
So you're already on aspirin, but you might also
be given one called heparin or warfarin.
And what these do is they prevent your clotting cascade
from happening as easily.
So they slow down the growth of,
first of all the clot that might have caused
your myocardial infarct,
and second any further clots that you might develop
down the track.
You'd probably be given a statin.
Statin's reduce your blood cholesterol level.
And so they decrease progression
of atherosclerotic buildup in your coronary arteries.
Remember plaques are filled with cholesterol,
so you'd probably be given a statin
to take indefinitely.
Finally, you might be given an ace inhibitor.
Ace inhibitor's reduce blood pressure
and actually studies have shown
that ace inhibitors can reduce negative structural changes
that can happen in your heart after myocardial infarct.
So those are the major, sort of treatments
with medications that you get
after having a myocardial infarct.