The number 1 cause of death in developed countries is heart disease. It progresses slowly, without symptoms for many years, but when its presence is finally noted death or serious disability can result. Chest pain, especially persistent, recurrent and worsening is a medical emergency because the window of opportunity to prevent damage is narrow.

A person presenting to the emergency department with symptoms concerning for myocardial infarction (MI), also known as a heart attack, are treated in a standard fashion. A history and physical examination is taken quickly while heart monitoring is started and intravenous access is obtained. Blood work and an electrocardiogram (ECG) are done. In most cases an adult aspirin is given immediately unless there are contraindications. If the blood pressure is high, medications to lower it are prescribed and this is repeated until a more acceptable range is achieved. Medications to relieve the chest pain are also given. All of these steps are designed to not only provide comfort but to minimize in further damage to the heart.

The results of the blood test and the ECG will confirm if there is an on-going acute infarction. The results can even suggest the infarct location within the heart. The next step might include an emergent cardiac catherization, which would localize the site of the obstructed artery and allow for immediate reperfusion of the infarcted area by either placing a stent or injecting medication to lyse the clot. In a small percentage of cases, the angiography might suggest the need for emergency coronary artery bypass surgery.

Once the acute situation has been stabilized, long-term care must be addressed. The goal is to prevent recurrence of the acute ischemia, limit progression of the heart disease and manage any problems that have developed from the recent event. Common management includes the use of a daily anti-clotting agent such as aspirin to decrease the chance of clot development within the atherosclerotic plaques. A beta-blocker is sometimes prescribed which controls the heart rate, preventing it from working too hard. Blood pressure control with an angiotensin agent or others is given to also help ease the work of the heart. A statin is given to keep the blood lipid levels within a certain range to prevent further development of atherosclerotic plaques within the arteries. Finally, in those with diabetes, aggressive glucose control is initiated. All of these steps have been proven to decrease the chance of future heart attacks.

A heart attack is a scary event, but is also a wake up call. Treatment is available to manage acute events but it is up to you to be compliant with long-term regimens otherwise the ischemia will return and eventually cause death. Take advantage of the available medications and listen to the advise of healthcare providers regarding lifestyle changes.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!