The initial treatment of a heart attack at the time of these interviews (2004) included pain relief, thrombolysis (clotbusting) and other blood thinning drugs (e.g. aspirin), given by ambulance staff or at the hospital. Many of these treatments are still given in the same way.
Thrombolysis (see below) is still widely used as a first-line treatment, but increasingly the treatment of first choice for most heart attacks is a procedure in which the clot is disrupted with a balloon catheter before giving any clotbusting drugs. This is the same procedure as a coronary angioplasty but called a primary angioplasty if given as an emergency. Where possible it is usually done within a few hours of admission. An increasing number of larger hospitals in the UK now have the facilities to do primary angioplasty and the government wants to have this facility available throughout the UK (see Department of Health - Treatment of heart attack national guidance for more details).
Because primary angioplasty requires a stand-by team of cardiologists to be available at all times, heart attack patients may now find themselves transferred as rapidly as possible to a centre some distance from home. But the advantage of immediate removal of the clot is that it can spare heart muscle damage and promote fuller and more rapid recovery from the attack.
Ambulance staff may give oxygen or a mixture of nitrous oxide and oxygen (Entonox) through a mask to help relieve the pain. They may also give glyceryl trinitrate (GTN), as a tablet under the tongue or as a spray, to relieve the pain, and an aspirin to chew to thin the blood.
Thrombolytic (clotbuster) drugs help to dissolve the clot that is blocking the artery (see 'Information' section) and are usually given immediately upon arrival in hospital. But in some parts of the country, people get them before they reach hospital, to speed up treatment. Ideally the injection should be given as soon as possible after the onset of symptoms of the heart attack. If the injection is delayed beyond six hours, benefit is less and beyond 12 hours there is little or no benefit.
Before and after primary angioplasty, a range of injected drugs may be used to improve the success of the procedure and prevent further clotting. If a metal mesh (called a stent) is used to keep the artery open after the procedure, an anti-clotting drug called clopidogrel is prescribed, usually for a year afterwards.
One man said that he found it very reassuring being in the ambulance and receiving treatment. One woman said that ambulance staff did an ECG while in the ambulance, which was immediately transmitted electronically to the coronary care unit, and enabled her to receive treatment immediately on arrival at hospital (see 'Making a diagnosis').
Others describe the interventions they received when they got to hospital. Where diagnosis was not straightforward, it took a little longer for initial treatments to be given.
Thrombolysis was a very effective treatment for people who received the drug early enough after their symptoms began. One man described how the doctor explained the risks and the benefits of thrombolysis, so that he could give informed consent to it being used. Another woman chose not to have this treatment. One man was given warfarin to thin the blood instead of thrombolysis, because staff thought that his heart attack had occurred a few days previously.
After initial diagnosis and treatment, people were cared for in the hospital's coronary care unit (CCU), where further tests and decisions about treatment were made (see 'The coronary care unit'). Sometimes, people are transferred to another hospital for specialist treatment and care.
Last reviewed August 2010.
Last updated August 2010.
