Coronary artery disease
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Heart attack (myocardial infarct) medications
- [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.