Treatment

Thrombolytics should be avoided or used with great caution in the following patients:

• People older than age 75 -- a 2000 study suggested that their risk of death was 38% higher than patients in their age group who were not given therapy; a higher risk exists in such older patients even if they are otherwise healthy
• Patients with elevated ST segments whose symptoms have continued beyond 12 hours
• Pregnant women
• People who have experienced recent trauma (especially head injury) or invasive surgery
• People with active peptic ulcers
• Patients who have been given prolonged CPR
• Current users of anticoagulants

Thrombolytics should not be used in the following patients:

• Patients who have experienced any recent major bleeding
• Patients with low ST segments
• Patients with a history of stroke
• Patients with uncontrolled high blood pressure

Other Heart Supportive Drugs

After a heart attack, the patient may need a number of different medications, depending on their risk factors for a future heart attack:

• Beta-blockers reduce the oxygen demand of the heart by slowing the heart rate and lowering arterial pressure.
• Angiotensin converting enzyme (ACE) inhibitors should be given on the first day to all patients, unless there are medical reasons for not taking them.
• Calcium channel blockers may provide relief in patients with unstable angina whose symptoms do not respond to nitrates and beta blockers. They are also useful for patients with Prinzmetal's angina.
• Statins. Statins are important cholesterol lowering drugs that are beneficial for patients who have experienced a heart attack. They may also have heart-protective properties that go beyond lowering cholesterol.
• Atropine. Atropine may be given for a very low heart rate (bradycardia) or signs of atrioventricular (AV) block, in which electric conduction of nerve impulses to specialized muscles in the heart is slowed or interrupted.

Treatment for Patients in Shock or with Heart Failure

Severely ill patients, particularly those in shock (a dangerous condition that includes a drop in blood pressure and other abnormalities) or with heart failure, will be monitored closely and stabilized. Oxygen is administered, and fluids are given or replaced when it is appropriate to either increase or reduce blood pressure. Such patients may be given dopamine, dobutamine, or both. Other treatments depend on the specific condition.

Heart failure. Intravenous furosemide may be administered. Patients may also be given nitrates, and ACE inhibitors, unless they have a severe drop in blood pressure or other conditions that preclude them. Clot-busting drugs or angioplasty may be appropriate and life-saving in many of these patients, although heart failure patients are less likely to be given these treatments.