Tests and Treatments for heart attack: the following tests and treatments are usually not performed in the emergency room.
Cardiac catheterization
A thin catheter (plastic tube) is inserted through an artery in the arm or leg and is guided into the coronary arteries of the heart. A skilled doctor usually injects dye through the catheter into the origins of the coronary arteries and identifies arterial obstructions by observing dye flow. This test can provide information about functioning of the heart muscles and valves as well as the arteries.
Angioplasty
As briefly mentioned, your doctor may decide to treat you with angioplasty to establish reperfusion when he/she feels that thrombolytic therapy is either not primarily indicated or was ineffective in relieving your heart attack symptoms. Angioplasty can be performed during a cardiac catheterization. The technique consists of a small balloon being placed at the site of the coronary blockage and blown up with air. This causes the material forming the blockage to be compressed along the wall of the vessel. The inflated balloon can also cause the vessel to stretch, making it wider so more blood can flow through. It can also cause cracks in the blockage that will allow more blood to flow through. In order to keep the blood vessel open a small device called a stent may be placed in the coronary artery. A stent is a small tubular scaffolding that is inserted with the help of the catheter. Some of these stents are made of bare metal; others have a coating of a drug that will be absorbed by the blood vessel over time (these are called drug eluting stents). The decision of what type of device to use, or whether to use a device is dependant upon the anatomy of the lesion. Interventional cardiologists are experts in deciding what fits best for you.
You will be mildly sedated during angioplasty, and most people report feeling only minor discomfort. Like a catheterization, your doctor will inject dye into your arteries that will allow him/her to monitor your blood flow and determine the site(s) of blockage. The tube carrying the balloon, regarded as the catheter, is inserted at the site of artery access, usually in the groin area. The catheter is moved along the artery until it reaches the blockage. The balloon is then inflated for a period of a few seconds to a few minutes and then deflated. Blood flow is monitored to ensure adequate reperfusion or restoration of blood flow. Sometimes the balloon will be reinflated at the same site or at another site.
Usually a stent is placed at the site of the balloon. A stent is a rigid tube that prevents the vessel from collapsing or a blood clot from forming at the site of the blockage. Great advances in stent technology have led to markedly improved outcomes for people who undergo angioplasty at the time of their heart attack, or shortly thereafter.
Bypass surgery
If angioplasty proves unsuccessful, the position of the block is too difficult to access by angioplasty, or you have severe blockages in multiple major vessels, the doctors may recommend bypass surgery.
Bypass surgery is a major operation. If you undergo this operation, you will receive general anesthesia, and thus be completely asleep during the surgery. Pre-operative medications are often administered to bypass patients by mouth, muscular or subcutaneous injection, or IV. During bypass surgery, the chest bone (sternum) is separated, and the ribs are spread apart to allow visible and physical access to the heart. During surgery, blood circulation and breathing functions will be taken over by a heart-lung machine. The operation usually lasts between two and six hours. A bypass graft is performed to reroute blood flow around the blockage. Veins used in bypass surgery are usually taken from one of the legs or an artery is usually taken from the chest wall (internal mammary artery), or forearm (radial artery) to complete the graft.
A newer technique, minimally invasive bypass surgery, requires a much smaller incision in the chest (only three inches) instead of sawing through the chest bone. An artery from the chest is used to bypass the blockage. While fewer patients are candidates for this type of surgery, the technique is less painful and leads to a shorter hospital stay than the usual bypass surgery.
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