What drugs may be used?

Drugs maybe used for two different reasons either to relieve
symptoms or to prevent a further heart attack. Details about individual drugs
are available from the British Heart Foundation booklet “Medicines for the
Heart” (HIS 6).
Drugs that are used for treatment of angina include nitrates (especially
glyceryl trinitrate), beta-blockers and calcium antagonists. Drugs to treat
breathlessness include the diuretics, digitalis (digoxin) and the ACE
(angiotensin converting enzyme) inhibitors. Drugs to prevent further heart
attacks include aspirin, the beta blockers and anticoagulants (e.g., warfarin).
Tests that may be undertaken
Various tests may be carried out in the convalescent period after a
heart attack, to allow the doctors to evaluate its severity so that they can
decide what the outlook is likely to be, the amount of exercise that may be
permitted and what further treatment might be needed.
Tests are described as “non-invasive” if they do not involve the
introduction of tubes (catheters) into the blood vessels and are, therefore,
virtually free of any discomfort or risk. These tests include
electrocardiography, echocardiography and nuclear imaging.                                                                                                        Electrocardiogram (ECG)
This record of the electrical activity of the heart is essential for the
diagnosis of the heart attack, but is also useful in assessing recovery, although it
tells us little about the amount of damage that the heart muscle has suffered.
Exercise Electrocardiogram
Exercise often brings out new abnormalities in the ECG that are not seen
at rest. Those who have made an excellent recovery can undertake a gentle test
lasting 8-10 minutes on a treadmill or stationary bicycle one week or so after the
heart attack and get no further changes on the ECG. Those who still have
problems with a narrowed artery may develop angina or ECG abnormalities; this
suggests that treatment for this is required and may indicate the need for further
tests. Patients who are too unwell to have an exercise test even one month after
the attack will almost certainly require medical or surgical treatment to improve
the function of the heart.
Ambulatory (“Holter”) Monitoring
This technique involves the use of a small portable tape recorder (rather
like a Walkman) which is attached to electrodes affixed to the chest. These are
left in place for 24 hours and record the rhythm of the heart throughout that
time. Subsequently the tape is removed and analysed. It is mainly used for
those who have palpitation or who have evidence suggestive of heart rhythm
disturbance.
Chest X-Ray
At least one chest X-Ray is usually taken during the convalescent
period to check on the size of the heart and that there is no congestion of the
lungs.                                                                                                                                                                                                            Echocardiography
This involves an ultrasound beam which can be used to image the
various structures of the heart and their movements. It can be helpful in
establishing the severity of the heart attack, but is not necessary in all cases.
Nuclear Imaging
A gamma camera is used to detect radioactivity in the heart after the
injection of a very small and harmless dose of a radioactive isotope.
Depending upon the technique used, this allows evaluation of the pumping
activity of the heart muscle, or an assessment of whether areas of the heart
are deficient in blood supply due to narrowed arteries.
Invasive Tests and Treatments
Cardiac Catheterisation
Involves the introduction of a narrow tube (catheter) into a blood
vessel to investigate the condition of the heart and coronary arteries. The
test most likely to be carried out after a heart attack is a coronary angiogram,
in which a small catheter is inserted under a local anaesthetic into an artery
in the arm or groin. The tip of the catheter is advanced under X-ray control
into each of the coronary arteries in turn, which are made visible by the
injection of a substance opaque to X-rays. Coronary angiography is not
carried out as a routine after a heart attack. It is usually undertaken only if
angina is proving troublesome or if there are other reasons for thinking that
further treatment by angioplasty or surgery is necessary.
If tests show that one or more coronary artery is severely narrowed
and that medical treatment is not likely to be successful, two procedures may
be considered:-
Angioplasty
A special catheter with a small inflatable balloon at the tip is passed
into the narrowed artery; the balloon is inflated at the point of narrowing and
widens the vessel so that blood can flow down it more easily when the
balloon is removed. This is most likely to be used after a heart attack if                                                                                      there is persistent angina. It is particularly suitable if only one of the three
coronary arteries is involved.
Coronary Artery Bypass Surgery
This operation is used to provide an alternative route for blood flow to
an artery when this is partially or completely blocked. A segment of vein
from the leg or one of the arteries on the inside of the chest wall is used to
make a connection between the aorta (the main blood vessel) and the artery
beyond the area of narrowing. After a heart attack it is usually only
undertaken if angina fails to respond to medical treatment and angioplasty is
not suitable.
Rehabilitation Programme
Rehabilitation programmes are becoming increasingly available in this
country, although there are still many areas where they are not. They are
usually based in a hospital but may be run independently, either privately or
by general practitioners.
The purpose of rehabilitation schemes is to provide a co-ordinated
programme of counselling and graduated exercises tailored to the individual.
This may involve attendance at the rehabilitation centre two or three times a
week for several weeks.
Not everyone needs such a structured programme but, for many,
rehabilitation helps to restore confidence and ensures that the patient
achieves a return to normal activity as soon as possible.
Self-Help Groups
Patients who have recovered from heart attacks may get comfort and
reassurance by having regular meetings with others who have been through
the same experience. On the other hand, there is a potential danger that those
who have made an excellent recovery may continue to regard themselves as
patients at a time when they should be trying to put the heart attack behind
them. The organisers of good self-help groups recognise the possibility and
are successful in getting former patients to take an outward looking and
positive approach to life, and play a part in helping others through their                                                                                    difficulties. Details of self-help groups are available from the British Heart
Foundation.
Conclusion
Those who are recovering from heart attacks should view their
experience as an unfortunate episode, but one that can lead to a new life
which may be just as or more rewarding than what has gone before. New and
healthier habits may be called for but these may enhance rather than impair
the quality of life.