Last month's article covered the basics regarding how to respond to a possible heart attack. As you may recall, a heart attack, or myocardial infarction, occurs when there is damage to the heart muscle caused by a blockage in the coronary arteries that supply the heart with blood. This month's article will cover what may happen in the ambulance, in the ER and what studies, treatments and medications may be used.

In the ambulance: Because a heart attack can make your heart beat erratically, the ambulance crew may be trained to shock your heart back to normal rhythm, if needed. They may also be able to start an intravenous (IV) line and give medication. All crews can administer oxygen and do an assessment. Some crews may be able to do an EKG and radio results ahead.

In the ER: Patients with chest pain are usually "fast tracked" and the ambulance crew will fill in the ER doctors about your condition. IV and EKG will be done if not done already, you will be put on a monitor, and the doctor will question you about your chest pain and medical history. Blood will be drawn, you may receive a chest x-ray, and appropriate medications may be given.

What next? If the EKG indicates a blockage to a blood vessel to your heart, you may receive a thrombolytic (a clot-busting) drug, or be sent to the cath lab for an emergency angiogram and maybe an angioplasty. Sometime the treatment depends on the capabilities of the hospital.

In the cath lab: The angiogram is diagnostic and involves threading a catheter through blood vessels via a small incision, usually in the groin. Contrast dye is pushed through and x-rays are taken to find the blockages. If indicated, the blocked vessels are opened with angioplasty and a stent is placed. If the blockage can't be treated, cardiac bypass surgery is done.

Going home: If your heart attack was caught early and treated with angioplasty you could be going home in 1 - 2 days. That is why it is important to take possible heart attack symptoms seriously and call 911. Immediate action increases your potential for active and healthy years ahead.

Sources include Harvard Health Letter, July 2002; and Healthwise Handbook