The American College of Cardiology and American Heart Association have developed guidelines for emergency treatment of patients having a heart attack. The goal of emergency treatment is to restore circulation to the heart muscle as soon as possible. This can prevent or reduce the amount of permanent damage to the heart and reduce the risk of sudden death. 

Damage from a blocked artery on the heart doesn't happen all at once. Permanent damage occurs over several hours after the artery becomes blocked and part of the heart muscle is without oxygen. However, there can be a significant amount of damage after the first hour. Treatment is most effective in preventing or limiting the amount of permanent damage when it is started in the first hour after symptoms start. Remember that time is muscle! 

Restoring circulation can be done in 2 ways. 

• Thrombolytics or 'clot-busting drugs'
• Artery opening techniques 

'Clot-busting drugs' are medications that are given through an intravenous line. They dissolve the clot (thrombus) that is blocking the artery. This opens the artery to restore the blood flow to the heart muscle. To use these medications during a heart attack, the electrocardiogram (EKG) must show a particular pattern. This pattern includes 'elevated ST segments' or new development of a 'left bundle branch block' (LBBB). The medication can prevent or limit the amount of permanent damage to the heart when given in the 1st hour of the start of symptoms of a heart attack. 'Clot-busters' can be given up to 12 hours after the start of symptoms. However, the later they are given, the less effective they are in limiting the amount of permanent damage to the heart. 

Artery opening techniques are procedures used when clot-busters aren't effective or in place of clot-busters when the procedure is available. The 2 special procedures are: 

• Coronary angioplasty or balloon angioplasty 
• Coronary artery bypass graft surgery 

Coronary angioplasty or balloon angioplasty is a procedure where a thin tube or catheter is inserted into the blockage in artery on the heart. There is a balloon on the tip of the catheter, and when it is inflated, opens the artery. A stent, or wire mesh tube is often inserted into the artery after angioplasty to keep the artery open. 

To be considered, as an emergency treatment during a heart attack, balloon angioplasty must have the artery open in 2 hours after the patient is admitted to the Emergency department. If it will take longer than 2 hours to open the artery, use of clot-busters is recommended as the emergency treatment. This may be the case if you are in a hospital that does not perform balloon angioplasty or transport to one that does will take longer than 2 hours (this includes the time it takes to open the artery). Coronary angioplasty may then occur as an additional treatment, after emergency treatment has been given. 

Coronary artery bypass graft surgery is also known as 'bypass surgery' or 'CABG.' It is a surgical procedure where a piece of vein, usually taken from the leg, is attached to the heart artery above and below the blockage to restore circulation below the blockage. This may need to be done as an emergency procedure when 'clot busters' don't open the artery, balloon angioplasty does not open the artery wide enough, or the doctor is unable to get the balloon catheter into the blockage. 

Your doctor will determine which is the most effective emergency treatment for you, keeping in mind that circulation needs to be restored as quickly and effectively as possible. 

Emergency treatment for unstable angina 
The American College of Cardiology and American Heart Association have developed guidelines for treatment of patients with high-risk unstable angina. These guidelines also apply to those people who are having a heart attack but the pattern on their electrocardiogram (EKG) is different from those people who qualify for 'clot busters.' Another term for this type of heart attack is non-ST segment elevated myocardial infarction (NSTEMI). 

Emergency treatment is important for those people with high-risk unstable angina, usually caused by a partial blockage of an artery, to prevent heart attack or sudden death. Emergency treatment is also important for patients with a NSTEMI to limit the amount of permanent damage to the heart and reduce the risk of sudden death. Emergency treatment includes: 

• Antiplatelet Therapy - medications that prevent platelets in the blood from forming a net, that traps red blood cells and allows a blood clot to form. Medications may include one or more of the following: 
  • Aspirin - given in the ambulance or as soon as possible after admission 
  • Plavix (clopidogrel) - used if the patient is allergic or unable to take aspirin 
  • GP IIb/IIIa antagonists - given intravenously for 1-2 days. There are 3 medications in this class of drugs. It is especially helpful for patients who will be scheduled for balloon angioplasty in the next 1-2 days. Your doctor will determine if it is necessary for you to receive this type of medication and which of the 3 medications is right for you. 
• Anticoagulant Therapy - medications that increase the time it takes to make a blood clot. They are commonly referred to as "blood thinners." These medications may be given as a continuous intravenous infusion or injected under the skin twice/day. There are 2 types that can be used in combination with antiplatelet therapy. One of the following will be chosen by your doctor: 
  • Unfractionated heparin (UFH) 
  • Low molecular weight heparin (LMWH)