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Heart attack

Initial treatments for heart attacks

The initial treatment of a heart attack at the time of these interviews (2004 and 2011) included pain relief, thrombolysis (clot busting) and other blood thinning drugs (e.g. aspirin), given by ambulance staff or at the hospital. Many of these treatments are still given in the same way.

On the way to the hospital, ambulance staff may give people oxygen if they have a low level of oxygen in their blood. To relieve pain they may give morphine intravenously (through a vein) and glyceryl trinitrate (GTN) as a tablet under the tongue or as a spray and an aspirin to chew to thin the blood.

 

Mervyn describes the treatments he received in the ambulance on his way to the hospital.

Mervyn describes the treatments he received in the ambulance on his way to the hospital.

Age at interview: 76
Sex: Male
Age at diagnosis: 73
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Mervyn' So I rang NHS Direct and they said that. They asked me what was wrong and different things and then they said, ‘Well we’ll talk to the doctor and he’ll probably, he will get back to you very shortly and he will tell you then what to do.’ So I waited and the doctor rang me and I again I gave him all the symptoms and he said, ‘I think what we’ll do is
 
I’ll ring the hospital for you and they will send paramedics down to check you over.’ The paramedics arrived I would imagine 15 minutes, 15 to 20 minutes later and they checked me over and they then decided that they would take me up to my local hospital. And they, whilst I was in the ambulance I believe they put the spray under my tongue and they also…
 
Did an ECG?
 
Mervyn' Yeah I think they did an, yeah they did an ECG and they also. What did they give me?
 
Mervyn’s wife' Took some blood.
 
Mervyn' Oh yeah they took some blood. On the way in the ambulance up to the hospital I felt violently sick. And we arrived at the hospital and I can’t remember much what happened then. Everything was very vague so I’d probably been given something that probably dulled me a bit.
 

 

Some people we talked to said that they found it very reassuring being in the ambulance and receiving treatment. One woman said that ambulance staff did an ECG while in the ambulance, which was immediately transmitted electronically to the coronary care unit, and enabled her to receive treatment immediately on arrival at hospital (see 'DIagnosing a heart attack').
 
One woman described the series of tests she had done, in the ambulance, and over the next few days while she was in hospital to assess the amount of damage caused by the heart attack and a few months later to establish whether she would need further treatment for narrowing of her coronary arteries.
 

She describes the series of tests she had done in the ambulance and in hospital.

She describes the series of tests she had done in the ambulance and in hospital.

Age at interview: 37
Sex: Female
Age at diagnosis: 36
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They wired me up to the ECG monitor [in the ambulance] which actually goes straight through to the coronary care unit at the hospital so at the coronary care unit the Sister there could see whether or not it was anything wrong with my heart which she could see it was, so when I got to the hospital it was just straight to coronary care. 

In coronary care it was just, everything happened so fast and the team were, just working on you like from all directions, there's a doctor, there's nurses, you know, they're taking blood, they're doing this, they're doing that. So that all happened so, so fast and some of it was like a bit of a blur as well. 

I can't really recall everything that happened while I was actually in coronary care. All I know is that they worked really fast to get me stable. So that's when, you know, they actually realised that I was having a heart attack and just spoke to me obviously to make sure that they were going to give me the correct drugs, just asked me a few questions and, basically, that's all I can remember there for a little while because then I was just in a daze. 

It felt like I was drifting and I just recall people and, I didn't, I wasn't actually unconscious but I think I might have been drifting in and out while I was in coronary care. So, but then they got me stable and then, over the next few days in coronary care it was, obviously they just wanted me to rest and get better the best that I could. 

They did an echo of my heart which, there was some slight damage to my heart but not a great deal of damage to my heart. And then, before they'd let me come home I had to go on a sort of like it was a stress test, they call it, where I just had to go on a treadmill and be all wired up and monitored up to, to see whether my heart got into any difficulty, which it did after so many minutes of doing exercise. 

So they decided then that I'd have to have an angiogram and I had to wait a few months to have the angiogram and it, and when I had the angiogram they decided that because of one of my arteries was narrowed 90% that I would benefit from having an angioplasty and, and a stent. 

People we talked to found it reassuring being in the ambulance and receiving treatment even before they arrived in hospital enabling healthcare staff to plan treatment before the person arrived at the hospital.

 

The ambulance crew did an ECG which was sent electronically to the hospital. On arrival, the...

The ambulance crew did an ECG which was sent electronically to the hospital. On arrival, the...

Age at interview: 63
Sex: Male
Age at diagnosis: 62
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The ambulance also took an ECG and that ECG was sent through to the hospital. This ECG was probably the most important because the doctors that were going to operate on me later were able to see the information of what my heart was doing at the time I entered the ambulance. Thirty minutes later I was laid in the emergency room at the [Hospital name]. They were very good, everyone was there, I had a specialist, there were doctors and there were nurses. They explained to me the problem with my heart and the fact that they wanted to do an antiplasty…
 
Angioplasty?
 
Angioplasty as soon as possible as this would then not damage the heart any more than it had been damaged by my heart attack.

 

Primary angioplasty: Is one of the first choices of treatment for most heart attacks. It is a procedure in which the clot causing the heart attack is disrupted with a balloon catheter. This is the same procedure as a coronary angioplasty but called a primary angioplasty if given as an emergency. Where possible it is usually done within a two hours of admission (see ‘What is a heart attack' for more information). An increasing number of hospitals in the UK now have the facilities to do primary angioplasty and the government wants to have this facility available throughout the UK. But thrombolysis (clot busting by a drug) is still widely used as a first line of treatment.
 

Once it was established that John was having a heart attack, it was agreed that he should be...

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Once it was established that John was having a heart attack, it was agreed that he should be...

Age at interview: 67
Sex: Male
Age at diagnosis: 67
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So in the land ambulance they connected me to the ECG. I was feeling not terribly well at that stage but not in huge pain still and they confirmed that it was, again confirmed that it was, the ECG was showing something, they kept referring to as ST which I didn’t understand at the time but now obviously realise it’s part of the heart pattern. And they said, ‘We’ll give you some GNT’. Just so GTN isn’t it. So, you know, I can’t remember was it TNG, trinitroglycerine and they actually sprayed some under my tongue which I knew was designed to dilate the arteries but the reality was. It was awful because the. I just suddenly said, ‘I feel very, very faint’. So they put my head down and they had previously put an injection into the arm. So they said, ‘We are going to push some saline into you now because your blood pressure is dropping through the floor’. So that was going on while they were actually driving off. As they drove off they were in touch with the [Hopsital name] in [City] and because this is [County], [Hospital name] was asking them to send telemetry of the ECG outputs but they couldn’t because [Town] don’t carry telemetry for it. So there was a lot of debate between the [Hospital name] and the ambulance as to whether it was ST but once they knew that it was, the [Hospital name] said, ‘Yes we are happy to admit him.’ So we just proceeded and I drove feeling more uncomfortable because of the angle I was at more than anything else but not, not too. I mean in the whole scheme of things it’s pretty small.

Because primary angioplasty requires a stand-by team of cardiologists to be available at all times, heart attack patients may now find themselves transferred as rapidly as possible to a centre some distance from home. But the advantage of immediate removal of the clot is that it can spare heart muscle damage and promote fuller and more rapid recovery from the attack.
 

The cardiologist at the hospital told James that he needed primary angioplasty without delay to...

The cardiologist at the hospital told James that he needed primary angioplasty without delay to...

Age at interview: 63
Sex: Male
Age at diagnosis: 62
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They explained that my heart had had; the blood flow in my heart had actually in two cases nearly blocked completely. It was channelling through a different channel to make my heart continue to; the longer they left this procedure the longer, sorry, the larger the damage to my heart, that is how it was explained to me which is why I had absolutely no objections to anything they said and to be honest because obviously I knew of people who had had heart attacks and to what they'd suffered and I had no doubts about having that operation on that day, no doubts at all because they explained it in such a way that if it left, if I left it any longer the damage could increase. They needed to do it immediately, the sooner they do the operation after a heart attack the less damage. The longer they leave it then the damage can increase.

 

 

James explains primary angioplasty and the care he received after the operation.

James explains primary angioplasty and the care he received after the operation.

Age at interview: 63
Sex: Male
Age at diagnosis: 62
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I signed the acceptance form and within thirty minutes I was in the operating theatre. The operation was very easy for me probably than it was for the doctors. The operation was done with local anaesthetic which was fantastic. The actual stents were fitted through my groin and through my wrist, the wrist one being one that they needed to take because of the angle they wanted to come in from the heart. The pain, there was very little soreness afterwards when obviously the local anaesthetic wore off. While I was in the operating theatre I was able to watch what they were doing. It was very interesting to see my own heart on a screen and something moving within it and it was reassuring in some respects that something was being done. I was still not certain I'd had a heart attack that was probably the worst thing. I was being operated on for something that I had not had real symptoms for. After the operation I was taken back to the cardiac ward; in the cardiac ward excellent set of nurses who were there at all times, they looked after me. I was put on a drip primarily because of obviously I had not had anything to eat and the, obviously dehydrated a little during the day. I'd also picked up a chest infection which they say I had before I went in which they treated with antibiotics.

 

Before and after primary angioplasty, a range of injected drugs may be used to improve the success of the procedure and prevent further clotting. If a metal mesh (called a stent) is used to keep the artery open after the procedure, an anti-clotting drug usually clopidogrel is prescribed for a year afterwards.
 
People who have had a heart attack need to be treated within two hours to make primary angioplasty effective and to avoid further damage to the heart muscle. [Department of health - Treatment of Heart Attack National Guidance 2008]
 
Other treatments:
Other people we interviewed s describe the interventions they received when they got to hospital. Where diagnosis was not straightforward, it took a little longer for initial treatments to be given.
 

He felt much better after the initial treatments he was given in hospital.

He felt much better after the initial treatments he was given in hospital.

Age at interview: 63
Sex: Male
Age at diagnosis: 63
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And of course everything started happening then, I was put on drips and clot busters and pain killers and everything were administered, quite a flurry of activity. And within twenty minutes I felt as right as rain, I felt oh you know I can go home now but they wouldn't let me [laughs]. 

I stayed in under observation in A & E for about six hours and this was through the night. They called my wife who arrived with one of my daughters with her partner in the early hours of the morning and stayed with me for some while and were rather surprised to see me sitting up feeling quite bright and cheerful wondering what the hell all the panic was about. They went, I started pressing them about being discharged. 

They said that in fact I'd had a major heart attack and it was probably as a result of my diabetes that I was not feeling any pain other than general discomfort. The following morning I was admitted to the cardiac ward.

 

Staff were unsure when his heart attack occurred so he had warfarin to thin the blood instead of...

Staff were unsure when his heart attack occurred so he had warfarin to thin the blood instead of...

Age at interview: 66
Sex: Male
Age at diagnosis: 65
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Was it a chest pain?

Not really, it was as if there was a mouse running up my chest, it was a most peculiar feeling, as if there was something just going like that, up my chest. And it was just a little pain that ran up, most peculiar feeling, and that was really all I was getting and I didn't feel right, I didn't feel right at all. 

So I was taken, my wife took me in the car this time to the hospital, went again to the Accident Unit and they were very good. As soon as I mentioned heart problems in the reception I was straight through to the doctors area. They did, they put the tests on me, they said 'yes, you're in trouble', and they took me through to the local CCU which is at that hospital. And they said, 'yes, you've had a heart attack'. 

They weren't sure whether it was the first time or whether it was Wednesday or whether Wednesday was a prelim to it or whether it was three o'clock in the morning. 

They said, 'unfortunately, because if it was three o'clock in the morning which they were beginning to think it was, I couldn't have this clot busting drug which everybody gets and you should have within the first hour or so. So I just stayed in the CCU, they put me on warfarin and all the usual sort of drugs and looked after me really.

Thrombolytic (clot buster) drugs help to dissolve the clot that is blocking the artery and are usually given immediately upon arrival in hospital. But in some parts of the country, people get them before they reach hospital, to speed up treatment. Ideally the injection should be given as soon as possible after the onset of symptoms of the heart attack. If the injection is delayed beyond six hours, the benefit is less and beyond 12 hours there is little or no benefit.

Thrombolysis was a very effective treatment for people who received the drug early enough after their symptoms began. One man described how the doctor explained the risks and the benefits of thrombolysis, so that he could give informed consent to it being used. Another woman chose not to have this treatment. One man was given warfarin to thin the blood instead of thrombolysis, because staff thought that his heart attack had occurred a few days previously.
 

Explains what he was told and why he agreed to have the thrombolysis (clotbuster drug).

Explains what he was told and why he agreed to have the thrombolysis (clotbuster drug).

Age at interview: 54
Sex: Male
Age at diagnosis: 54
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I was then ushered into a cubicle. There was a consultant immediately present, as well as nurses. A lot of things then happened very quickly. But one of the things that needed to happen I think, was for the consultant to explain (a) what had happened to me but (b) what was required. 

When he said I was having a heart attack, that the next few hours were crucial and what was really important, if possible, was to try and attack the clot that would be in my, the part of the heart that the clot would be in. I'm not physiologically terribly well tuned I'm afraid. 

He explained, I mean I was very impressed actually because he squatted down and spoke to me at my level. He explained that there were risks attached to this process, which I think is called thrombolysis. There was a one percent risk of spontaneous bleeding, which I said is hardly, that I'm not really concerned about that. 

He said there was also a one percent risk of stroke. But he obviously pointed out the risks of not taking this treatment were much more significant. And that if it could be effective early enough, it could minimise the long term damage to my heart muscle. So I clearly was happy to agree.

 

Explains why she chose not to have the thrombolysis (clotbuster drug).

Explains why she chose not to have the thrombolysis (clotbuster drug).

Age at interview: 54
Sex: Female
Age at diagnosis: 53
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They offered me the clot buster drug but I declined. I didn't want to take the risk and as the heart attack had already happened, and I judged that it wasn't too bad, I just didn't think I needed the clot busting drug, so I didn't have it. 

I asked what the risks were and he said you could haemorrhage because obviously it's going to thin your blood down and you could haemorrhage from your brain and I said, 'Well, what's the worst scenario?' and he said, 'Well, death.' [laughs] and I thought, 'well I don't really want a brain haemorrhage.' 

I thought, 'I've had a heart attack, or I'm having a heart attack or whatever' and to me it didn't feel that bad because I didn't have the crushing pain. That's all I'd got to go by really, and nobody could make the decision, only me. That's what I decided.

After initial diagnosis and treatment, people were cared for in the hospital's coronary care unit (CCU), where further tests and decisions about treatment were made (see 'The coronary care unit'). Sometimes, people are transferred to another hospital for specialist treatment and care.

 

He was transferred within 24 hours to a regional cardiac centre because his condition was not...

He was transferred within 24 hours to a regional cardiac centre because his condition was not...

Age at interview: 69
Sex: Male
Age at diagnosis: 66
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I understand by this time, I was totally unconscious. I understand from my wife that the medical staff were waiting at the door to take me in on to the stretcher and straight up the corridor and they did indicate to her, 'Don't, we'll be running up this corridor,' because that particular hospital had a very long incline passageway to the cardiac unit and said, 'don't run, we'll have to run.'  

Apparently they had all of the equipment on there. Took me up to the ward and I knew nothing of this, this was what was related to me by my wife. The first thing I recall was the following morning, roughly about seven to half past, I couldn't say exactly. 

I came round and I remember saying to my wife, 'You know I feel a wee bit better,' and at that time I was in a cubicle near to the nurses station and then my wife and my daughter appeared because my wife had stayed all night and then thought now we've got to get [my] daughter. 

So she came down and they came in again and was standing just outside of the curtain and then they allowed them to come in again to see me because the doctors were there and they had come in to see me and just at that time when they came in, I said, 'I'm going to be sick.' 

And I did, I vomited and immediately, as it happened the doctors were still there, virtually at the end of the bed, and they ushered my wife and my daughter out and then I lost conscious again. 

Came round and by this time they were making arrangements to transfer me to a hospital [in the next county], on [in the next county] which specialises in heart conditions.

And of course off I went and between leaving the hospital and the [specialist] hospital, from time to time I came around a little bit. I can remember the driver making certain remarks about people being in his way [laughs] and then in to hospital. And as I say, I sort of lost consciousness from time to time, well most of the time actually on the journey. 

I can remember being taken out and in to the hospital, going up the corridor and straight through from the ambulance, up the corridor and in to the operating theatre where they started to treat me. By this time I was sort of more unconscious than awake. I was in the theatre for three and a half hours.

Last reviewed June 2017.

Last updated June 2017.

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