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Tests and Treatments

Diagnosis (and treatment) of a heart attack can begin when emergency medical personnel arrive after you call 911. Don't put off calling 911 because you are not sure that you are having a heart attack.

At the hospital emergency room, doctors will work fast to find out if you are having or have had a heart attack. They will consider your symptoms, medical and family history, and test results. Initial tests will be quickly followed by treatment if you are having a heart attack.

Tests used include:

  • Electrocardiogram (ECG or EKG). This test is used to measure the rate and regularity of your heartbeat. A 12-lead EKG is used in diagnosing a heart attack.
  • Blood tests. When cells in the heart die, they release enzymes into the blood. They are called markers or biomarkers. Measuring the amount of these markers in the blood can show how much damage was done to your heart. These tests are often repeated at intervals to check for changes.  The specific blood tests are: (1)Troponin test. This test checks the troponin levels in the blood. It is considered the most accurate blood test to see if a heart attack has occurred and how much damage was done to the heart. (2) CK or CK-MB test. These tests check for the amount of the different forms of creatine kinase in the blood. (3) Myoglobin test. This test checks for the presence of myoglobin in the blood. Myoglobin is released when the heart or other muscle is injured.
  • Nuclear heart scan. This test uses radioactive tracers (technetium or thallium) to outline heart chambers and major blood vessels leading to and from the heart. A nuclear heart scan shows any damage to your heart muscle.
  • Cardiac catheterization. A thin flexible tube (catheter) is passed through an artery in the groin or arm to reach the coronary arteries. Your doctor can determine pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x-ray.
  • Coronary angiography. This test is usually performed along with cardiac catheterization. A dye that can be seen using x-ray is injected through the catheter into the coronary arteries. Your doctor can see the flow of blood through the heart and see where there are blockages.

How is a Heart Attack Treated?

A heart attack is a medical emergency. Delaying treatment can mean lasting damage to your heart or even death. The sooner treatment begins, the better your chances of recovering. Your treatment may begin in the ambulance or in the emergency room.

If you are having a heart attack, doctors will:

  • Work quickly to restore blood flow to the heart
  • Continuously monitor your vital signs to detect and treat complications

The length of your hospital stay after a heart attack depends on your condition and response to treatment. Most people spend several days in the hospital after a heart attack. While in the hospital, your heart will be monitored, and you will receive needed medications. You will probably have further testing, and you will be treated for any complications that arise.

While you are still in the hospital or after you go home after your heart attack, your doctor may order other tests, such as:

  • Echocardiogram. In this test, ultrasound is used to make an image of your heart that can be seen on a video monitor. It shows how well the heart is filling with blood and pumping it to the rest of the body.
  • Exercise stress test. This test shows how well your heart pumps at higher workloads when it needs more oxygen. EKG and blood pressure readings are taken before, during, and after exercise to see how your heart responds to exercise. The first EKG and blood pressure reading are done to get a baseline. Readings are then taken while you walk on an exercise treadmill or pedal a stationary bicycle. The test continues until you reach a heart rate set by your doctor. The exercise part is stopped if chest pain or a very sharp rise in blood pressure occurs. Monitoring continues for 10 to 15 minutes after exercise or until your heart rate returns to baseline.

Cardiac Rehabilitation (Rehab)

Your doctor may prescribe cardiac rehabilitation (rehab) to help you recover from a heart attack and help prevent another heart attack. Almost everyone who has survived a heart attack can benefit from rehab.

Rehab has two parts:

  • Exercise training to help you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual ability, needs, and interests.
  • Education, counseling, and training to help you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.

After You Leave the Hospital

After a heart attack, your treatment may include cardiac rehab in the first weeks or months, checkups and tests, lifestyle changes, and medications. You will need to see your doctor for checkups and tests to see how your heart is doing. Your doctor will most likely recommend lifestyle changes, such as quitting smoking, losing weight, changing your diet, or increasing your physical activity.

After a heart attack, most people take daily medications. These may include:

  • Aspirin
  • Medicines that lower your cholesterol or your blood pressure
  • Other medicines to help reduce your heart's workload.

Always take medications as your doctor directs.

Source:  National Heart Lung Blood Institute, http://www.nhlbi.nih.gov/health/dci/Diseases/HeartAttack/HeartAttack_Diagnosis.html