Heart Attack Follow-Up

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Medications that may be recommended on discharge from the hospital include:
  • aspirin for its anti-platelet effect,

  • a beta blocker to blunt the effect of adrenaline on the heart and make it beat more efficiently,

  • a statin drug to control cholesterol and

  • clopidogrel (Plavix) or prasugrel (Effient), other anti-platelet drugs.
Since the heart may have been damaged, further testing may be needed to assess its pumping capabilities. Echocardiography can measure ejection fraction, the amount of blood that heart pumps out to the body compared to how much it receives. A normal ejection fraction should be greater than 50% to 60%.
A monitored exercise program may be arranged.
Attempts will be made to minimize cardiac risk factors including:
  • smoking cessation,

  • weight loss,

  • control blood pressure, and

  • lower "bad" cholesterol.
Some patients will require coronary artery bypass surgery if their angiogram shows multiple areas of blockage.

Special Situations
Prinzmetal Angina
In some people, the coronary arteries can go into spasm and cause decreased blood flow to heart muscle. This can lead to chest pain known as Prinzmetal angina, even if there is no buildup of plaque in the blood vessels. In severe episodes the EKG can suggest a heart attack, and muscle damage can be confirmed by measuring cardiac enzymes.

Cocaine
There is a strong correlation between cocaine usage and heart attack. Aside from the artery spasm that cocaine induces, the drug turns on the adrenaline system of the body, increasing pulse rate and blood pressure, requiring the heart to do more work.

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