治疗-Heart attack

心脏病发作的治疗选择取决于您是否患有ST段高度心肌梗塞（STEMI）或另一种类型的心脏病发作。

An ST segment elevation myocardial infarction(STEMI)is the most serious form of heart attack and requires emergency assessment and treatment. It's important you're treated quickly, to minimise damage to your heart after an STEMI.

If you have symptoms of a heart attack and anelectrocardiogram (ECG)shows you have an STEMI, you'll be assessed for treatment to unblock your coronary arteries.

The treatment used will depend on when your symptoms started and how soon you can access treatment.

• If your symptoms started within the past 12 hours – you'll usually be offered primary percutaneous coronary intervention (PCI).
• If your symptoms started within the past 12 hours but you cannot access PCI quickly – you'll be offered medicine to break down blood clots.
• If your symptoms started more than 12 hours ago – you may be offered a different procedure, especially if your symptoms have improved. The best course of treatment will be decided after anangiogram并可能包括药物，PCI或旁路手术。
• If a PCI isn’t suitable for you – you may be offered a combination of medicines to prevent blood clots, called antiplatelet medicines.

原发性经皮冠状动脉干预（PCI）

原发性经皮冠状动脉干预（PCI）is the term for emergency treatment of an STEMI. It's a procedure to widen the coronary artery(coronary angioplasty).

冠状动脉造影is done first, to assess your suitability for PCI.

You may also be given blood-thinning medicines to prevent further clots from forming, such aslow-dose aspirin.

You may need to continue taking medicines for some time after PCI.

Coronary angioplasty

Coronary angioplasty是一个可能需要专业人员和设备的潜在复杂程序，并非所有医院都有设施。

This means you'll need to be taken urgently, by ambulance, to one of the specialist centres (Heart Attack Centres) that now serve most of the UK's regions.

During coronary angioplasty, a tiny tube with a sausage-shape balloon at the end (a balloon catheter) is put into a large artery in your groin or arm. The catheter is passed through your blood vessels and up to your heart, over a fine guidewire, using X-rays to guide it.

Once the catheter is in the narrowed section of your coronary artery, the balloon is inflated to open it. Flexible metal mesh (a stent) is usually inserted into the artery to help keep it open afterwards.

Medicines to break down and prevent blood clots

Medicines to prevent blood clots

There are two types of medicines to prevent blood clots. These are called antiplatelets and anticoagulants and are usually taken as a tablet. They make blood flow through your veins more easily. This means your blood will be less likely to form a clot.

Medicines to break down blood clots

Medicines used to break down blood clots, known as thrombolytics or fibrinolytics, are usually given by injection.

Thrombolytics, or fibrinolytics, target and destroy a substance called fibrin. Fibrin is a tough protein that makes up blood clots by acting like a sort of fibre mesh that hardens around the blood.

You may also be given a medicine called a glycoprotein IIb/IIIa inhibitor if you have an increased risk of experiencing another heart attack in the future.

Glycoprotein IIb/IIIa inhibitors do not break up blood clots, but they prevent blood clots from getting bigger. They're an effective method of stopping your symptoms getting worse.

Coronary artery bypass graft

A coronary angioplasty may not be technically possible if the anatomy of your arteries is different from normal. This may be the case if there are too many narrow sections in your arteries or if there are lots of branches coming off your arteries that are also blocked.

在这种情况下，一种替代操作，称为coronary artery bypass graft (CABG), may be considered.

A CABG involves taking a blood vessel from another part of your body (usually your chest, leg or arm) and attaching it to your coronary artery above and below the narrowed area or blockage. This new blood vessel is known as a graft.

The graft diverts blood around narrowed or clogged parts of your major arteries to improve blood flow and oxygen supply to your heart.

Treating non-ST segment elevation myocardial infarction (NSTEMI) and unstable angina

If an ECG shows you have an NSTEMI or unstable angina (the "less serious" types of heart attack), blood-thinning medicine, including aspirin and other medicines, is usually recommended.

In some cases, further treatment withcoronary angioplastyorcoronary artery bypass graft (CABG)may be recommended in cases of NSTEMI or unstable angina, after initial treatment with these medicines.