The main way to prevent progressive damage is to restore blood flow quickly. Antithrombotic agents are initial treatment of choice and need to be given as soon as possible. It reduces the morbidity and mortality rates. Thrombolytic therapy is highly effective if given with in 30 min to 1 hr.

 

Medications used in heart attack

Antithrombotic agents

• Ex- Asprin and ticlopidine
• Aspirin inhibits blood clotting, thus helping maintain blood flow through a narrowed artery.
• Antithrombotic agent should be administered immediately; aspirin has been shown to decrease mortality and reinfarction rates after MI.
• Use clopidogrel in case of aspirin allergy
• Super aspirins- its action is similar to aspirin, its platelet IIB/IIIA antagonists. It prevents new clot formation.

Vasodilators

• Nitroglycerin is the vasodilator of choice; it’s available in sublingual route, transdermal patch, spray, oral and intravenous forms.
• It needs to be given immediately, and sublingual route is better than other route, as it has rapid absorption and quick onset of action.
• These agents relive coronary spasms, improve coronary blood flow, and reduces preload and after load on the heart.

Pain relieving medications

• Morphine is given by intravenous route as it alleviates pain, anxiety and reduces pulmonary edema.
• Pethidine is next option if morphine is contraindicated.

Beta blockers

• Cardio selective beta blockers are preferred
• Metoprolol is the standard and is a selective beta-blocker therapy in heart attacks
• It controls heart rate and resultant decrease of myocardial oxygen demand.

ACE inhibitors and AT antagonists

• ACE inhibitors/ AT antagonists should be given with in 24 hrs of attack
• Its control blood pressure, has cardioprotective action, and reduces the after load on heart to some extent.
• Its mainly indicated in anterior infarcts, pulmonary congestion and when ejection fraction is less than 40%

Platelet aggregation inhibitors

• Platelet aggregation inhibitors like Abciximab, Tirofiban, Eptifibatide and others
• Fibrinolytic are administered in addition to aspirin in patients with continuing ischemia or with other high-risk features and to patients in whom coronary intervention is planned.
• Studies suggest that the addition of intravenous platelet aggregation inhibitors to aspirin and heparin improves both early and late outcomes of heart attacks

Thrombolytic therapy

• Ex- Streptokinase, Alteplase, Tenecteplase, Reteplase
• Door-to-drug time should be no more than 30 minutes.
• Thrombolytic therapy administered within the first 2 hours can occasionally abort myocardial infarct and dramatically reduce the mortality rate.
• Thrombolytic agents prevent recurrent thrombus formation and they also remove pathologic intraluminal thrombus or embolus not yet dissolved by the endogenous fibrinolytic system.

Heparin and LMWH

• Heparin has an established role as an adjunctive agent in patients receiving fibrinolytic like Alteplase, Reteplase, or Tenecteplase but should not be used with nonselective fibrinolytic agent such as streptokinase
• Heparin is also indicated in patients undergoing primary coronary intervention.
• Low-molecular-weight heparins (LMWH) are commonly used because of convenient dosing and reliable therapeutic levels. 

Lipid lowering medications

• Statins are first line drugs to treat high cholesterol levels
• Other options are niacin and fibrates