What happens in hospital

A lot of people delay calling 999 because they're scared of what happens next. Here's what actually happens. Most of it is quick, and none of it hurts much.

In the ambulance

• ECG within minutes. Stickers on your chest, arms and legs record your heart's electrical activity. Takes about a minute. Painless. This one test decides where you go.
• Aspirin, if you haven't had it. Sometimes also GTN spray, pain relief (usually morphine) and something for sickness.
• Oxygen only if your levels are low. It's no longer given routinely.
• The crew phone ahead. If the ECG shows a particular type of heart attack (a STEMI), you may bypass A&E completely and go straight to a specialist heart attack centre, which may not be your nearest hospital. This is a good thing. The team will be waiting for you.

The two kinds of heart attack

In A&E or the assessment unit

1. Another ECG, and often repeated every few hours, or continuously on a monitor.
2. Troponin blood test. Troponin is a protein that leaks from damaged heart muscle. It's measured on arrival and again 1 to 3 hours later. If both are normal, a heart attack is very unlikely and you can often go home. If it's raised, you're admitted.
3. Chest X-ray to look at the lungs and the size of the heart.
4. A cannula (small plastic tube) in a vein in your arm for blood tests and medicines.
5. Medicines: usually aspirin plus a second antiplatelet (ticagrelor, clopidogrel or prasugrel), a blood-thinning injection in the tummy (fondaparinux or heparin), and a statin.

How long? If your tests are normal, expect 4 to 8 hours. If you're admitted, typically 2 to 5 days.

The angiogram

This is the test everyone's nervous about, and it's far less dramatic than it sounds.

• You're awake. You get local anaesthetic in the wrist (occasionally the groin) and usually a little sedation.
• A thin tube (catheter) is passed up the artery to the heart. You don't feel it moving.
• Dye is injected and X-ray pictures show exactly where the narrowings are. You may feel a warm flush for a few seconds.
• Takes 30 to 60 minutes. Afterwards a tight band on the wrist for a few hours to stop bleeding.

Stents

If a narrowing or blockage is found, it's often treated there and then. A tiny balloon is inflated to open the artery, and a small metal mesh tube (stent) is left in place to hold it open. This is called PCI or angioplasty. You might feel a brief return of chest discomfort as the balloon goes up. Most people have one or two stents. They stay in for life and you won't feel them. You'll take two blood-thinning tablets for up to a year afterwards to stop clots forming on the stent, so don't stop them without asking.

Bypass surgery

If there are several severe narrowings, or they're in places stents can't reach, you may be advised to have a coronary artery bypass graft (CABG). Blood vessels from your leg or chest are used to bypass the blockages. This is major surgery with a week or so in hospital and 2 to 3 months recovery, but the results are excellent and it's usually planned rather than done in an emergency.

Words you'll hear

Before you go home

• You'll have an echo to check how much the heart has been affected.
• You'll leave with a bag of new medicines and, ideally, a clear explanation of what each is for. Ask if you don't get one. Write the answers down.
• You'll be referred to cardiac rehab. Say yes. See the recovery page.
• Ask for a copy of your discharge letter and what your ejection fraction was.
• Ask when you can drive. There are legal rules. See recovery.