Secondary prevention, which is prevention of another heart attack after a heart attack, and includes drugs, diet and exercise, does work very well.  It reduces the risk of a second heart attack by 50% to 80%. 

Of course, the first step in preventing a second heart attack is to treat the first one effectively. The purpose of all treatments is to increase blood flow to the heart muscle.  A variety of treatments are currently available, most involving medication and/or surgery.

As indicated in the program, recovering heart attack patients are often asked to take a "cocktail of drugs," that is, several medicines at the same time, on a prescribed schedule.  These medicines can include:

• Anticoagulant drugs to prevent blood clots that can block blood flow to the heart
• Aspirin, also useful in preventing blood clots
• Other classes of drugs, such as antiplatelet agents, that also prevent blood clots,
• Plavix, mentioned in the program, is a brand name for clopidogrel, an antiplatelet agent
• Thrombolytic drugs to dissolve blood clots
• To be most effective, thrombolytics must be given within one hour of start of symptoms
• Beta blockers : drugs that slow down the heart rate, correct arrhythmias (irregular heartbeat) and reduce blood pressure, all of which helps lower the heart's workload; they can also reduce chest pain and fluid retention
• ACE inhibitors (angiotensin enzyme inhibitors) : drugs that act as vasodilators, that is, they open ("dilate") the arteries, lowering blood pressure and the heart's workload.  ARB's, angiotensin receptor blockers work in a similar manner.
• Nitrates (including nitroglycerin): drugs that relax blood vessels and reduce the work load of the heart 
• Statins : a class of drugs that help lower lipid levels in the blood and have anti-inflammatory properties, stabilizing the inner walls of the coronary arteries
• Other cholesterol lowering drugs
• Antiarrhythmic drugs that stabilize an irregular, fast or slow heart beat
• Diuretics: drugs that help eliminate excess fluid, and therefore aid the heart in working more efficiently

There is also a wide variety of surgical methods to treat heart attack.  One commonly used technique to widen a narrowed artery is called angioplasty (or balloon angioplasty).  A small tube (catheter) is inserted through a blood vessel and threaded up into the heart and into the coronary artery needing treatment.  A balloon located on the catheter is inflated and reopens the artery.  Sometimes, a spring-like device called a stent is used with a balloon.  Because a blood clot can form around a stent, a clot preventing drug, such as clopidogrel mentioned above, may be prescribed.  Often a balloon angioplasty and/or a stent work permanently, but sometimes the procedure has to be repeated.

Another important surgical technique is coronary artery bypass grafting popularly known as "a bypass."  As its name implies, its purpose is to allow blood to bypass or go around a blocked artery.  During the procedure, blood vessels from other parts of the body (usually arteries from the chest, arm and veins from the leg) are grafted into place to create a detour around the blockage in the coronary artery. This process is also known as revascularization.

There are many other surgical options depending, of course, on the nature and severity of the heart attack.  They range from implanting a pacemaker if a slow heart rate caused the heart attack (a tiny device that sends electrical signals to the heart to restore its regular rhythm) in a person's chest, to giving them a new heart through a heart transplant.
 
For information about many of these options, watch the "Heart Failure" episode of Second Opinion and visit its web page.  You can also learn about them at the American Heart Association's web site.

Along with the continued use of medications, secondary prevention includes a medically supervised cardiac rehabilitation program.  This program normally has several components, such as directed exercises (under the care of a physician or nurse) and important lifestyle changes to minimize the risk of another heart attack, such as:

• Changes in diet to reduce obesity, lower cholesterol and lower blood pressure
• Other steps to lower cholesterol, lipids, and blood pressure
• Stopping smoking
• Controlling diabetes

The most important part of any rehabilitation program is that the person commits to it as lifelong therapy.  Medical and psychological counseling are available to help people help themselves and give them the emotional support they need while making changes in their lives - changes that can save their lives.